Agents that can be considered as Amiodarone alternatives for the treatment of atrial fibrillation depend upon the patient’s cardiac history, as individuals with reduced left ventricular systolic function are especially prone to the proarrhythmic effects of certain antiarrhythmic agents.
Some commonly used Amiodarone alternatives include ibutilide, dofetilide, and sotalol. Strong consideration should be made for obtaining consultation with a cardiac electrophysiologist prior to initiating Amiodarone alternatives.
Sotalol has combined class II and class III properties and is active against a variety of arrhythmias and has the ability to produce profound bradycardia or prolongation of the QT interval.
Of the many indications, sotalol is most commonly used for maintenance of sinus rhythm after cardioversion for atrial fibrillation and reducing ventricular tachyarrhythmias as an Amiodarone alternatives.
Despite its ability to prevent tachyarrhythmias, sotalol can also be proarrhythmic (as with any other antiarrhythmic) through its ability to profoundly prolong the QT interval.
As a result, initiation of this drug should occur while the patient is closely monitored. Sotalol is contraindicated in patients with reduced creatinine clearance (below 40 mL/minute) and asthma.
Amiodarone alternatives like sotalol should be avoided in patients with serious conduction defects, in bronchospastic disease, and when there are evident risks of proarrhythmia.