Elderly patient with accidental overdose of sotalol. Describe the ECG.

Describe and interpret this ECG


Main Abnormalities

This ECG demonstrates the key features of sotalol toxicity:

Sotalol is a beta blocker with additional class III effects (potassium channel blockade), so it causes both bradycardia and QT prolongation in overdose.

Risk of Torsades

  • In comparison to ECG Quiz 022, this patient is at significant risk of TdP
  • The combination of bradycardia and significant QT prolongation means that this patient plots well above the “at risk” line on the QT nomogram
  • Prophylaxis of TdP in this case would include correction of QT-dependent electrolytes (K, Mg, Ca) to the high-normal range and positive chronotropy (e.g. with isoprenaline) to move the patient below the at-risk line

TOP 100 ECG Series

Emergency Physician in Prehospital and Retrieval Medicine in Sydney, Australia. He has a passion for ECG interpretation and medical education | ECG Library |

MBBS (UWA) CCPU (RCE, Biliary, DVT, E-FAST, AAA) Adult/Paediatric Emergency Medicine Advanced Trainee in Melbourne, Australia. Special interests in diagnostic and procedural ultrasound, medical education, and ECG interpretation. Editor-in-chief of the LITFL ECG Library. Twitter: @rob_buttner

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