Would you consider sotalol to be a suitable non-selective beta blocker for primary prevention of variceal bleeding in a patient who requires sotalol for treatment of arrhythmia in the setting of Fontan-associated liver disease and clinically significant portal hypertension?

The answer to this question will need to be case-by-case, unfortunately.

The short answer:

The priority in this patient's case for using sotalol is likely the underlying heart disease and its associated arrhythmia, and this cardiac benefit would not be achieved by carvedilol and other NSBBs. Thus, it would be reasonable to use sotalol, which may or may not lower portal hypertension, and it would be reasonable to still do an EGD while on sotalol, about 3-6 months after initiation, to assess the response of the pre-existing varices while on sotalol. Favorable signs would include whether the varices now flatten with insufflation and if no red wale sign is present.

If there were no varices to start with, then this patient's bleed risk is already q...