Drug therapy and efficacy of heart failure caused by supraventricular tachycardia in infants / 中国小儿急救医学

Objective:To investigate the effect of drug therapy on heart failure caused by supraventricular tachycardia(SVT) in infants.Methods:Fifty-five infants with heart failure caused by SVT, including 24 boys and 31 girls, were treated at Beijing Children′s Hospital of Capital Medical University from January 2014 to December 2021.The drug treatment effects of heart failure caused by SVT were analyzed.Results:The average age of 55 infants at the first diagnosis was 5.8 months(1-11 months). All of them had heart failure, including three cases of atrial flutter, 23 cases of atrial tachycardia(13 cases of disordered atrial tachycardia and ten cases of monomorphic atrial tachycardia), and 29 cases of paroxysmal supraventricular tachycardia.Ultrasonic cardiogram showed that the left ventricular diameter increased and/or left ventricular systolic function decreased.Anti-heart failure therapy was effective in 55 cases(100.0%). Anti-arrhythmic drug therapy: atrial flutter and atrial tachycardia were mainly treated by controlling ventricular rate, digitalis combined with metoprolol was effective in 21 cases(80.8%, 21/26), digitalis alone was effective in four cases(15.4%, 4/26), and sotalol was effective in one case(3.8%, 1/26); paroxysmal supraventricular tachycardia was mainly treated with sinus rhythm conversion.The success rates of conversion were: ATP 20.7%(6/29), ATP combined with digitalis 26.1%(6/23), propafenone combined with digitalis 42.9%(3/7), amiodarone combined with digitalis 60.0%(3/5), and sotalol 92.9%(12/13). During follow-up period for 1 to 12 months, heart failure symptoms of all 55 cases(100.0%) improved, and ultrasonic cardiogram of 53 cases(96.3%)returned to normal.Conclusion:Anti-heart failure and anti-arrhythmic drugs for infants with heart failure caused by SVT need to be selected individually.Atrial tachycardia, especially disordered atrial tachycardia, is sensitive to digitalis.Sotalol can be used to treat refractory SVT.

Pharmaceutical Care for Sotalol-induced QT Prolongation in Aged Patient with Heart Failure / 中国药房

OBJECTIVE:To explore the role of clinical pharmacists participating in the prevention and treatment of sotalol-in-duced QT prolongation in aged patient with heart failure. METHODS:Clinical pharmacists participated in the treatment for a aged patient with heart failure,and assisted physicians to identify and assess the risk of sotalol-induced QT prolongation. According to the clinical symptoms and laboratory indexes,it was suggested to continue to use sotalol for antiarrhythmic,adjust the hepatoprotec-tive drug,given pharmaceutical care of ECG,electrolyte level monitoring,drug education and so on. RESULTS:Physicians adopt-ed the suggestions of clinical pharmacists to relive the illness without malignant arrhythmia and discharged after 11 d. CONCLU-SIONS:The patient with heart failure should be dominated by improving cardiac function and maintaining hemodynamic stability;combined with related guidelines and documentation,clinical pharmacists can assist physicians to identify the drug that induced QT prolongation,asses the risk of torsades de pointes ventricular tachycardia and other bad consequences,develop and optimize the regimen and strengthen pharmaceutical care to ensure the safe and effective treatment.

Sotalol: A rescue drug in the face of life-threatening refractory ventricular tachycardia.

We describe postoperative refractory ventricular tachycardia (VT) in a patient following aortic and mitral valve replacement. Following an uneventful separation from cardiopulmonary bypass with dobutamine, the patient developed recurrent VT, 4 hours into the postoperative period. The VT did not respond to standard doses of xylocard, magnesium and amiodarone. Electrolyte and acid base parameters were normal. Multiple cardioversions failed to revert back to a stable rhythm. Intra‑aortic balloon pumping was instituted and overdrive right ventricular pacing was unsuccessful. Following intravenous sotalol 80 mg, the VT came under control and reverted to a nodal rhythm, which required atrial pacing for the next 8 hours. Oral sotalol therapy was continued at 40 mg daily. The VT did not recur.

Efficacy of sotalol hydrochloride on supraventricular tachycardia after surgery in children with congenital heart / 中华实用儿科临床杂志

Objective To observe the efficacy of sotalol hydrochloride on supraventricular tachycardia after surgery in children with congenital heart disease(CHD).Methods Twenty-one cases were observed from Sep.2005 to Mar.2012 from Beijing Anzhen Hospital Affiliated to Capital Medical University,who had sotalol hydrochloride for supraventricular tachycardia after CHD surgery.All patients were divided into 3 groups according to different dosage of sotalol hydrochloride,group Ⅰ:≤0.30 mg/(kg · dose),group Ⅱ:0.31-0.80 mg/(kg · dose),group Ⅲ:0.81-2.00 mg/(kg · dose).The efficacy,the heart rate (HR),systolic blood pressure (SBP),central venous pressure (CVP) were compared at different time.If bradycardia,long QT syndrome,torsade de pointes and other arrhythmia happened were observed.Results The efficacy were 16.7％,20.0％ and 100％ in group Ⅰ,group Ⅱ and group Ⅲ.The efficacy in group Ⅲ was the highest and there was statistical difference in 3 groups(P ＜0.05).The heart rate dropped separately 17.2％,21.5％,34.9％ in 3 groups and the HR in group Ⅲ was lower than group Ⅰ and group Ⅱ at different times,but it had statistically significant difference only at time of 8 hours after administration(P ＜ 0.05).The SBP and CVP dropped slightly and there was no statistical difference in SBP and CVP in 3 groups(all P ＞ 0.05).There were no bradycardia,long QT syndrome and torsade de pointes,etc.Conclusions Sotalol hydrochloride is a safe and effective drug with slight side effect on supraventricular tachycardia after CHD surgery.The higher the dose,the better the efficacy.

Prenatal management with digoxin and sotalol combination for fetal supraventricular tachycardia : Case report and review of literature.

Sustained fetal supraventricular tachycardia (SVT) with a heart rate of approximately 210 bpm may lead to increased atrial and venous pressures and congestive heart failure. There is no clear consensus regarding the best drug-treatment regimens for fetal SVT. However, considerable nonrandomized experience in the transmaternal treatment of fetal SVT is available with a number of antiarrhythmic agents. We report a case of fetal supraventricular tachyarrhythmia with hydrops detected at 32 weeks that was managed with combination of oral digoxin and sotalol and review management guidelines available in the literature.

Effeits of sotalol and amiodarone on patents with atrium filament trembles / 中国基层医药

Objective Curative effect of 2 drugs which present elinie used in atrium filament trembles,provides the elinieal experience.Methods Choice outpatient service atrial fibrillation trembles the patient 344 eases,plants stochastically according to sickness divides into two groups,takes the rope separately Sotalol and Amiedarone,the adjustment medication dosage treats and observes for 12 months,carries on the material summary.Results The rope Sotalol group and the Amiedarone group each is 172 people,the rope Sotalol group atrial fibrillation trembles transfers sinous rhythm 45 peoples,transfers rate 26.2%,recurs 5 patients,after transfers sinous rhythm maintenance rate 88.9% ; Amiodarone,group atrial fibrillation trembles transfers sinus rhythm 41 people,transfers rate 23.8%,recurs 2 patients,after transfers sinous rhythm maintenance rate 95.1% ; Conclusion Sotalol group treats atrial fibrillation trembles rate to be higher than the Amiedarone group,after transfers sinous rhythm maintenance rate Amiedarone group to be higher than Sotalol group.

Amiodarone vs.Sotalol for Atrial Fibrillation:Cost-Effectiveness Analysis / 中国药房

OBJECTIVE:To evaluate the cost-effectiveness of amiodarone versus sotalol for Atrial fibrillation.METHODS:A total of 102 patients with atrial fibrillation were treated with amiodarone(Group A)or sotalol(Group B).The cost-effectiveness analysis was performed on two groups.RESULTS:The total cost in Group A was 2 714.18 yuan versus 2 176.56 yuan in Group B;the effective rates were 78.43% vs.70.59%(P

Antifibrillatory and Proarrhythmic Effects of d,l-Sotalol Mediated by the Action Potential Duration Restitution Kinetics

BACKGROUND AND OBJECTIVES: The action potential duration (APD) restitution kinetics has been known to play a crucial role in the initiation and maintenance of ventricular tachycardia (VT)/fibrillation (VF). We hypothesized that "the anti-arrhythmic and proarrhythmic effects of d,l-sotalol are mediated by changing the APD restitution (APDR) kinetics". MATERIALS AND METHODS: The purposes of this study were: 1) to assess the effects of d,l-sotalol on the APDR kinetics, and 2) to correlate the anti-arrhythmic and proarrhythmic action using the APDR kinetics. We recorded the transmembrane potentials (TMPs), using the microelectrode technique, in seven isolated perfused swine right ventricles, at the baseline, and with 1, 5, 10 and 20 mg/L of d,l-sotalol, with a washout period of 1 hour. The ventricular effective refractory periods (VERP), APD at 90% repolarization (APD90), spontaneous defibrillation rate and VF inducibility were measured at each concentration. We plotted APDR curves of S1-S2 pacing against VF, and calculated the maximal slopes (Smax) of the APDR. RESULTS: Sotalol (10 mg/L) prolonged the APD90 (p<0.001) by reducing the Smax of the APDR (by S1-S2 pacing, p<0.01; during VF, p<0.05). Accordingly, 41.7% of the VT/VF was terminated spontaneously, and VT/VF inducibility reduced from 91.1% at the baseline to 25% with 10 mg/L sotalol. A higher dose of sotalol (20 mg/L) increased the Smax, despite continuous prolongation of the VERP and APD90, resulting in the increase in the VT/VF inducibility (36.4%). CONCLUSION: Sotalol produces its anti-fibrillatory effect by APD prolongation in parallel with a flattening of the Smax at therapeutic doses. However, a higher concentration of sotalol increased the Smax and VF inducibility in isolated swine ventricular tissue.

The effect of sotalol to the patients with ventricular premature beat in heart rate variability / 中国实用内科杂志

Objective\ To in vestigate the change of the premature ventricular complexes(PVC)and the heart rate variability(HRV)before and after the treatment of Sotalol on PVC patients.Methods\ To observe the different index of HRV in 50 cases with PVC by means of 24h.ambulator ECG before and after the use of Sotalol,the other 50 cases with PVC as the control.Results\ After the therapy of Sotalol,the SDNN,SDANNI and SDNNI that showd the total HRV significantly(P

Efficácia das drogas antiarrítmicas. Proposta para uma nova forma de avaliação baseada nos efeitos farmacológicos horários / Antiarrhythmic drug effectiveness. Proposal for a new approach based on pharmacological hourly effects

PURPOSE--To use a new approach in order to assess the antiarrhythmic drugs, based in the hourly autonomic effects and antiarrhythmic efficacy of sotalol. METHODS--Sixteen patients were evaluated in a randomized double-blind placebo-controlled study. Patients were classified in group 1 (anti-arrhythmic efficacy) and group 2 (no antiarrhythmic efficacy). The following parameters were analyzed: 1) clinical variables as age, gender, cardiac disease and ventricular ectopies density; 2) drug effects on pNN50 in 24-hour and on mean hourly cardiac cycle length; 3) percentage of hourly ventricular ectopies distribution and its correlation with pNN50 and with mean hourly cardiac cycle length in all patients; 4) drug effects on mean hourly cardiac cycle length in groups 1 and 2; 5) correlation between hourly pNN50 and ventricular ectopies density after sotalol administration in groups 1 and 2; 6) hourly drug efficacy in groups 1 and 2 and correlation with pNN50. RESULTS--Efficacy of the drug was present in 8 (50) patients. Sotalol significantly increased 24-hour pNN50 (placebo 5.01 +/- 2.02; after drug, 11.70 +/- 5.59-p < 0.001), also increasing mean hourly cardiac cycle length during the day and night, in all patients (placebo 758.25 +/- 75.68 ms; after drug 967.71 +/- 80.17 ms-p < 0.000). It was noted that patients under placebo had different autonomic tonus; group 1 showed higher sympathetic activity as compared to group 2. Hourly drug efficacy was seen in 23 of 24-hour recordings in group 1 while it was not seen at any time in group 2. CONCLUSION--Sotalol significantly increased parasympathetic cardiac activity. The anti-arrhythmic response was related to the autonomic tonus seen before and after drug administration.

Eficácia do sotalol nas arritmias ventriculares idiopáticas com origem em trato de saída de ventrículo direito / Efficacy of Sotalol in Patients With Idiophatic Right Ventricular Arrhythmias

PURPOSE--To evaluate the effects of sotalol in patients (pts) with idiophatic ventricular arrhythmias (VT) from right ventricular outflow tract. METHODS--Eighteen pts with VT were enrolled (five with monomorphic repetitive ventricular tachycardia - MRVT). Pts were submitted to a double-blind crossover randomized study (placebo vs. 320 mg/po/d/sotalol; four weeks each), after a wash-out control period. Holter recording were recorded in control and placebo and drug periods. Eligible pts have > 50/h isolated ventricular premature beats (VPB) in control, with or without paired VPB or nonsustained VT (NSVT- > 3 beats, > 100bpm). Drug efficacy criteria was: > 75//reduction in isolated VPB and > 90//of paired VPB or NSVT. The effects of the drug on uncorrected QT interval was evaluated and also on circadian rhythm of VT through the hourly pNN50/VPB ratios. Values are given as mean +/- SD. Three recordings were compared by using paired Student's ®t® test. Statistical significance was assumed for p < 0.05. RESULTS--Differences between control and placebo were NS. Drug was effective in 61//of pts, reducing the 3 types of ET (VPB: placebo = 23.508 +/- 34.537; drug: 975 +/- 1357; paired placebo = 443 +/- 587; drug = 9 +/- 20). The drug was evaluated in 4 pts with MRVT, reducing all ectopic events, with efficacy of 60//over VPB and paired and 80//over NSVT (VPB: placebo = 52.639 +/- 42.207; drug: 1631 +/- 2062; paired: placebo = 796 +/- 754; drug: 20 +/- 30; NSVT: placebo = 4287 +/- 6343; drug: 9 +/- 11). Mean QT interval was 0.40 +/- 0.01s in control and 0.50 +/- 0.04s in the drug period, with no correlation between duration and efficacy. Sotalol modified the circardian rhythm of VPB in the non-responders group, mainly during the morning. CONCLUSION--Sotalol was effective in control of VT, mainly the MRVT. Its effect on VPB circadian rhythm may independently contribute to the overall efficacy profile and myocardial protective effect of this drug

Mechanism of gender difference in sotalol-induced torsade de pointes / 中国病理生理杂志

AIM: To investigate the mechanism of gend er difference in sotalol-induced torsade de pointes (TdP) in rabbits in vitro. METHODS: 40 rabbits of both sexes were divided into two groups: low concentration (1?10 -5 mol/L d-sotalol) group and high concentration (1?10 -4 mol/L d-sotalol) group. With the monophasic action potential (MAP ) recording technique, MAP of epicardium, midmyocardium and endocardium were sim ultaneously recorded by specially designed plunge-needle electrodes across the l eft ventricular free wall of rabbit hearts purfused by Langendorff method. TdP w as induced by bradycardia, d-sotalol and low-K+, Mg 2+ tyrode solution. RESULTS: d-sotalol prolonged the duration of 90% repolarizat ion (MAPD 90) of epicardium, midmyocardium and endocardium in a concentration-d ependent manner and the effect on midmyocardium was the most obvious. In low con centration group, MAPD 90 of midmyocardium of male rabbit heart increased f rom (222?11) ms to (230?10) ms and that of female rabbit heart increased from (263?12) ms to (281?12) ms. In high concentration group, MAPD 90 of midmy ocardium of male rabbit heart increased from (217?10) ms to (296?18) ms and th at of female rabbit heart increased from (258?10) ms to (368?19) ms. There was no difference in TDR between male and female rabbit hearts before perfusion wit h d-sotalol. D-sotalol prolonged TDR in a concentration-dependent manner. In low concentration group, TDR of male and female rabbit hearts was (20.0?5.1) ms and (28.0?5.6) ms. In high concentration group, TDR of male and female rabbit hearts was (38.0?4.8) ms and (55.0?7.7) ms, respectively. There was EAD i n 6 female hearts while no EAD develop ed in male heart and no TdP developed in low concentration group. In high concen tration group, 10 female, 9 male hearts developed EAD, 9 female and 3 male he arts developed TdP. CONCLUSION: The greater TDR induced by d-sotalol in female may b e responsible for the higher incidence of TdP of female rabbit heart.

Influence of sotalol on the QT dispersion in patients with radiofrequency catheter ablation / 第二军医大学学报

Objective: To observe the influence of sotalol on the QT dispersion in patients with atrioventricular accessory pathways underwent radiofrequency catheter ablation (RFCA). Methods: Thirty six patients were divided into 2 groups by random. One was the drug group(18 cases) treated by RFCA, and sotalol 160 mg was orally administered and intracardiac electrophysiological study was performed every 30 min for 5 times. The other group(control group, 18 cases) only treated by RFCA.QTd,QTcd and QTLcd were measured before and after RFCA. Results: There was no significant difference with QT dispersion before and after RFCA in control group. When compared with before RFCA, QTd in patients administered sotalol was (30.9?14.3) ms vs (24.7?9.6) ms; QTcd(33.7?17.1) ms vs (25.2?10.1) ms; QTLcd(30.8?14.1)ms vs (25.6?19.4) ms ( P