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Efficacy and safety of d,l-sotalol in patients with ventricular tachycardia and in survivors of cardiac arrest.
Haverkamp, W; Martinez-Rubio, A; Hief, C; Lammers, A; Mühlenkamp, S; Wichter, T; Breithardt, G; Borggrefe, M.
Afiliação
  • Haverkamp W; Hospital of the Westfälische Wilhelms-University, Department of Cardiology and Angiology, Münster, Germany. w.haverkamp@uni-muenster.de
J Am Coll Cardiol ; 30(2): 487-95, 1997 Aug.
Article em En | MEDLINE | ID: mdl-9247523
OBJECTIVE: The aim of this study was to assess the antiarrhythmic efficacy and safety of d,l-sotalol in patients with ventricular tachycardia (VT) or ventricular fibrillation (VF) and in survivors of cardiac arrest and to identify the factors that are associated with arrhythmia suppression and therefore might be helpful in predicting drug efficacy. BACKGROUND: Despite increasing use of the class III antiarrhythmic agent d,l-sotalol, data on its short- and long-term efficacy in a large patient cohort are lacking. Information on its long-term tolerability and safety is limited. METHODS: A total of 396 patients with inducible sustained VT or VF (VT/VF) underwent programmed stimulation before and after receiving oral d,l-sotalol (240 to 640 mg/day). Patients in whom VT/VF was rendered either noninducible or more difficult to induce (more extrastimuli or faster drive cycle length needed for VT/VF induction) were discharged on a regimen of oral d,l-sotalol. RESULTS: d,l-Sotalol suppressed VT/VF in 151 patients (38.1%) and rendered the arrhythmia more difficult to induce in 76 patients (19.2%). The extent of drug-induced prolongation of right ventricular refractoriness and a shorter VT cycle length at baseline were independent predictors of immediate drug efficacy. Torsade de pointes developed in seven patients (1.8%). Two hundred ten patients (53%) continued to receive d,l-sotalol and were followed up for 34 +/- 18 months (mean +/- SD). The actuarial rates for the absence of arrhythmic recurrence (either VT/VF or sudden death) at 1 and 3 years were 89% and 77%, respectively. Actuarial rates for overall survival at 1 and 3 years were 94% and 86%, respectively. VT/VF suppression by d,l-sotalol was an independent discriminant variable that separated patients with and without arrhythmia recurrence. However, noninducibility of VT/VF did not predict freedom from sudden death. CONCLUSION: Oral d,l-sotalol is effective and safe in patients with VT/VF. However, sudden cardiac death develops in a significant proportion of patients, and programmed stimulation seems to be of limited value for its prediction.
Assuntos
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Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Sotalol / Taquicardia Ventricular / Parada Cardíaca / Antiarrítmicos Tipo de estudo: Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Female / Humans / Male / Middle aged Idioma: En Revista: J Am Coll Cardiol Ano de publicação: 1997 Tipo de documento: Article País de afiliação: Alemanha País de publicação: Estados Unidos
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Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Sotalol / Taquicardia Ventricular / Parada Cardíaca / Antiarrítmicos Tipo de estudo: Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Female / Humans / Male / Middle aged Idioma: En Revista: J Am Coll Cardiol Ano de publicação: 1997 Tipo de documento: Article País de afiliação: Alemanha País de publicação: Estados Unidos