LONG-TERM EFFICACY OF D L SOTALOL IN PATIENTS WITH SUSTAINED VENTRICULAR-TACHYCARDIA REFRACTORY TO CLASS-I ANTIARRHYTHMIC DRUGS/

The efficacy of dll sotalol was investigated in 50 patients (43 men, s even women, 33 with coronary artery disease, 15 with dilated cardiomyo pathy, ejection fraction 33 +/- 10%) with inducible sustained ventricu lar tachycardia. Before dlI sotalol a mean of 2 +/- 1 (1 to 4) class I antiarrhythmic drugs were ineffective. In 24 patients (48%) oral dll sotalol (320 +/- 47 mg . day(-1)) prevented induction of the ventricul ar tachycardia, in 23 patients the ventricular tachycardia remained in ducible (d/l sotalol 326 +/- 50 mg . day(-1)). The electrophysiologica l effects of d/l sotalol did not differ between patients in whom d/l s otalol prevented induction of ventricular tachycardia and those in who m the ventricular tachycardia remained inducible. In two patients, tor sade des pointes developed after oral application of d/l sotalol, one patient suffered from severe hypotension even with 80 mg of sotalol pe r day. During long-term follow-up (27 +/- 12 months) 5/24 patients (21 %) had a non-fatal recurrence of ventricular tachycardia (1 week to 21 months), one patient died suddenly and another from progressive heart failure. In patients in whom the ventricular tachycardia could be ind uced despite oral application of d/l sotalol, control of the ventricul ar tachyarrhythmia was attempted by the use of sotalol in combination with mexiletine (n=2), amiodarone (n=9), catheter ablation (n=2), anti tachycardia surgery (n=1) or the implantation of an automatic cardiove rter defibrillator (n=12). Recurrence of ventricular tachycardia was o bserved in four patients without an implanted cardioverter defibrillat or. Seven out of 12 patients with an implanted cardioverter defibrilla tor received appropriate shocks or successful antitachycardia pacing. Although no patient died suddenly, overall mortality was 17% in this g roup. It is concluded that d/l sotalol is highly effective in the supp ression of sustained monomorphic ventricular tachycardia inducible by programmed electrical stimulation. However during a mean follow-up of 27 +/- 12 months a recurrence of ventricular tachycardia was seen in 2 1% of patients, and one patient died suddenly.