COMPARISON OF D,L-SOTALOL AND IMPLANTABLE DEFIBRILLATORS FOR TREATMENT OF SUSTAINED VENTRICULAR-TACHYCARDIA OR FIBRILLATION IN PATIENTS WITH CORONARY-ARTERY DISEASE
D. Bocker et al., COMPARISON OF D,L-SOTALOL AND IMPLANTABLE DEFIBRILLATORS FOR TREATMENT OF SUSTAINED VENTRICULAR-TACHYCARDIA OR FIBRILLATION IN PATIENTS WITH CORONARY-ARTERY DISEASE, Circulation, 94(2), 1996, pp. 151-157
Background Implantable cardioverter-defibrillators (ICDs) and d,I-sota
lol are widely used to treat ventricular tachyarrhyth mia and ventricu
lar fibrillation (VT/VF). The purpose of this study was to compare the
long-term efficacy of dl-sotalol and ICDs in patients with coronary a
rtery disease. Methods and Results In a case-control study, 50 patient
s treated with oral d,l-sotalol were matched to 50 patients treated wi
th ICDs. Both groups were matched for sex (82 men), age (58+/-10 years
), ejection fraction (40+/-12%), extent of coronary artery disease, pr
esenting arrhythmia, and year that treatment began. In all patients in
the sotalol group, VT/VF was inducible in the drug-free electrophysio
logical study. Induction of sustained VT/VF was suppressed by ri,l-sot
alol (438+/-95 mg/d). In the ICD group, either VT/VF was not inducible
(n=5) or inducible sustained VT/VF was refractory to antiarrhythmic d
rug treatment (n=45). Sotalol treatment led to a marked reduction in a
rrhythmic events. Whereas 83% of the patients in the sotalol group wer
e free of sudden death and nonfatal VT at 3 years, only 33% of the ICD
patients did not receive appropriate ICD therapies (P<.005). Actuaria
l rates for absence of sudden death at 3 years were 85% in the sotalol
group and 100% in the ICD group (P<.005). Actuarial rates for overall
survival at 3 years were 75% in the sotalol group and 85% in the ICD
group (P=.02). Conclusions In this case-control study, ICD therapy was
more effective than electrophysiologically guided antiarrhythmic trea
tment with d,l-sotalol in prevention of sudden death and reduction of
total mortality in patients with coronary artery disease. Prospective
studies are needed to confirm these results.