EFFICACY OF SOTALOL GUIDED BY PROGRAMMED ELECTRICAL-STIMULATION FOR SUSTAINED VENTRICULAR ARRHYTHMIAS SECONDARY TO CORONARY-ARTERY DISEASE

Sotalol is a class III antiarrhythmic drug with additional beta-blocke r activity that has been shown to be effective in supraventricular and ventricular arrhythmias. Its long-term efficacy for ventricular arrhy thmias is not as well described. Patients with documented sustained ve ntricular tachycardia (VT) or ventricular fibrillation (VF) who had th eir clinical arrhythmia inducible at baseline electrophysiologic study received sotalol 320 to 640 mg/day. Repeat programmed stimulation was performed after a minimum of 72 hours while receiving the final dose. Of 28 patients (25 men and 3 women) whose arrhythmias were inducible at baseline, 15 had their arrhythmias suppressed with sotalol. Sotalol had greater success in suppressing arrhythmias in those with VF (8 of 9, 89%) than in those with VT (7 of 19, 37%, p <0.01). In patients wi th a history of coronary artery disease but no history of myocardial i nfarction the arrhythmia was suppressed in 7 of 8 (88%) compared with 8 of 20 (40%, p <0.05) patients with a history of myocardial infarctio n. All 15 patients in whom ventricular arrhythmias were suppressed con tinued to take long-term sotalol, and at a follow-up of 10.3 +/- 6.4 m onths none has had arrhythmia recurrence. Thus, sotalol is an effectiv e drug for the suppression of ventricular arrhythmias as judged by pro grammed electrical stimulation. It appears to be more effective in pat ients in whom the clinical arrhythmia is VF rather than VT.