DOUBLE-BLIND TRIAL OF LIGNOCAINE VERSUS SOTALOL FOR ACUTE TERMINATIONOF SPONTANEOUS SUSTAINED VENTRICULAR-TACHYCARDIA

The efficacy of antiarrhythmic drugs for terminating sustained ventric ular tachycardia (VT) has been disappointing. Lignocaine is the tradit ional drug but it is not very effective. Sotalol, one of the most effe ctive drugs in suppressing spontaneous or induced VT, should theoretic ally be useful in this setting. We have compared lignocaine with sotal ol for the acute termination of spontaneous sustained VT not causing c ardiac arrest in 33 patients (26 males, 7 females, aged 21-90) whose u nderlying heart disease was old myocardial infarction (28), acute myoc ardial infarction (2), dilated cardiomyopathy (1), or idiopathic cardi omyopathy (2). Left-ventricular ejection fraction was 35% (range 18-76 %). Patients were randomly allocated in a double-blind fashion to lign ocaine 100 mg (n = 17) or sotalol 100 mg (n = 16) given intravenously over 5 min. Those with persistent VT 15 min after onset of administrat ion of the first drug were crossed over to the other drug. Sotalol was significantly more effective than lignocaine whether analysed on an i ntention-to-treat basis (69% vs 18%; 95% confidence interval for absol ute difference of 51% 22-80%, p = 0.003) or by analysis limited to the 31 patients with subsequent electrophysiologically proven VT (69% vs 20%). 1 patient in each group required cardioversion after the first d rug. Tachycardia persisted in 14 patients in the lignocaine group and 4 in the sotalol group after 15 min. Tachycardia ceased in 7 (50%) pat ients who crossed over to sotalol, and in 1 patient who crossed over t o lignocaine. There was 1 death in each group after the first drug and 1 death after both drugs. We conclude that sotalol was superior to li gnocaine for the acute termination of sustained VT, The incidence of a dverse effects was similar for the two drugs.