LONG-TERM COMPARATIVE TRIAL OF SOTALOL, M ETOPROLOL AND AMIODARONE INPATIENTS WITH SEVERE HEART-FAILURE AND MALIGNANT VENTRICULAR ARRHYTHMIA

Efficacy of class III antiarrhythmic amiodarone, cardioselective beta- blocker metoprolol and class III antiarrhythmic with strong beta-block ing properties sotalol was compared in 52 patients with congestive hea rt failure (NYHA class II - IV) and ventricular arrhythmia above grade 3 in a long-term (12 months) trial with parallel groups, Amiodarone ( 200 mg/day) was given to 13, metoprolol (12,5 - 50 mg/day) - to 13, an d sotalol (40 - 320 mg/day) - to 26 patients. Metoprolol was effective in 33% of patients, Its administration was associated with high dropo ut (53,8%) and death (n=3; 23%) rates. Meanwhile in patients who compl eted the study left ventricular ejection infraction and NYHA class sli ghtly improved (by 12 and 33%, respectively). Amiodarone was effective in 55% of patients. Its action became evident after 3 months of treat ment. There were no cases of proarrhythmia, deaths or other complicati ons in this group and 85,4% of patients successfully finished the stud y, Hemodynamic effect of amiodarone was not significant and improvemen t of NYHA class appeared after 12 months. Sotalol produced antiarrhyth mic effect in 50% of patients. This effect became evident after 1 mont h of therapy. Treatment with sotalol was associated with stable hemody namic improvement, Left ventricular ejection fraction eventually incre ased by 21% and of NYHA functional class decreased by 40% also startin g from the first month of therapy. There was one death (pulmonary embo lism) and one case of proarrhythmia in this group while 73,1% of patie nts completed the study. We conclude that low doses of amiodarone and sotalol could be drugs of choice in the treatment of severe congestive heart failure with malignant ventricular arrhythmia. Amiodarone is sa fer but effect of sotalol develops faster and this can be vital in urg ent situations. Cardioselective beta-blockers are not indicated to pat ients with severe congestive heart failure and life-threatening ventri cular arrhythmia.