Comparison of the long-term efficacy of implantable defibrillators and sotalol for documented spontaneous sustained ventricular tachyarrhythmias secondary to coronary artery disease

Background: The relative efficacy of antitachycardia pacing implantable car dioverter defibrillators (ATPICD) and sotalol in the treatment of ventricul ar tachyarrhythmias is controversial. Aim: To compare the mortality in patients treated with ATPICD and sotalol f or documented spontaneous sustained ventricular tachyarrhythmias occurring late after previous myocardial infarction. Methods: In this non-randomised retrospective study of 139 consecutive pati ents all patients had inducible ventricular tachycardia at baseline electro physiological studies. Before the availability of ATPICD, 22 patients were treated with sotalol as part of a randomised study comparing the efficacy o f sotalol to amiodarone. After ATPICD became available sotalol was used in 49 patients in whom intravenous testing predicted sotalol to be effective a nd ATPICD were implanted in 68 patients in whom sotalol was predicted to be ineffective at electrophysiological testing. Thus, 68 patients were treate d with an ATPICD and 71 with sotalol. Results: The two groups were well-matched for age, type of presenting arrhy thmia, severity of coronary artery disease and ventricular function. At 36 months Kaplan-Meier estimates of mortality from ventricular tachyarrhythmia were 0% with ATPICD and 15% with sotalol (p=0.03). Kaplan-Meier estimates of total mortality at 36 months were 12% with ATPICD and 25% with sotalol ( p=0.09). Multivariate analysis showed hazard ratio of 7.9 (p=0.06) for deat h from ventricular tachyarrhythmia in patients treated with sotalol compare d to ATPICD. Conclusions: While no difference in total mortality was demonstrated, treat ment with ATPICD is probably superior to sotalol for preventing deaths due to ventricular tachyarrhythmia.