EFFICACY AND SAFETY OF D,L-SOTALOL IN PATIENTS WITH VENTRICULAR-TACHYCARDIA AND IN SURVIVORS OF CARDIAC-ARREST

Objectives. The aim of this study was to assess the antiarrhythmic eff icacy and safety of d,l-sotalol in patients with ventricular tachycard ia (VT) or ventricular fibrillation (VF) and in survivors of cardiac a rrest and to identify the factors that are associated with arrhythmia suppression and therefore might be helpful in predicting drug efficacy . Background, Despite increasing use of the class III antiarrhythmic a gent d,l-sotalol, data on its short- and long-term efficacy in a large patient cohort are lacking, Information on its long-term tolerability and safety is limited. Methods. A total of 396 patients with inducibl e sustained VT or VF (VT/VF) underwent programmed stimulation before a nd after receiving oral d,l-sotalol (240 to 640 mg/day). Patients in w hom VT/VF was rendered either noninducible or more difficult to induce (more extrastimuli or faster drive cycle length needed for VT/VF indu ction) were discharged on a regimen of oral d,l-sotalol. Results. d,l- Sotalol suppressed VT/VF in 151 patients (38.1%) and rendered the arrh ythmia more difficult to induce in 76 patients (19.2%), The extent of drug-induced prolongation of right ventricular refractoriness and a sh orter VT cycle length at base line were independent predictors of imme diate drug efficacy, Torsade de pointes developed in seven patients (1 .8%), Two hundred ten patients (53%) continued to receive d,l-sotalol and were followed up for 34 +/- 18 months (mean +/- SD). The actuarial rates for the absence of arrhythmic recurrence (either VT/VF or sudde n death) at 1 and 3 years were 89% and 77%, respectively, Actuarial ra tes for overall survival at 1 and 3 years were 94% and 86%, respective ly. VT/VF suppression by d,l-sotalol was an independent discriminant v ariable that separated patients with and without arrhythmia recurrence , However, noninducibility of VT/VF did not predict freedom from sudde n death. Conclusions. Oral d,l-sotalol is effective and safe in patien ts with VT/VF, However, sudden cardiac death develops in a significant proportion of patients, and programmed stimulation seems to be of lim ited value for its prediction. (C) 1997 by the American College of Car diology.