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CLINICAL STUDIES

Suppression of sustained ventricular tachyarrhythmias: a comparison of d,l-sotalol with no antiarrhythmic drug treatment

^a Eberhard-Karls-University, Medical Department III, Tübingen, Germany

Manuscript received October 28, 1997; revised manuscript received August 11, 1998, accepted September 23, 1998.

Address for correspondence: Dr. Volker Kühlkamp, Eberhard-Karls-Universität, Medizinische Klinik III, Otfried Müller Str. 10, 72076 Tübingen, Germany
Volker.Kuehlkamp{at}uni-tuebingen.de

Objectives. This study evaluates the clinical efficacy of d,l-sotalol in patients with sustained ventricular tachyarrhythmias.

Background. D,l-sotalol is an important antiarrhythmic agent to prevent recurrences of sustained ventricular tachyarrhythmias (VT/VF). However, evidence is lacking that an antiarrhythmic agent like d,l-sotalol can reduce the incidence of sustained ventricular tachyarrhythmias in comparison to no antiarrhythmic drug treatment.

Methods. A prospective study was performed in 146 consecutive patients with inducible sustained ventricular tachycardia or ventricular fibrillation. In 53 patients, oral d,l-sotalol prevented induction of VT/VF during electrophysiological testing and patients were discharged on oral d,l-sotalol (sotalol group). In 93 patients, VT/VF remained inducible and a defibrillator (ICD) was implanted. After implantation of the device patients were randomly assigned to oral treatment with d,l-sotalol (ICD/sotalol group, n = 46) or no antiarrhythmic medication (n = 47, ICD-only group).

Results. During follow-up, 25 patients (53.2%) in the ICD-only group had a VT/VF recurrence in comparison to 15 patients (28.3%) in the sotalol group and 15 patients (32.6%) in the ICD/sotalol group (p = 0.0013). Therapy with d,l-sotalol, amiodarone or metoprolol was instituted in 12 patients (25.5%) of the ICD-only group due to frequent VT/VF recurrences or symptomatic supraventricular tachyarrhythmias. In nine patients, 17% of the sotalol group, an ICD was implanted after VT/VF recurrence, three patients (5.7%) received amiodarone. Total mortality was not different between the three groups.

Conclusions. D,l-sotalol significantly reduces the incidence of recurrences of sustained ventricular tachyarrhythmias in comparison to no antiarrhythmic drug treatment.

Abbreviations and Acronyms   VT/VF = sustained ventricular tachyarrhythmias   ICD = implantable cardioverter defibrillator

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