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Electrophysiologic and antiarrhythmic efficacy of oral sotalol for sustained ventricular tachyarrhythmias evaluation by programmed stimulation and ambulatory electrocardiogram

, : Electrophysiologic and antiarrhythmic efficacy of oral sotalol for sustained ventricular tachyarrhythmias evaluation by programmed stimulation and ambulatory electrocardiogram. Journal of the American College of Cardiology 8(4): 949-958

Programmed ventricular stimulation and ambulatory electrocardiography were performed both before and during oral sotalol therapy in 39 patients with ventricular tachyarrhythmia inducible by programmed stimulation (sustained ventricular tachycardia [n = 31], ventricular fibrillation [n = 3], nonsustained ventricular tachycardia [n = 5]). Oral sotalol was started at 80 mg twice daily and the dose thereafter was then gradually increased until a mean dose of 300 mg (range 160-480) was reached. In 12 of 34 patients with inducible sustained ventricular tachycardia or fibrillation the arrhythmia was suppressed; in 19 patients it was not and in 3 the spontaneous arrhythmia recurred. Reproducibly inducible nonsustained ventricular tachycardia was suppressed by sotalol in all five patients with this arrhythmia. Thus, a favorable electrophysiologic response was obtained in 17 (44%) of 39 patients. Arrhythmia suppression correlated with the type of arrhythmia (unsustained or sustained) induced during the control period (p < 0.05), and nonresponders had a higher incidence of previously ineffective drug trials (p < 0.05). In 22 patients treated long term with sotalol suppression of arrhythmia inducibility on programmed stimulation predicted freedom from recurrences (16 of 17), whereas continued inducibility indicated drug failure (5 of 5) (p < 0.005). Serial ambulatory electrocardiograms performed in 37 of the 39 patients did not correlate with the results of electrophysiologic testing. For the patients on long-term treatment, invasive testing was superior to electrocardiographic monitoring in predicting outcome. These data indicate that in daily doses of 160 to 480 mg (1) oral sotalol is a very useful agent in patients presenting with sustained ventricular tachycardia or fibrillation, and (2) its efficacy is fairly well predicted by programmed stimulation.

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Accession: 005349240

PMID: 3760368

DOI: 10.1016/s0735-1097(86)80440-5

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