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Electrophysiological effects of sotalol in supraventricular tachycardias


, : Electrophysiological effects of sotalol in supraventricular tachycardias. Zeitschrift fuer Kardiologie 74(9): 506-511

The electrophysiological effects of sotalol, a beta-blocking drug with class III antiarrhythmic properties were assessed in 20 patients (mean age 33 .+-. 14.3 years) with supraventricular tachycardias. Sixteen patients had Wolff-Parkinson-White syndrome (overt n = 9, concealed n = 7), three patients AV-nodal reentrant tachycardias and another patient atrial tachycardias. Sotalol was administered intravenously (n = 16) in a dose of 1.5 mg/kg over 15 min. The effects of 320 to 480 mg/day oral sotalol were assessed in 7 patients. By intravenous and oral application of sotalol a significant increase in the AH interval, the refractory periods of the atrium and ventricle as well as a decrease of the antegrade and retrograde conduction capacity of the AV node or the accessory pathway were observed. The mean R-R interval during induced atrial fibrillation increased significantly in patients with Wolff-Parkinson-White syndrome from 224 .+-. 52 ms to 277 .+-. 59 ms (p < 0.05). In 10 patients, sotalol was administered during supraventricular reentrant tachycardia. The cycle length of supraventricular tachycardia increased from 276 .+-. 90 ms to 358 .+-. 25 ms (p < 0.01). The tachycardia terminated in 7 patients: in 5 patients block was observed in the AV node, while in another 2 patients tachycardia terminated retrogradely. After intravenous application supraventricular arrhythmias were no longer inducible in 5 of 12 patients. In a further 4 patients only non-sustained supraventricular tachycardias (4-20 QRS complexes) were inducible. In 2 patients the supraventricular tachycardia terminated distal to the His bundle. Thus, sotalol was effective in the treatment of supraventricular tachycardias. The drug prolonged myocardial refractoriness acutely and chronically. Its antiarrhythmic efficacy can be ascribed to its prolongation of refractoriness (class III activity).

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