Key result
In patients with inducible sustained VT/VF, oral d,l-sotalol therapy resulted in a 38.1% rate of arrhythmia suppression and a 77% actuarial rate of freedom from arrhythmic recurrence at 3 years.
Why the study?
Despite increasing use of the class III antiarrhythmic agent d,l-sotalol, data on its short- and long-term efficacy and safety in a large patient cohort are lacking.
Does oral d,l-sotalol effectively suppress arrhythmias and prevent arrhythmic recurrence or sudden death in patients with inducible sustained VT or VF?
Cohort (n=396)
Does oral d,l-sotalol effectively suppress arrhythmias and prevent arrhythmic recurrence or sudden death in patients with inducible sustained VT or VF?
Answers are grounded in this paper and cite their sources.
Oral d,l-sotalol provides effective arrhythmia suppression and good long-term freedom from arrhythmic recurrence in a subset of patients with VT/VF, though sudden cardiac death still occurs in a significant proportion.
OBJECTIVE: The aim of this study was to assess the antiarrhythmic efficacy and safety of d,l-sotalol in patients with ventricular tachycardia (VT) or ventricular fibrillation (VF) and in survivors of cardiac arrest 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 agent 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 inducible sustained VT or VF (VT/VF) underwent programmed stimulation before and after receiving oral d,l-sotalol (240 to 640 mg/day). Patients in whom VT/VF was rendered either noninducible or more difficult to induce (more extrastimuli or faster drive cycle length needed for VT/VF induction) 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 arrhythmia more difficult to induce in 76 patients (19.2%). The extent of drug-induced prolongation of right ventricular refractoriness and a shorter VT cycle length at baseline were independent predictors of immediate 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 sudden death) at 1 and 3 years were 89% and 77%, respectively. Actuarial rates for overall survival at 1 and 3 years were 94% and 86%, respectively. VT/VF suppression by d,l-sotalol was an independent discriminant variable that separated patients with and without arrhythmia recurrence. However, noninducibility of VT/VF did not predict freedom from sudden death. CONCLUSION: Oral d,l-sotalol is effective and safe in patients with VT/VF. However, sudden cardiac death develops in a significant proportion of patients, and programmed stimulation seems to be of limited value for its prediction.
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Haverkamp et al. (1997) conducted a cohort in Ventricular tachycardia (VT) or ventricular fibrillation (VF) and survivors of cardiac arrest (n=396). d,l-sotalol was evaluated on absence of arrhythmic recurrence (either VT/VF or sudden death) at 3 years. In patients with inducible sustained VT/VF, oral d,l-sotalol therapy resulted in a 38.1% rate of arrhythmia suppression and a 77% actuarial rate of freedom from arrhythmic recurrence at 3 years.
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