Summary
Oral sotalol was given to 64 patients (78% postinfarction) with recurrent, reentrant ventricular tachycardia (VT) during an average follow-up period of 19.7 months. Fifty-nine (92%) patients had previously experienced recurrent ventricular tachycardia, in spite of having received an average of three conventional antiarrhythmic drugs (13 had previously failed on other Class III drugs). The nature and mechanism of the VT was proved with electrophysiologic testing (EPS), and the chronic sotalol dosage was determined by repeated EPS at 3- to 4-day intervals until the VT was no longer inducible.
Sotalol failed in five patients and was discontinued in six patients because of severe side effects (three proarrhythmic effects, including two with torsades de pointes)—a total of 18%. Sotalol was successful alone in 42 patients (65%) and in combination with another antiarrhythmic drug in 11 patients (18%). The average dose of sotalol required for success was 589 mg; 658 mg was the mean daily dose when given alone and 486 mg when given in combination.
Side effects were common and were due mainly to the beta-blocking effects of sotalol. Dual chamber pacing was required by 11 patients because of poorly tolerated bradycardia, and 14 patients remained symptomatic from worsening of the cardiac failure in spite of pacing, increased diuretics, or vasodilator therapy. The average drug dosage was the same for symptomatic (680 mg) and asymptomatic (627 mg) patients.
Sotalol is a valuable antiarrhythmic drug for reentrant ventricular tachycardia. High doses are needed, and at these doses the beta-blocking activity is responsible for most of the side effects.
Similar content being viewed by others
References
Bazzet HC. An analysis of the time relations of electrocardiograms. Heart 1920;7:353–370.
Vaughan Williams EM. A classification of antiarrhythmic actions reassessed after a decade of new drugs. J Clin Pharmacol 1984;24:129–147.
Nademanee K, Feld G, Hendrickson J, et al. Electrophysiologic and antiarrhythmic effects of sotalol in patients with life threatening ventricular tachyarrhythmias. Circulation 1985;72:555–564.
Jordaenes LJ, Palmer A, Clement DL. Low dose oral sotalol for monomorphic ventricular tachycardia: Effects during programmed electrical stimulation and follow up. Eur Heart J 1989;10:218–226.
Senges J, Lengfelder W, Jauerning R, et al. Electrophysiologic testing in assessment of therapy with sotalol for sustained ventricular tachycardia. Circulation 1984;69:577–584.
Roop L, Chapman PD, Naccarelli GV, et al. Short and long term experience with flecainide acetate in the treatment of life threatening ventricular arrhythmias. J Am Coll Cardiol 1985;6:772–779.
Mitchell LB, Duff HJ, Dante EM, Wyse DG. A randomised clinical trial of the noninvasive approaches to drug therapy of ventricular tachycardia. N Engl J Med 1987;317:1681–1687.
McKibben JK, Pocock WA, Barlow JB, et al. Sotalol, hypokalemia, syncope, and torsades de pointes. Br Heart J 1984;51:157–162.
Strauss HC, Bigger JR, Hoffman BF. Electrophysiological and beta receptor blocking effects of MJ 1999 on dog and rabbit cardiac tissue. Circ Res 1970;26:661–670.
Ward E, Camm AJ, Spurell RAJ. The acute cardiac electrophysiological effects of intravenous sotalol hydrochloride. Clin Cardiol 1979;2:185–191.
Nathan AW, Hellestrand KJ, Brixton RS, et al. Electrophysiological effects of sotalol—just another beta blocker? Br Heart J 1982;47:515–520.
Edvardson N, Olsson SB. Effects of acute and chronic beta receptor blockade on ventricular repolarization in man. Br Heart J 1981;45:628–636.
Brachman J, Senges J, Rizos I, et al. Sotalol for the treatment of patients with documented ventricular fibrillation: Electrophysiological and anti-arrhythmic properties (abstract). Am Coll Cardiol 1986;7:247.
Brodsky MA, Allen BJ, Luckett CR, et al. Antiarrhythmic efficacy of solitary beta-adrenergic blockade for patients with sustained ventricular tachyarrhythmias. Am Heart J 1989;118:272–280.
Hillis WS, Whiting B. Anti-arrhythmic drugs. Br Med J 1983;286:1332–1336.
Milne JR, Camm AJ, Ward DE, et al. Effect of intravenous propranalol on Q-T interval. A new method of assessment. Br Heart J 1980;43:1–6.
Raine AEG, Vaughan Williams EM. Adaptation to beta blockade of rabbit atrial Purkinje and ventricular potentials and papillary muscle contraction. Circ Res 1981;48:804–815.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Obel, I.W.P., Jardine, R., Haitus, B. et al. Efficacy of oral sotalol in reentrant ventricular tachycardia. Cardiovascular Drugs and Therapy 4 (Suppl 3), 613–618 (1990). https://doi.org/10.1007/BF00357039
Issue Date:
DOI: https://doi.org/10.1007/BF00357039