Comparison of d,l-sotalol and implantable defibrillators for treatment of sustained ventricular tachycardia or fibrillation in patients with coronary artery disease

Background Implantable cardioverter-defibrillators (ICDs) and d,I-sotalol are widely used to treat ventricular tachyarrhyth mia and ventricular fibrillation (VT/VF). The purpose of this study was to compare the long-term efficacy of dl-sotalol and ICDs in patients with coronary artery disease. Methods and Results In a case-control study, 50 patients treated with oral d,l-sotalol were matched to 50 patients treated with ICDs. Both groups were matched for sex (82 men), age (58+/-10 years), ejection fraction (40+/-12%), extent of coronary artery disease, presenting arrhythmia, and year that treatment began. In all patients in the sotalol group, VT/VF was inducible in the drug-free electrophysiological study. Induction of sustained VT/VF was suppressed by ri,l-sotalol (438+/-95 mg/d). In the ICD group, either VT/VF was not inducible (n=5) or inducible sustained VT/VF was refractory to antiarrhythmic drug treatment (n=45). Sotalol treatment led to a marked reduction in arrhythmic events. Whereas 83% of the patients in the sotalol group were free of sudden death and nonfatal VT at 3 years, only 33% of the ICD patients did not receive appropriate ICD therapies (P<.005). Actuarial rates for absence of sudden death at 3 years were 85% in the sotalol group and 100% in the ICD group (P<.005). Actuarial rates for overall survival at 3 years were 75% in the sotalol group and 85% in the ICD group (P=.02). Conclusions In this case-control study, ICD therapy was more effective than electrophysiologically guided antiarrhythmic treatment with d,l-sotalol in prevention of sudden death and reduction of total mortality in patients with coronary artery disease. Prospective studies are needed to confirm these results.