Suppression of sustained ventricular tachyarrhythmias:: A comparison of d,l-sotalol with no antiarrhythmic drug treatment

Objectives. This study evaluates the clinical efficacy of d,I-sotalol in patients with sustained ventricular tachyarrhythmias. Background. D,I-sotalol is an important antiarrhythmic agent to prevent recurrences of sustained ventricular tachyarrhythmias (VT/VF). However, evidence is lacking that an antiarrhythmic agent like d,I-sotalol can reduce the incidence of sustained ventricular tachyarrhythmias in comparison to no antiarrhythmic drug treatment. Methods. A prospective study was performed in 146 consecutive patients with inducible sustained ventricular tachycardia or ventricular fibrillation. In 53 patients, oral d,I-sotalol prevented induction of VT/VF during electrophysiological testing and patients were discharged on oral d,I-sotalol (sotalol group). In 93 patients, VT/VF remained inducible and a defibrillator (ICD) was implanted. After implantation of the device patients were randomly assigned to oral treatment with d,I-sotalol (ICD/sotalol group, n = 46) or no antiarrhythmic medication (n = 47, ICD-only group). Results. During follow up, 25 patients (53.2%) in the ICD only group had a VT/VF recurrence in comparison to 15 patients (28.3%) in the sotalol group and 15 patients (32.6%) in the ICD/sotalol group (p = 0.0013). Therapy with d,I-sotalol, amiodarone or metoprolol was instituted in 12 patients (25.5%) of the ICD only group due to frequent VT/VF recurrences or symptomatic supraventricular tachyarrhythmias. In nine patients, 17% of the sotalol group, an ICD was implanted after VT/VF recurrence, three patients (5.7%) received amiodarone. Total mortality was not different between the three groups. Conclusions. D,I-sotalol significantly reduces the incidence of recurrences of sustained ventricular tachyarrhythmias in comparison to no antiarrhythmic drug treatment. (C) 1998 by the American College of Cardiology.