Programmed ventricular stimulation and ambulatory electrocardiography were performed both before and during oral Sotalol therapy in 39 patients with ventricular tachyarrhythmia inducible by programmed stimulation (sustained ventricular tachycardia [n = 31], ventricular fibrillation [n = 3], nonsustained ventricular tachycardia [n = 5]). Oral Sotalol was started at 80 mg twice daily and the dose thereafter was then gradually increased until a mean daily dose of 300 mg (range 160–480) was reached. In 12 of 34 patients with inducible sustained ventricular tachycardia or fibrillation the arrhythmia was suppressed; in 19 patients it was not and in 3 the spontaneous arrhythmia recurred. Reproducibly inducible nonsustained ventricular tachycardia was suppressed by Sotalol in all five patients with this arrhythmia. Thus, a favorable electrophysiologic response was obtained in 17 (44%) of 39 patients. Arrhythmia suppression correlated with the type of arrhythmia (unsustained or sustained) induced during the control period (p < 0.05), and nonresponders had a higher incidence of previously ineffective drug trials (p < 0.05). In 22 patients treated long term with Sotalol suppression of arrhythmia inducibility on programmed stimulation predicted freedom from recurrences (16 of 17), whereas continued inducibility indicated drug failure (5 of 5) (p < 0.005). Serial ambulatory electrocardiograms performed in 37 of the 39 patients did not correlate with the results of electrophysiologic testing. For the patients on long-term treatment, invasive testing was superior to electrocardiographic monitoring in predicting outcome. These data indicate that in daily doses of 160 to 480 mg 1) oral Sotalol is a very useful agent in patients presenting with sustained ventricular tachycardia or fibrillation, and 2) its efficacy is fairly well predicted by programmed stimulation. © 1986, American College of Cardiology Foundation. All rights reserved.
Steinbeck, G., Bach, P., & Haberl, R. (1986). Electrophysiologic and antiarrhythmic efficacy of oral sotalol for sustained ventricular tachyarrhythmias: Evaluation by programmed stimulation and ambulatory electrocardiogram. Journal of the American College of Cardiology, 8(4), 949–958. https://doi.org/10.1016/S0735-1097(86)80440-5