[Effect of sotalol on systemic hemodynamics and electrophysiology in patients with life-threatening ventricular tachyarrhythmias].

OBJECTIVE

To evaluate the systemic hemodynamics and electrophysiology effect of intravenous and oral sotalol and its tolerance of long-term oral therapy in patients with life-threatening ventricular tachyarrhythmias.

METHODS

Twenty-three patients, 17 with sustained ventricular tachycardias (VTs), 6 with ventricular fibrillation (VF) were studied. 16 patients were postmyocardial infarction, 4 were right ventricular dysplasia and 3 were dilated cardiomyopathy.

RESULTS

Sotalol prevented the induction of arrhythmias in 34.3% with bolus intravenous injection (1 mg/kg body weight) and 60.8% with oral (160 mg twice daily for 10 to 14 days). Both intravenous and oral sotalol led to bradycardia, decreased in cardiac index, increased in left ventricular filling pressure as well as in systemic vascular resistance. The stroke volume increased significantly after sotalol intravenous, but not changed at peak action after oral sotalol. During a follow-up of 3 to 6 months, oral sotalol prevented the recurrent of arrhythmias in 12 of 16 patients who were response to electrophysiology testing. Congestive heart failure associated with a marked bradycardia developed in one patient. This patient was managed with a reduction in the dosage and with a regimen of digoxin and furosemide.

CONCLUSION

Sotalol provided effective prophylaxis against life- threatening Ventricular tachyarrhythmias. It exerted significant negative hemodynamics effects but with quite good clinical tolerance, even in patients with compromised heart function.