Hohnloser S H, Zabel M, van de Loo A, Klingenheben T, Just H
University Hospital, Department of Cardiology, Freiburg, Germany.
Int J Cardiol. 1992 Dec;37(3):283-91. doi: 10.1016/0167-5273(92)90257-4.
Sotalol is a unique beta-blocker that prolongs repolarization. Its use in 626 patients with complex ventricular ectopic activity, as reported in the literature, resulted in suppression of arrhythmia in 50 to 60% of treatment attempts. Detailed analysis of data on arrhythmias in 356 patients that were entered prospectively into a database revealed a median reduction in ventricular premature beats of 76%, compared to a median suppression of repetitive ventricular ectopic activity of 91% and of episodes of nonsustained ventricular tachycardia of 97% (p = 0.002 vs reduction of ventricular premature beats). This marked antiarrhythmic potency of sotalol in repetitive ventricular arrhythmias is thought to be due to its class III activity. Drug efficacy was independent of age, sex, the presence or absence of organic heart disease and the degree of sotalol-induced prolongation of corrected QT interval. Evaluation of left ventricular function in 215 patients treated with the drug demonstrated that depression of left ventricular ejection fraction occurred far less frequently than expected with conventional beta-blockers. Even patients with severely depressed pump function tolerated sotalol surprisingly well. There is a propensity of the drug to aggravate arrhythmia, which resulted in serious proarrhythmic events in 30 (3.5%) of 853 patients. These often consisted of torsades de pointes (9 of 30 patients). Proarrhythmia occurred primarily within the first 3 days of dosing, and exhibited a dose-dependence. In conclusion, sotalol is an effective and well-tolerated antiarrhythmic drug in patients with complex ventricular ectopic activity.(ABSTRACT TRUNCATED AT 250 WORDS)
索他洛尔是一种独特的可延长复极的β受体阻滞剂。据文献报道，其用于626例复杂性室性异位活动患者时，在50%至60%的治疗尝试中可抑制心律失常。对前瞻性录入数据库的356例患者心律失常数据的详细分析显示，室性早搏中位数减少76%，相比之下，重复性室性异位活动中位数抑制率为91%，非持续性室性心动过速发作的抑制率为97%（与室性早搏减少相比，p = 0.002）。索他洛尔在重复性室性心律失常中这种显著的抗心律失常效力被认为归因于其Ⅲ类活性。药物疗效与年龄、性别、有无器质性心脏病以及索他洛尔引起的校正QT间期延长程度无关。对215例接受该药治疗患者的左心室功能评估表明，左心室射血分数降低的发生率远低于传统β受体阻滞剂预期。即使是泵功能严重受损的患者对索他洛尔的耐受性也出奇地好。该药有加重心律失常的倾向，在853例患者中有30例（3.5%）发生了严重的促心律失常事件。这些事件常为尖端扭转型室速（30例患者中有9例）。促心律失常主要发生在给药的头3天内，且表现出剂量依赖性。总之，索他洛尔对于复杂性室性异位活动患者是一种有效且耐受性良好的抗心律失常药物。（摘要截短于250字）
