Obel I W, Jardine R, Haitus B, Millar R N
Department of Cardiology, University of Witwatersrand, Johannesburg General Hospital, Republic of South Africa.
Cardiovasc Drugs Ther. 1990 Jun;4 Suppl 3:613-8. doi: 10.1007/BF00357039.
Oral sotalol was given to 64 patients (78% postinfarction) with recurrent, reentrant ventricular tachycardia (VT) during an average follow-up period of 19.7 months. Fifty-nine (92%) patients had previously experienced recurrent ventricular tachycardia, in spite of having received an average of three conventional antiarrhythmic drugs (13 had previously failed on other Class III drugs). The nature and mechanism of the VT was proved with electrophysiologic testing (EPS), and the chronic sotalol dosage was determined by repeated EPS at 3- to 4-day intervals until the VT was no longer inducible. Sotalol failed in five patients and was discontinued in six patients because of severe side effects (three proarrhythmic effects, including two with torsades de pointes)--a total of 18%. Sotalol was successful alone in 42 patients (65%) and in combination with another antiarrhythmic drug in 11 patients (18%). The average dose of sotalol required for success was 589 mg; 658 mg was the mean daily dose when given alone and 486 mg when given in combination. Side effects were common and were due mainly to the beta-blocking effects of sotalol. Dual chamber pacing was required by 11 patients because of poorly tolerated bradycardia, and 14 patients remained symptomatic from worsening of the cardiac failure in spite of pacing, increased diuretics, or vasodilator therapy. The average drug dosage was the same for symptomatic (680 mg) and asymptomatic (627 mg) patients. Sotalol is a valuable antiarrhythmic drug for reentrant ventricular tachycardia. High doses are needed, and at these doses the beta-blocking activity is responsible for most of the side effects.
对64例（78%为心肌梗死后患者）复发性折返性室性心动过速（VT）患者给予口服索他洛尔，平均随访期为19.7个月。59例（92%）患者既往曾经历复发性室性心动过速，尽管平均接受过三种传统抗心律失常药物治疗（13例此前使用其他III类药物治疗无效）。通过电生理检查（EPS）证实VT的性质和机制，并每隔3至4天重复进行EPS以确定索他洛尔的慢性剂量，直至VT不再可诱发。5例患者使用索他洛尔治疗失败，6例患者因严重副作用（3例促心律失常作用，包括2例尖端扭转型室速）停药，共计18%。索他洛尔单独使用成功治疗42例患者（65%），与另一种抗心律失常药物联合使用成功治疗11例患者（18%）。成功所需索他洛尔的平均剂量为589 mg；单独使用时平均每日剂量为658 mg，联合使用时为486 mg。副作用常见，主要归因于索他洛尔的β受体阻滞作用。11例患者因心动过缓耐受性差需要双腔起搏，14例患者尽管进行了起搏、增加利尿剂或血管扩张剂治疗，但仍因心力衰竭恶化而有症状。有症状患者（680 mg）和无症状患者（627 mg）的平均药物剂量相同。索他洛尔是治疗折返性室性心动过速的一种有价值的抗心律失常药物。需要高剂量，而在这些剂量下，β受体阻滞活性是大多数副作用的原因。
