Ruder M A, Ellis T, Lebsack C, Mead R H, Smith N A, Winkle R A
Department of Cardiology, Sequoia Hospital, Redwood City, California.
J Am Coll Cardiol. 1989 Jan;13(1):145-52. doi: 10.1016/0735-1097(89)90563-9.
Sixty-five patients with symptomatic, drug-refractory, sustained ventricular tachycardia or fibrillation were treated with oral sotalol (80 to 480 mg twice daily). Sotalol was withdrawn in 11 patients because of continued inducibility of ventricular tachycardia at the time of follow-up electrophysiologic study. Therefore, the clinical effectiveness of sotalol could be evaluated in 54 patients followed up for 11.5 +/- 6 months (range 0.2 to 25). The actuarial incidence of successful sotalol therapy was 54 +/- 13% at 6 months and 47 +/- 13% at 12 months. In 39 patients who underwent electrophysiologic testing while receiving oral sotalol, the drug prevented the reinduction of ventricular tachycardia/fibrillation in 8 (20%). During follow-up study, arrhythmia recurred in 1 (17%) of 6 patients whose ventricular tachycardia was noninducible with oral sotalol and in 8 (44%) of 18 with inducible tachycardia but who were continued on oral sotalol therapy. Adverse effects were noted in 28 patients (42%), requiring drug withdrawal in 13 (22%) and dose reduction after hospital discharge in 10 (15%). Exacerbation of ventricular arrhythmia occurred in six patients (9%), one of whom had associated hypokalemia. Sotalol is frequently useful in the control of intractable, life-threatening ventricular arrhythmias, and its efficacy appears to be predicted by programmed stimulation. However, there is a high rate of limiting side effects, which precludes its use in a large number of patients, and a substantial risk of arrhythmia exacerbation.
65例有症状的、药物难治性持续性室性心动过速或心室颤动患者接受了口服索他洛尔治疗（每日2次，每次80至480毫克）。11例患者因随访电生理研究时室性心动过速仍可诱发而停用索他洛尔。因此，可对54例患者进行索他洛尔临床疗效评估，这些患者随访了11.5±6个月（范围0.2至25个月）。索他洛尔治疗成功的累积发生率在6个月时为54±13%，12个月时为47±13%。在39例接受口服索他洛尔时进行电生理测试的患者中，该药物使8例（20%）患者的室性心动过速/心室颤动未能再次诱发。在随访研究中，口服索他洛尔不能诱发室性心动过速的6例患者中有1例（17%）心律失常复发，18例可诱发心动过速但继续口服索他洛尔治疗的患者中有8例（44%）心律失常复发。28例患者（42%）出现不良反应，13例（22%）需要停药，10例（15%）出院后需要减量。6例患者（9%）发生室性心律失常加重，其中1例伴有低钾血症。索他洛尔在控制难治性、危及生命的室性心律失常方面常常有效，其疗效似乎可通过程控刺激来预测。然而，其限制性副作用发生率较高，这使得许多患者无法使用，且存在心律失常加重的重大风险。
