Kienzle M G, Martins J B, Wendt D J, Constantin L, Hopson R, McCue M L
Department of Internal Medicine, University of Iowa, Iowa City 52242.
Am J Cardiol. 1988 May 1;61(13):1012-7. doi: 10.1016/0002-9149(88)90117-8.
Sotalol is a nonselective beta-adrenergic blocking agent with Vaughn-Williams class III activity. Its efficacy was tested in 9 patients with sustained ventricular tachycardia (VT) that had previously remained inducible during electrophysiologic testing of type I drugs (procainamide or quinidine). Eight patients had coronary artery disease with remote myocardial infarction and 1 had cardiomyopathy (ejection fraction 0.34 +/- 0.08, mean +/- standard deviation). Type I drugs prolonged the effective refractory period of the right ventricle 12 +/- 14% and prolonged the VT cycle length 41 +/- 24%. In contrast, despite an equivalent effect on the effective refractory period, a sustained VT could no longer be initiated in any of the 8 patients ultimately tested while taking oral sotalol. Daily doses averaged 600 +/- 103 mg and blood levels associated with VT suppression in electrophysiologic studies were generally greater than 3,000 ng/ml. In addition, sotalol was moderately effective at reducing ventricular ectopic activity measured by ambulatory electrocardiography. Over a mean follow-up of 23 months (range 1 to 37), mild heart failure (3 patients), symptomatic brady-cardia requiring pacemaker (1) and drug-related polymorphous VT (1) have occurred. Sudden death occurred in 1 patient and nonfatal VT recurrence was noted in 2. Five of 8 chronically treated patients currently are successfully treated with minimal side effects. Sotalol appears to be a promising antiarrhythmic drug in the treatment of serious ventricular arrhythmias, even in patients refractory to type I antiarrhythmic agents.
索他洛尔是一种具有Ⅲ类（ Vaughan-Williams分类法）活性的非选择性β肾上腺素能阻滞剂。对9例持续性室性心动过速（VT）患者进行了其疗效测试，这些患者在I类药物（普鲁卡因胺或奎尼丁）的电生理测试中先前一直可诱发出室性心动过速。8例患者患有冠状动脉疾病并伴有陈旧性心肌梗死，1例患有心肌病（射血分数为0.34±0.08，均值±标准差）。I类药物使右心室有效不应期延长12±14%，使室性心动过速周期长度延长41±24%。相比之下，尽管索他洛尔对有效不应期有同等作用，但在最终接受口服索他洛尔治疗的8例患者中，无一例能再诱发出持续性室性心动过速。平均每日剂量为600±103mg，电生理研究中与室性心动过速抑制相关的血药浓度一般大于3000ng/ml。此外，索他洛尔在通过动态心电图测量减少室性异位活动方面有中度疗效。平均随访23个月（范围1至37个月）期间，出现了轻度心力衰竭（3例患者）、需要起搏器治疗的症状性心动过缓（1例）以及与药物相关的多形性室性心动过速（1例）。1例患者发生猝死，2例患者出现非致命性室性心动过速复发。8例接受长期治疗的患者中有5例目前以最小的副作用获得了成功治疗。索他洛尔在治疗严重室性心律失常方面似乎是一种有前景的抗心律失常药物，即使在对I类抗心律失常药物难治的患者中也是如此。
