University of Connecticut Primary Care Internal Medicine Residency, New Britain, CT; and.
Hartford Healthcare Heart and Vascular Institute, Hartford Hospital, Hartford, CT.
J Cardiovasc Pharmacol. 2023 Aug 1;82(2):86-92. doi: 10.1097/FJC.0000000000001439.
According to the American Heart Association, approximately 6 million adults have been afflicted with heart failure in the United States in 2020 and are more likely to have sudden cardiac death accounting for approximately 50% of the cause of mortality. Sotalol is a nonselective β-adrenergic receptor antagonist with class III antiarrhythmic properties that has been mostly used for atrial fibrillation treatment and suppressing recurrent ventricular tachyarrhythmias. The use of sotalol in patients with left ventricular dysfunction is not recommended by the American College of Cardiology or American Heart Association because studies are inconclusive with conflicting results regarding safety. This article aims to review the mechanism of action of sotalol, the β-blocking effects on heart failure, and provide an overview of clinical trials on sotalol use and its effects in patients with heart failure. Small- and large-scale clinical trials have been controversial and inconclusive about the use of sotalol in heart failure. Sotalol has been shown to reduce defibrillation energy requirements and reduce shocks from implantable cardioverter-defibrillators. Torsades de Pointes is the most life-threatening arrhythmia that has been documented with sotalol use and occurs more commonly in women and heart failure patients. Thus far, mortality benefits have not been demonstrated with sotalol use and larger multicenter studies are required going forward.
根据美国心脏协会的数据，2020 年美国约有 600 万成年人患有心力衰竭，并且更有可能发生导致约 50%死亡率的心脏性猝死。索他洛尔是一种具有 III 类抗心律失常特性的非选择性β肾上腺素能受体拮抗剂，主要用于治疗心房颤动和抑制复发性室性心动过速。由于研究结果不一致，存在矛盾，美国心脏病学会和美国心脏协会不建议将索他洛尔用于左心室功能障碍的患者。本文旨在回顾索他洛尔的作用机制、对心力衰竭的β阻断作用，并概述索他洛尔在心力衰竭患者中的使用及其效果的临床试验。小规模和大规模临床试验对心力衰竭患者使用索他洛尔的问题存在争议和不确定性。索他洛尔已被证明可降低除颤能量需求并减少植入式心脏复律除颤器的电击次数。尖端扭转型室性心动过速是索他洛尔使用中记录到的最具生命威胁性的心律失常，并且在女性和心力衰竭患者中更常见。迄今为止，索他洛尔的使用并未显示出降低死亡率的益处，需要进行更大规模的多中心研究。
