Nademanee K, Feld G, Hendrickson J, Singh P N, Singh B N
Circulation. 1985 Sep;72(3):555-64. doi: 10.1161/01.cir.72.3.555.
Sotalol is a unique beta-blocker that lengthens cardiac repolarization and effective refractory period (ERP). Its efficacy after intravenous (1.5 mg/kg) and oral (160 to 480 mg bid) administration was therefore evaluated in 37 patients with refractory recurrent ventricular tachycardia/fibrillation (VT/VF). Thirty-five patients, 33 with inducible VT/VF, underwent electrophysiologic testing. Intravenous sotalol lengthened the ERP in the atrium (+24.6%, p less than .01), atrioventricular node (+24.9%, p less than .01), and ventricle (+14.9%, p less than .01). It also significantly lengthened sinus node recovery time, corrected QT interval (QTc), and the AH interval, but not the HV interval. Sotalol prevented reinduction of VT/VF in 15 patients (45.5%). Twenty-five of the 33 patients (15 with positive results of electrophysiologic tests; 10 with negative results) were given oral sotalol. The drug was ineffective in seven (26.9%) and aggravated arrhythmia in one (3.8%). In four patients sotalol was withdrawn because of side effects; arrhythmias recurred late in two (7.7%). Eleven patients (42.3%) have continued on oral sotalol over a mean follow-up period of 9.2 +/- 8.6 months. Sotalol reduced (n = 21) total premature ventricular complex (PVC) count on the Holter electrocardiogram by 73% (p less than .01), paired PVCs by 89% (p less than .01), and beats of ventricular tachycardia by 95% (p less than .01). In 52% (n = 11), total reduction in PVCs was at least 85%, and incidence of paired and tachycardiac beats was reduced at least 90% (group A). In the remainder (n = 10), PVC suppression was not significant (group B). Group A included nine patients with nonreinducible VT/VF and two in whom it was reinducible; in group B, eight of 10 patients had reinducible VT/VF. The difference between the two groups (Fisher exact test) was significant (p less than .01). The prevention of reinduction of VT/VF by intravenous sotalol and suppression of spontaneously occurring arrhythmias by the oral drug were both predictive of long-term drug efficacy. Sotalol is a significant advance in the short- and long-term management of life-threatening ventricular tachyarrhythmias.
索他洛尔是一种独特的β受体阻滞剂，可延长心脏复极化和有效不应期（ERP）。因此，对37例难治性复发性室性心动过速/心室颤动（VT/VF）患者评估了静脉注射（1.5mg/kg）和口服（160至480mg，每日两次）索他洛尔后的疗效。35例患者（其中33例可诱发出VT/VF）接受了电生理检查。静脉注射索他洛尔可延长心房ERP（增加24.6%，p<0.01）、房室结ERP（增加24.9%，p<0.01）和心室ERP（增加14.9%，p<0.01）。它还显著延长窦房结恢复时间、校正QT间期（QTc）和AH间期，但不延长HV间期。索他洛尔预防了15例患者（45.5%）VT/VF的再次诱发。33例患者中的25例（15例电生理检查结果阳性；10例阴性）给予口服索他洛尔。该药物在7例患者（26.9%）中无效，在1例患者（3.8%）中加重了心律失常。4例患者因副作用停用索他洛尔；2例患者（7.7%）后期心律失常复发。11例患者（42.3%）在平均9.2±8.6个月的随访期内持续口服索他洛尔。索他洛尔使动态心电图上的室性早搏（PVC）总数（n = 21）减少了73%（p<0.01），成对PVC减少了89%（p<0.01），室性心动过速的搏动减少了95%（p<0.01）。在52%（n = 11）的患者中，PVC总数减少至少85%，成对和心动过速搏动的发生率降低至少90%（A组）。其余患者（n = 10）中，PVC抑制不显著（B组）。A组包括9例不可诱发出VT/VF的患者和2例可诱发出VT/VF的患者；B组10例患者中有8例可诱发出VT/VF。两组之间的差异（Fisher精确检验）具有显著性（p<0.01）。静脉注射索他洛尔预防VT/VF的再次诱发以及口服药物抑制自发发生的心律失常均预示着长期药物疗效。索他洛尔在危及生命的室性快速性心律失常的短期和长期治疗方面是一项重大进展。
