Brachmann J, Schöls W, Beyer T, Montero M, Enders B, Kübler W
Medical University Hospital, Department of Cardiology, Heidelberg, Germany.
Eur Heart J. 1993 Nov;14 Suppl H:85-7. doi: 10.1093/eurheartj/14.suppl_h.85.
To evaluate the clinical efficacy of d-sotalol, 84 patients with a history of sustained ventricular tachycardia (VT) or ventricular fibrillation (VF), who had inducible sustained VT/VT at baseline electrophysiologic study (EPS), were investigated after intravenous (IV) d-sotalol (1.5-2.5 mg.kg-1). A total of 29 additional patients received only oral d-sotalol, (400-600 mg.day-1). Acute success of antiarrhythmic therapy was defined as suppression of inducible sustained VT/VF. The overall success rate of IV d-sotalol was 38% (32/84) after a mean of 4.3 drugs failed to suppress inducibility. A 78% success rate (31/40) was demonstrated in patients who were also assessed after oral d-sotalol. Torsade de pointes type VT was seen in one patient. After 1 year, only 16% of patients with a positive EPS had a recurrence compared to 43% of patients with a negative EPS (P < 0.05). Estimated survival rates were 95 and 88% after 1 and 2 years of follow-up, respectively. Only five of 56 patients discontinued d-sotalol therapy because of adverse effects. IV d-sotalol appears to be an effective antiarrhythmic agent. Its long-term efficacy is predictable on the basis of therapy guided by electrophysiologic testing in patients with refractory ventricular tachyarrhythmias. The efficacy of d-sotalol seems comparable to that reported for d,l-sotalol.
为评估d - 索他洛尔的临床疗效，对84例有持续性室性心动过速（VT）或室颤（VF）病史、在基线电生理研究（EPS）时可诱发出持续性VT/VF的患者，在静脉注射（IV）d - 索他洛尔（1.5 - 2.5 mg·kg⁻¹）后进行了研究。另有29例患者仅接受口服d - 索他洛尔（400 - 600 mg·日⁻¹）治疗。抗心律失常治疗的急性成功定义为可诱发性持续性VT/VF受到抑制。静脉注射d - 索他洛尔的总体成功率为38%（32/84），平均有4.3种药物未能抑制诱发性。在接受口服d - 索他洛尔评估的患者中成功率为78%（31/40）。1例患者出现尖端扭转型室性心动过速。1年后，EPS阳性的患者复发率仅为16%，而EPS阴性的患者复发率为43%（P < 0.05）。随访1年和2年后的估计生存率分别为95%和88%。56例患者中只有5例因不良反应停用d - 索他洛尔治疗。静脉注射d - 索他洛尔似乎是一种有效的抗心律失常药物。在难治性室性快速心律失常患者中，基于电生理测试指导的治疗，其长期疗效是可预测的。d - 索他洛尔的疗效似乎与报道的d，l - 索他洛尔相当。
