Böcker D, Haverkamp W, Block M, Borggrefe M, Hammel D, Breithardt G
Westfälische Wilhelms-University, Department of Cardiology, Münster, Germany.
Circulation. 1996 Jul 15;94(2):151-7. doi: 10.1161/01.cir.94.2.151.
Implantable cardioverter-defibrillators (ICDs) and d,l-sotalol are widely used to treat ventricular tachyarrhythmia and ventricular fibrillation (VT/VF). The purpose of this study was to compare the long-term efficacy of d,l-sotalol and ICDs in patients with coronary artery disease.
In a case-control study, 50 patients treated with oral d,l-sotalol were matched to 50 patients treated with ICDs. Both groups were matched for sex (82 men), age (58 +/- 10 years), ejection fraction (40 +/- 12%), extent of coronary artery disease, presenting arrhythmia, and year that treatment began. In all patients in the sotalol group, VT/VF was inducible in the drug-free electrophysiological study. Induction of sustained VT/VF was suppressed by d,l-sotalol (438 +/- 95 mg/d). In the ICD group, either VT/VF was not inducible (n = 5) or inducible sustained VT/VF was refractory to antiarrhythmic drug treatment (n = 45). Sotalol treatment led to a marked reduction in arrhythmic events. Whereas 83% of the patients in the sotalol group were free of sudden death and nonfatal VT at 3 years, only 33% of the ICD patients did not receive appropriate ICD therapies (P < .005). Actuarial rates for absence of sudden death at 3 years were 85% in the sotalol group and 100% in the ICD group (P < .005). Actuarial rates for overall survival at 3 years were 75% in the sotalol group and 85% in the ICD group (P = .02).
In this case-control study, ICD therapy was more effective tha electrophysiologically guided antiar-rhythmic treatment with d,l-sotalol in prevention of sudden death and reduction of total morality in patients with coronary artery disease. Prospective studies are needed to confirm these results.
植入式心脏转复除颤器（ICD）和 d，l - 索他洛尔被广泛用于治疗室性快速心律失常和心室颤动（VT/VF）。本研究的目的是比较 d，l - 索他洛尔和 ICD 对冠心病患者的长期疗效。
在一项病例对照研究中，50 例接受口服 d，l - 索他洛尔治疗的患者与 50 例接受 ICD 治疗的患者进行匹配。两组在性别（82 名男性）、年龄（58±10 岁）、射血分数（40±12%）、冠状动脉疾病程度、出现的心律失常以及治疗开始年份方面进行了匹配。在索他洛尔组的所有患者中，在无药物的电生理研究中可诱发 VT/VF。d，l - 索他洛尔（438±95mg/d）可抑制持续性 VT/VF 的诱发。在 ICD 组中，要么 VT/VF 不可诱发（n = 5），要么可诱发的持续性 VT/VF 对抗心律失常药物治疗无效（n = 45）。索他洛尔治疗导致心律失常事件显著减少。索他洛尔组 83%的患者在 3 年时无猝死和非致命性 VT，而 ICD 组只有 33%的患者未接受适当的 ICD 治疗（P <.005）。索他洛尔组 3 年时无猝死的精算率为 85%，ICD 组为 100%（P <.005）。索他洛尔组 3 年时的总生存率精算率为 75%，ICD 组为 85%（P =.02）。
在本病例对照研究中，ICD 治疗在预防冠心病患者猝死和降低总死亡率方面比电生理指导下使用 d，l - 索他洛尔进行抗心律失常治疗更有效。需要进行前瞻性研究来证实这些结果。
