Kühlkamp V, Mewis C, Mermi J, Bosch R F, Seipel L
Eberhard-Karls-University, Medical Department III, Tübingen, Germany.
J Am Coll Cardiol. 1999 Jan;33(1):46-52. doi: 10.1016/s0735-1097(98)00521-x.
This study evaluates the clinical efficacy of d,l-sotalol in patients with sustained ventricular tachyarrhythmias.
D,l-sotalol is an important antiarrhythmic agent to prevent recurrences of sustained ventricular tachyarrhythmias (VT/VF). However, evidence is lacking that an antiarrhythmic agent like d,l-sotalol can reduce the incidence of sustained ventricular tachyarrhythmias in comparison to no antiarrhythmic drug treatment.
A prospective study was performed in 146 consecutive patients with inducible sustained ventricular tachycardia or ventricular fibrillation. In 53 patients, oral d,l-sotalol prevented induction of VT/VF during electrophysiological testing and patients were discharged on oral d,l-sotalol (sotalol group). In 93 patients, VT/VF remained inducible and a defibrillator (ICD) was implanted. After implantation of the device patients were randomly assigned to oral treatment with d,l-sotalol (ICD/sotalol group, n=46) or no antiarrhythmic medication (n=47, ICD-only group).
During follow-up, 25 patients (53.2%) in the ICD-only group had a VT/VF recurrence in comparison to 15 patients (28.3%) in the sotalol group and 15 patients (32.6%) in the ICD/sotalol group (p=0.0013). Therapy with d,l-sotalol, amiodarone or metoprolol was instituted in 12 patients (25.5%) of the ICD-only group due to frequent VT/VF recurrences or symptomatic supraventricular tachyarrhythmias. In nine patients, 17% of the sotalol group, an ICD was implanted after VT/VF recurrence, three patients (5.7%) received amiodarone. Total mortality was not different between the three groups.
D,l-sotalol significantly reduces the incidence of recurrences of sustained ventricular tachyarrhythmias in comparison to no antiarrhythmic drug treatment.
本研究评估消旋索他洛尔对持续性室性心律失常患者的临床疗效。
消旋索他洛尔是预防持续性室性心律失常（室速/室颤）复发的一种重要抗心律失常药物。然而，尚无证据表明像消旋索他洛尔这样的抗心律失常药物与不使用抗心律失常药物治疗相比，能降低持续性室性心律失常的发生率。
对146例连续的可诱发性持续性室性心动过速或室颤患者进行了一项前瞻性研究。53例患者口服消旋索他洛尔后在电生理检查期间未诱发出室速/室颤，这些患者出院时继续口服消旋索他洛尔（索他洛尔组）。93例患者室速/室颤仍可诱发，植入了除颤器（ICD）。植入该装置后，患者被随机分配接受口服消旋索他洛尔治疗（ICD/索他洛尔组，n = 46）或不使用抗心律失常药物（n = 47，单纯ICD组）。
随访期间，单纯ICD组有25例患者（53.2%）发生室速/室颤复发，而索他洛尔组有15例患者（28.3%），ICD/索他洛尔组有15例患者（32.6%）（p = 0.0013）。由于频繁的室速/室颤复发或有症状的室上性心律失常，单纯ICD组12例患者（25.5%）接受了消旋索他洛尔、胺碘酮或美托洛尔治疗。索他洛尔组9例患者（17%）在室速/室颤复发后植入了ICD，3例患者（5.7%）接受了胺碘酮治疗。三组的总死亡率无差异。
与不使用抗心律失常药物治疗相比，消旋索他洛尔能显著降低持续性室性心律失常的复发率。
