Cardiovascular Drugs and Therapy

, Volume 9, Issue 3, pp 437–443 | Cite as

Long-term antiarrhythmic efficacy and safety of d-sotalol in patients with ventricular tachycardia and a low ejection fraction

  • K. T. Koch
  • D. R. Düren
  • P. A. van Zwieten


Since in patients with ventricular tachycardia (VT) and compromised left ventricular function, antiarrhythmic therapy poses a particular problem, an open-label safety study of d-sotalol, a new class III antiarrhythmic agent, was performed. Thirteen patients with defined VT and a low left ventricular ejection fraction (LVEF) were treated with orally administered d-sotalol, 100 mg bid, and in a few patients 100 mg tid, in an open study. Patients were followed up for 35±11 months, with the longest follow-up amounting to 51 months. The data obtained suggest that d-sotalol was moderately effective as an antiarrhythmic agent, in particular with respect to premature ventricular contractions (PVCs) and coupled and repetitive PVCs. The beneficial effect appeared to persist on long-term treatment. d-Sotalol was well tolerated and no subjective or objective adverse reactions were observed. There were no signs of worsening of congestive heart failure, proarrhythmogenic activity, or torsades de pointes, although QT-prolongation was observed. There were no dropouts in the study. Two patients died: One patient with idiopathic dilated cardiomyopathy (with LVEF=11%) died suddenly after 38 months of follow-up and one patient after 17 months from recurrent myocardial infarction. Neither of these had shown recurrence of VT on 24 hour ambulatory ECG recordings. In conclusion, in this small group of patients d-sotalol appeared to be safe and well tolerated during long-term treatment of patients with VT and poor left ventricular function. There were clear suggestions of antiarrhythmic activity, reflected by the suppression of complex ventricular arrhythmias and by the absence of recurrent VT on long-term follow-up in the majority of patients. These results would encourage a larger, formal trial on the use of d-sotalol in this type of patients,.

Key Words

d-sotalol ventricular tachycardia heart failure antiarrhythmic treatment 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Hammermeister KE. Adverse hemodynamic effects of antiarrhythmic drugs in congestive heart failure.Circulation 1990;81:1151–1153.Google Scholar
  2. 2.
    Singh BN. Amiodarone: Historical development and pharmacologic profile.Am Heart J 1983;106:788–797.Google Scholar
  3. 3.
    Singh BN, Nademanee K. Amiodarone and thyroid function: Clinical implications during antiarrhythmic therapy.Am Heart J 1983;106:857–859.Google Scholar
  4. 4.
    Singh BN, Nademanee K. Sotalol, a beta-blocker with unique antiarrhythmic properties.Am Heart J 1987;114:121–139.Google Scholar
  5. 5.
    Singh BN, Deedwania P, Nademanee K, Weud A, Sorkin EM. Sotalol. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic use.Drugs 1987;34:311–349.Google Scholar
  6. 6.
    Ruder MA, Ellis T, Lebsack C, Mead RH, Smith NA, Winkle RA. Clinical experience with sotalol in patients with drug-refractory ventricular arrhythmias.J Am Coll Cardiol 1989;13:145–152.Google Scholar
  7. 7.
    Petzl DH, Probst P, Glogar D, Schuster E. The effect of sotalol on exercise-induced ventricular arrhythmias.Eur Heart J 1988;9:265–270.Google Scholar
  8. 8.
    Ramsdale DR, Llewellyn MJ, Pidgeon J, Faragher EB, Charles RB. Effects of intravenous sotalol on the Q-T interval and incidence of ventricular arrhythmias early in acute myocardial infarction.Am J Noninv Cardiol 1988;2:52–58.Google Scholar
  9. 9.
    Hohnloser SH, Woosley RL. Sotalol.N Engl J Med 1994;331:31–38.Google Scholar
  10. 10.
    Brachmann J, Schöls W, Schmitt C, Waldecker B, Wöhrnschimmel E. Refractory sustained ventricular tachycardia: Role of d-sotalol.Circulation 1988;78:60.Google Scholar
  11. 11.
    Brachmann J, Beyer T, Schöls W, et al. Electrophysiologic and antiarrhythmic effects of d-sotalol.J Cardiovasc Pharmacol 1992;20(Suppl 2):S91-S95.Google Scholar
  12. 12.
    Echt DS, Liebson PR, Mitchel LB, et al. Mortality and morbidity in patients receiving encainide, flecainide or placebo: The Cardiac Arrhythmia Suppression Trial.N Engl J Med 1991;324:781–788.Google Scholar
  13. 13.
    Waagstein F, Bristow MR, Swedbey K, et al. Beneficial effects of metoprolol in idiopathic dilated cardiomyopathy.Lancet 1993;342:1441–1446.Google Scholar
  14. 14.
    Katritsis D, Camm AJ. New class III antiarrhythmic drugs.Eur Heart J 1993;14(Suppl H):93–99.Google Scholar
  15. 15.
    Aström M, Edhag O, Nyquist O, Vallin H. Electrophysiological effects of intravenous sotalol in acute myocardial infarction: A double-blind placebo-controlled study.Eur Heart J 1990;11:35–42.Google Scholar
  16. 16.
    Kopelman HA, Woosley L, Lee JT, Roden DM, Echt DS. Electrophysiologic effects of intravenous and oral sotalol for sustained ventricular tachycardia secondary to coronary artery disease.Am J Cardiol 1988;61:1006–1011.Google Scholar
  17. 17.
    Jordaens LJ, Palmer A, Clement D. Low-dose oral sotalol for monomorphic ventricular tachycardia: Effects during programmed electrical stimulation and follow-up.Eur Heart J 1989;10:218–226.Google Scholar
  18. 18.
    Trappe HJ, Klein H, Lichtlen P. Sotolol in patients with life-threatening ventricular tachyarrhythmias.Cardiovas Drugs Ther 1990;4:1425–1432.Google Scholar
  19. 19.
    Amiodarone vs. Sotalol Study Group. Multicentre randomized trial of sotalol vs. amiodarone for chronic malignant ventricular tachyarrhythmias.Eur Heart J 1989;10:685–694.Google Scholar
  20. 20.
    Mason JW, for the ESVEM investigators. A comparison of seven antiarrhythmic drugs in patients with ventricular tachyarrhythmias.N Engl J Med 1993;329:452–458.Google Scholar
  21. 21.
    Tande PM, Refsum H. Class III antiarrhythmic action linked with positive inotropy: Effects of the d- and l-isomer of sotalol on isolated rate atria at threshold and supra threshold stimulation.Pharmacol Toxicol 1988;62:272–277.Google Scholar
  22. 22.
    Carmeliet E. Electrophysiologic and voltage clamp analysis of the effects of sotalol on isolated cardiac muscle and Purkinji fibers.J Pharmacol Exp Ther 1985;232:817–821.Google Scholar
  23. 23.
    Gomoll AW, Bartek MJ. Comparative β-blocking activities and electrophysiologic actions of racemic sotalol and its optical isomers in anesthetized dogs.Eur J Pharmacol 1986;132:123–135.Google Scholar
  24. 24.
    Kwan YW, Solca AM, Qwilt M, Kane A, Wadsworth RM. Comparative antifibrillatory effects of d- and dl-sotalol in normal and ischemic ventricular muscle of the cat.J Cardiovasc Pharmacol 1990;15:233–238.Google Scholar
  25. 25.
    Hoffmeister HM, Beyer M, Spiel L. Hemodynamic effects of d- and l-isomers of sotalol on normal myocardium.Cardiovasc Drugs Ther 1991;5:1027–1033.Google Scholar
  26. 26.
    Soyka LF, Wirtz C, Spangenberg ZRB. Clinical safety profile of sotalol in patients with arrhythmias.Am J Cardiol 1990;65(Suppl):74A-81A.Google Scholar
  27. 27.
    Cohn JM, Archibald DG, Francis GS. Veterans Administration Cooperative Study on vasodilator therapy of heart failure: Influence of prerandomisation variable on the reduction of mortality by treatment with hydralazine and isosorbide dinitrate.Circulation 1987;75(Suppl IV):IV-49.Google Scholar
  28. 28.
    Mason JW. A comparison of electrophysiologic testing with Holter monitoring to predict antiarrhythmic drug efficacy for ventricular tachyarrhythmias.N Engl J Med 1993;329:445–451.Google Scholar

Copyright information

© Kluwer Academic Publishers 1995

Authors and Affiliations

  • K. T. Koch
    • 1
    • 2
  • D. R. Düren
    • 1
    • 2
  • P. A. van Zwieten
    • 1
    • 2
  1. 1.Department of Cardiology, Academic Medical CenterUniversity of AmsterdamAmsterdamThe Netherlands
  2. 2.Dept. of Pharmacotherapy, Pharmacology and Cardiology, Academic Medical CenterUniversity of AmsterdamAmsterdamThe Netherlands

Personalised recommendations