The efficacy of d/l
sotalol was investigated in 50 patients (43 men, seven women; 33 with
coronary artery disease, 15 with
dilated cardiomyopathy; ejection fraction 33 +/- 10%) with inducible sustained
ventricular tachycardia. Before d/l
sotalol a mean of 2 +/- 1 (1 to 4) class I
antiarrhythmic drugs were ineffective. In 24 patients (48%) oral d/l
sotalol (320 +/- 47 mg.day-1) prevented induction of the
ventricular tachycardia; in 23 patients the
ventricular tachycardia remained inducible (d/l
sotalol 326 +/- 50 mg.day-1). The electrophysiological effects of d/l
sotalol did not differ between patients in whom d/l
sotalol prevented induction of
ventricular tachycardia and those in whom the
ventricular tachycardia remained inducible. In two patients, torsade des pointes developed after oral application of d/l
sotalol; one patient suffered from severe
hypotension even with 80 mg of
sotalol per day. During long-term follow-up (27 +/- 12 months) 5/24 patients (21%) had a non-fatal recurrence of
ventricular tachycardia (1 week to 21 months), one patient died suddenly and another from progressive
heart failure. In patients in whom the
ventricular tachycardia could be induced despite oral application of d/l
sotalol, control of the
ventricular tachyarrhythmia was attempted by the use of
sotalol in combination with
mexiletine (n = 2),
amiodarone (n = 9),
catheter ablation (n = 2), antitachycardia surgery (n = 1) or the implantation of an automatic cardioverter
defibrillator (n = 12). Recurrence of
ventricular tachycardia was observed in four patients without an implanted cardioverter
defibrillator. Seven out of 12 patients with an implanted cardioverter
defibrillator received appropriate shocks or successful antitachycardia pacing. Although no patient died suddenly, overall mortality was 17% in this group. It is concluded that d/l
sotalol is highly effective in the suppression of sustained monomorphic
ventricular tachycardia inducible by programmed electrical stimulation. However during a mean follow-up of 27 +/- 12 months a recurrence of
ventricular tachycardia was seen in 21% of patients, and one patient died suddenly.