[Combination of sotalol with the class I B substances mexiletine or tocainide in complex ventricular extrasystole]

In 34 patients with ventricular tachyarrhythmias the effect of the antiarrhythmic therapy of sotalol (160-320 mg p.o.) in combination with the type-I-B-agent mexiletine (600-800 mg p.o.) or tocainide (800-1200 mg p.o.) was studied by Holter monitoring. In all patients 2.2 +/- 1.1 drugs trials had failed, including amiodarone in 8 patients and beta blocking substances in 15 patients. The combination of sotalol with mexiletine or tocainide reduced ventricular ectopic beats by 79% and complex ventricular arrhythmias (pairs and salvoes) by 85%. A significant reduction of ventricular ectopic beats (greater than 80%) was reached in 74% of the patients, of pairs and salvoes (greater than 90%) in 79%. There was no difference in the antiarrhythmic efficacy between the combination of sotalol/mexiletine and sotalol/tocainide. Intervals of the resting ECG or laboratory values did not change significantly. In 5 patients with sotalol/tocainide and 1 patient with sotalol/mexiletine, side effects were observed which necessitated discontinuation of the treatment. The results show that sotalol, in combination with mexiletine or tocainide, has a potent antiarrhythmic effect in patients with otherwise drug-refractory ventricular arrhythmias.