Low-dose oral sotalol for monomorphic ventricular tachycardia: effects during programmed electrical stimulation and...

The effects of oral sotalol were compared with the findings obtained in the baseline study of a group of 26 consecutive patients with sustained monomorphic ventricular tachycardia or ventricular fibrillation and inducible ventricular tachycardia. The mean age was 62 years and the mean ejection fraction 33%. The number of non-inducible patients after sotalol administration (mean dose of 251 +/- 81 mg day-1) was 13 out of 21 (62%). The cycle length of the induced tachycardia changed from 293 +/- 32 to 303 +/- 41 ms (non-significant (NS]. The coupling interval of the first extrastimulus did not lengthen for the subgroup with persistent inducibility. The number of patients requiring defibrillation during the induction study did not decrease on (2/8) or off drugs (6/22). After the first administration of oral sotalol, two patients developed polymorphic ventricular tachycardia or torsade de pointes and one suffered from left ventricular failure. Long-term treatment with sotalol was given to 15 non-inducible patients, and two inducible patients, combined with an AICD or a pacemaker. Over a mean follow-up period of 13 months, three recurrences were observed in these 17 patients, including the patient with the AICD. This represents an efficacy of 82% for patients chronically treated with a low dose of oral sotalol.