No abstract

Three shocks of 2 joules (2,000 volts within 0.3 msec) were given to a patient with ventricular tachycardia of right ventricular origin at the site of the earliest activation. A standard 6 Fr USCI mapping catheter was used. After the first shock the cycle length prolonged from 385 to 531 msec. After the second shock, the tachycardia was no longer inducible and it remained so after 1 week. No recurrences were seen during a follow-up period of 8 months. This is the first report demonstrating efficacy of modified low energy shocks for ventricular tachycardia.

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.