Comparison of sotalol with amiodarone for long-term treatment of spontaneous sustained ventricular tachyarrhythmia based on coronary artery disease

Kovoor, Pramesh; Eipper, Vicki; Cooper, Mark J.; Uther, John B.; Ross, David L.

doi:10.1053/euhj.1998.1279

Cited by 21 publications

(17 citation statements)

References 52 publications

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“…The lower rate of withdrawals during long-term follow-up in dofetilidetreated patients compared with sotalol strongly supports the clinical usefulness of this new drug. The limitations of sotalol with regard to tolerability have also been stressed by other studies [26,37] where a high rate of sotalol discontinuations (33% at 1 year) [26] or crossover to other treatments (27% within 3 months of treatment) [37] were found. The management of sustained ventricular tachyarrhythmias has been affected by the results of a prospective randomized trial, AVID [4] , demonstrating that, among survivors of ventricular fibrillation or in patients with sustained ventricular tachycardia causing severe symptoms, the implantable cardioverter-defibrillator is superior to amiodarone or sotalol for increasing overall survival.…”

Section: Discussionmentioning

confidence: 79%

A multicentre, double-blind randomized crossover comparative study on the efficacy and safety of dofetilide vs sotalol in patients with inducible sustained ventricular tachycardia and ischaemic heart disease

Boriani

Lubiński²,

Capucci³

et al. 2001

European Heart Journal

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Background Antiarrhythmic drugs are still used for the treatment of ventricular tachyarrhythmias, in combination with implantable cardioverter-defibrillators or without them.Aim of the study In a double-blind randomized crossover design, the short-and long-term efficacy and safety of oral dofetilide or oral sotalol were compared in 135 patients with ischaemic heart disease and inducible sustained ventricular tachycardia. MethodsThe inducibility of ventricular tachycardia was determined by programmed electrophysiological stimulation at baseline. Patients were then blindly randomized to receive either oral dofetilide 500 g twice daily or oral sotalol 160 mg twice daily, for 3 to 5 days. Suppression of inducible ventricular tachycardia on the drug was then assessed by programmed electrophysiological stimulation. After a wash-out period of at least 2·5 days, the patients received the alternative treatment for 3 to 5 days. Suppression of inducible ventricular tachycardia on the alternate drug was again determined by programmed electrophysiological stimulation. Selection of long-term treatment was allocated blindly according to programmed electrophysiological stimulation results.Results During the acute phase, 128 patients received both dofetilide and sotalol. Sixty-seven patients were responders to either drug. Forty-six patients (35·9%) were responders to dofetilide compared with 43 (33·6%) to sotalol (P=ns). Only 23 patients responded to both dofetilide and sotalol. Adverse events, deemed to be treatment related, were seen in 2·3% of patients receiving dofetilide and 8·6% of patients receiving sotalol (P=0·016). Three patients on dofetilide had torsade de pointes. Two patients receiving sotalol died during the acute phase (one was arrhythmic death, and the other was due to heart failure). During the long-term phase, two of 42 patients (4·8%) receiving dofetilide and three of 27 patients (11·1%) receiving sotalol withdrew from treatment due to lack of efficacy. Overall, during the long-term phase, 23·8% of the patients receiving dofetilide and 37·0% of the patients receiving sotalol, withdrew from treatment with a similar pattern of withdrawals for the two drugs.Conclusion Dofetilide was as efficacious as sotalol in preventing the induction of sustained ventricular tachycardia. There was no concordance in the response rate in two-thirds of the patients. Dofetilide was significantly better tolerated during the acute phase than sotalol. Both dofetilide and sotalol were well tolerated during the long term with no statistically significant difference in the adverse events.

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Section: Discussionmentioning

confidence: 79%

A multicentre, double-blind randomized crossover comparative study on the efficacy and safety of dofetilide vs sotalol in patients with inducible sustained ventricular tachycardia and ischaemic heart disease

Boriani

Lubiński²,

Capucci³

et al. 2001

European Heart Journal

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“…34 Two patients were excluded from an included study 43 because the individuals had been enrolled and described in another included study. 2 One study 45 was excluded because the results had been previously described.…”

Section: Resultsmentioning

confidence: 99%

“…9,[26][27][28][36][37][38]42,43,47,49,50 One of the primary authors of each of these studies was contacted for clarification. Close clinical monitoring was described in association with IV sotalol infusion in all of these studies, and in 11 studies the infusion was performed in the electrophysiology lab.…”

Section: 51mentioning

confidence: 99%

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Meta‐analysis of the Risk of Torsades de Pointes in Patients Treated with Intravenous Racemic Sotalol

Marill

Runge

2001

Academic Emergency Medicine

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Abstract. Objective: Intravenous (IV) racemic sotalol is useful for the treatment of multiple tachydysrhythmias. The authors hypothesized that the risk of torsades de pointes (TdP) in patients treated with a single IV infusion of sotalol is lower than the 2-4% risk associated with chronic oral sotalol therapy. Methods: A MEDLINE search under the subject heading ''sotalol'' was made of all publications involving humans written in English or German from 1966 to October 1, 2000. A meta-analysis of all original reports including patients who were given a single infusion of at least 1.5 mg/kg or 100 mg of IV sotalol over 30 minutes or less was performed. Potential variables predictive of TdP were assessed. The primary outcome was the observation of TdP associated with IV sotalol infusion. Secondary measurements included hypotension, bradycardia, and worsening of congestive heart failure. All excluded studies and case reports were also examined for evidence of TdP associated with IV sotalol treatment. Results: The search included 1,005 publications. There were 37 reports in which 962 patients received IV sotalol and met the inclusion criteria. There was one report of self-terminating TdP lasting 10 seconds among the 962 patients included in the study. There was no report of TdP associated with only IV racemic sotalol administration in any of the excluded studies. If it is assumed that the risk of TdP is homogeneous in the population of patients treated with IV sotalol, then based on the 962 included patients, the rate of TdP is 0.1% (95% CI = 0.003% to 0.6%). Conclusions: The overall risk of TdP in patients treated with a single infusion of IV sotalol is low compared with that in patients given chronic oral sotalol therapy.

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“…The first study reported no significant difference in efficacy between the two drugs [22]. The second study, however, which compared sotalol with amiodarone for long-term treatment of ventricular tachyarrhythmia secondary to coronary artery disease (when both drugs had been predicted to be ineffective on electrophysiologic testing), found sotalol to be superior to amiodarone [23]. At 36 months, 75% of patients on sotalol were free of arrhythmia recurrence, as compared with only 38% of those allocated to amiodarone (sotalol dose was 160 mg twice daily, and amiodarone dose was 800 mg loading followed by 400 mg daily).…”

Section: Role Of Drugsmentioning

confidence: 99%

Are drugs and catheter ablation effective for treating ventricular arrhythmias in populations that cannot afford implantable cardioverter defibrillators?

Naik

Juneja

2001

Curr Cardiol Rep

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Despite recent advances, ventricular arrhythmias continue to pose a therapeutic challenge, especially to the clinician in the developing world. Although the implantable cardioverter defibrillator (ICD) has improved survival in both primary and secondary prevention trials, it still remains a costly modality for the developing world. Even though certain subgroups stand to benefit unequivocally in survival from the ICD, there are others in whom this therapy may not offer a survival benefit over empiric antiarrhythmic drug therapy with amiodarone. The utility of optimized drug therapy (including either amiodarone or sotalol, b-blockers, and angiotensin-converting enzyme inhibitors) needs to be compared with the ICD in a randomized manner in these lower-risk patients with ventricular arrhythmias. The role of conventional catheter ablation techniques is mostly adjunctive to drugs and ICDs, although the newer mapping and ablation techniques may offer greater promise in the future.

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Comparison of sotalol with amiodarone for long-term treatment of spontaneous sustained ventricular tachyarrhythmia based on coronary artery disease

Cited by 21 publications

References 52 publications

A multicentre, double-blind randomized crossover comparative study on the efficacy and safety of dofetilide vs sotalol in patients with inducible sustained ventricular tachycardia and ischaemic heart disease

A multicentre, double-blind randomized crossover comparative study on the efficacy and safety of dofetilide vs sotalol in patients with inducible sustained ventricular tachycardia and ischaemic heart disease

Meta‐analysis of the Risk of Torsades de Pointes in Patients Treated with Intravenous Racemic Sotalol

Are drugs and catheter ablation effective for treating ventricular arrhythmias in populations that cannot afford implantable cardioverter defibrillators?

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