title: Clinical experience with sotalol in the treatment of cardiac arrhythmias.
abstract: The treatment of cardiac arrhythmias has changed over the past several years, as concerns have grown about proarrhythmias and increased mortality associated with certain antiarrhythmic agents. Sotalol, a unique racemic compound with both Class II (beta-blocking) and Class III (repolarization-prolonging) properties, effectively controls life-threatening arrhythmias and has a favorable safety profile, especially when compared with traditional antiarrhythmic drugs. A review of clinical trials demonstrates that sotalol is an effective treatment for premature ventricular complexes, ventricular tachycardia, and ventricular fibrillation. Moreover, it significantly reduces cardiac and all-cause mortality in these patient populations. Although sotalol currently is approved in the United States only for the treatment of life-threatening ventricular arrhythmias, it also is active against several supraventricular arrhythmias. Sotalol is safe and generally well tolerated; most of the adverse effects experienced with its use are related to its beta-blocking activity. However, sotalol has been associated with life-threatening proarrhythmias, including torsades de pointes, but the incidence of this adverse effect is low. Unlike pure Class II agents, sotalol usually is well tolerated in patients with mild-to-moderate left ventricular dysfunction and rarely causes new or worsening congestive heart failure. Sotalol represents an advance in the treatment and prevention of symptomatic ventricular arrhythmias and appears to be a reasonable first-line choice when the arrhythmia is life threatening.
authors.affiliation: Arnold & Marie Schwartz College of Pharmacy and Health Sciences, Long Island University, Brooklyn, New York.
authors.forename: H L
authors.initials: HL
authors.lastname: Kirschenbaum
authors.forename: J M
authors.initials: JM
authors.lastname: Rosenberg
mesh_terms: D000818:Animals; D001145:Arrhythmias, Cardiac / Q000188:drug therapy*; D006801:Humans; D013015:Sotalol / Q000009:adverse effects / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use*
chemical_list: D013015:Sotalol