title: Electrophysiologic study-guided therapy with sotalol for life-threatening ventricular tachyarrhythmias.
abstract: The aim of this study was to investigate the long-term efficacy and safety of electrophysiologic study (EPS)-guided sotalol administration combined with implantable cardioverter defibrillators (ICD) for ventricular tachyarrhythmias (VTA). This study enrolled 92 patients with both structural heart disease and sustained VTA. Sotalol was administered to 57 patients, and its efficacy was assessed by EPS. Long-term treatment was continued in combination with ICD in 31 patients (57%) whose VTA was no longer inducible (responder group) and in 16 patients whose VTA remained inducible (nonresponder group). The long-term outcomes were compared among the responder group, the nonresponder group, and 35 ICD recipients untreated with antiarrhythmic drugs (ICD-only group). During a mean follow-up of 44 +/- 33 months, the recurrence of VTA was not significantly different between all patients treated with sotalol (30%) and patients in the ICD-only group (46%). However, the recurrence of VTA was significantly lower in the responder (13%) than in the nonresponder (63%) or the ICD-only groups (46%). There was no significant difference in VTA recurrence between the nonresponder and the ICD-only groups. One patient each in the responder and the ICD-only groups died suddenly, and all-cause mortality was similar in the three groups. The incidence of inappropriate ICD discharges was less in the sotalol than in the ICD-only groups. No patient had to discontinue long-term sotalol treatment because of the adverse effects. In conclusion, sotalol reduced VTA recurrence in the responding patients and inappropriate ICD discharge. EPS may predict the efficacy of sotalol for VTA recurrence.
authors.affiliation: Division of Cardiology and School of Health Sciences, Niigata University Graduate School of Medical and Dental Science, 1-754 Asahimachidori, Niigata 951-8510, Japan. hiroshi7@med.niigata-u.ac.jp
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Watanabe
authors.forename: Masaomi
authors.initials: M
authors.lastname: Chinushi
authors.forename: Takashi
authors.initials: T
authors.lastname: Washizuka
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Sugiura
authors.forename: Takashi
authors.initials: T
authors.lastname: Hirono
authors.forename: Satoru
authors.initials: S
authors.lastname: Komura
authors.forename: Yukio
authors.initials: Y
authors.lastname: Hosaka
authors.forename: Yasutaka
authors.initials: Y
authors.lastname: Tanabe
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Furushima
authors.forename: Satoshi
authors.initials: S
authors.lastname: Fujita
authors.forename: Kiminori
authors.initials: K
authors.lastname: Kato
authors.forename: Yoshifusa
authors.initials: Y
authors.lastname: Aizawa
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D000889:Anti-Arrhythmia Agents; D016009:Chi-Square Distribution; D017147:Defibrillators, Implantable; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D013015:Sotalol / Q000008:administration & dosage / Q000627:therapeutic use*; D017180:Tachycardia, Ventricular / Q000188:drug therapy* / Q000503:physiopathology / Q000517:prevention & control; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents; D013015:Sotalol