Effect of dl-sotalol on mortality and recurrence of ventricular tachyarrhythmias: ischemic compared to nonischemic cardiomyopathy.
OBJECTIVE
We compared the effectiveness of sotalol on mortality and the recurrence of ventricular tachyarrhythmia (VTA) between idiopathic dilated cardiomyopathy (IDCM) and coronary artery disease (CAD).


METHODS
Forty patients with spontaneous VTA and induced VTA associated with CAD (n = 23) and IDCM (n = 17) were studied. In all patients, sotalol was prescribed and an electrophysiologic study (EPS) was performed to evaluate its effect on the induction of VTA. There were no significant differences in left ventricular ejection fraction (LVEF) between CAD and IDCM (35%+/- 10% vs. 35%+/- 12%).


RESULTS
After sotalol, there were no significant differences in the QTc interval on electrocardiogram (ECG) or in the effective refractory period in the apex of the right ventricle between the two groups, but sotalol was more effective in preventing the induction of VTA in CAD than in IDCM (65% vs. 29%; P < 0.05). During a mean follow-up period of 47 +/- 27 months, the overall VTA recurrence rate was significantly lower in CAD than in IDCM (P < 0.01). The all-cause mortality rate tended to be lower in CAD than in IDCM, but the difference was not significant (P = 0.07). Electrical storm (ES) occurred more frequently in IDCM than in CAD, (41% vs. 13%; P < 0.05), and all patients with ES (n = 10) failed to respond to sotalol as assessed by EPS.


CONCLUSIONS
Sotalol reduced the overall VTA recurrence rate and all-cause mortality more in CAD than in IDCM.
Furushima
Hiroshi
H
First Department of Internal Medicine, Niigata University School of Medicine, Niigata 951-8510, Japan. chimiri@med.niigata-u.ac.jp
Chinushi
Masaomi
M
Okamura
Kazuki
K
Komura
Satoru
S
Tanabe
Yasutaka
Y
Sato
Akinori
A
Izumi
Daisuke
D
Aizawa
Yoshifusa
Y
D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D009202:Cardiomyopathies / Q000401:mortality* / Q000517:prevention & control*; D015897:Comorbidity; D005260:Female; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000401:mortality* / Q000517:prevention & control*; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D055502:Secondary Prevention; D013015:Sotalol / Q000627:therapeutic use*; D016019:Survival Analysis; D015996:Survival Rate; D017180:Tachycardia, Ventricular / Q000401:mortality* / Q000517:prevention & control*; D016896:Treatment Outcome
D000889:Anti-Arrhythmia Agents; D013015:Sotalol