The efficacy of intravenous
sotalol (1 mg/kg) for suppressing inducibility of
supraventricular tachycardias (SVT) with different electrophysiologic mechanisms was studied in 30 consecutive patients referred for an electrophysiologic study because of paroxysmal SVT. Orthodromic SVT using accessory atrioventricular (AV) connection was inducible in 14 patients, AV nodal reentrant SVT in 8, and intraatrial SVT in 8 before administration of
sotalol, Isometric handgrip exercise facilitated the inducibility of SVT in 8 patients who were noninducible at rest. After intravenous
sotalol, 7 of 14 patients (50%) with orthodromic SVT, 8 of 8 (100%) with AV nodal reentrant SVT, and 8 of 8 (100%) with intraatrial reentrant SVT became noninducible into sustained SVT, Isometric exercise facilitated the inducibility of only 3 nonsustained SVT runs after
sotalol infusion, and exercise did not reverse the prolongation of refractory periods of the atrium, AV node, accessory pathway and ventricle caused by
sotalol. During a mean follow-up period of 18 +/- 7 months, none of the 14 patients who remained noninducible into sustained SVT during the stress test after intravenous
sotalol and tolerated long-term oral
sotalol therapy had recurrence of symptomatic SVT. Thus,
sotalol is efficacious for suppressing SVT with AV nodal or intraatrial reentrant mechanism, but less efficacious in patients with accessory AV pathway. The beta-blocking and cellular antiarrhythmic effects of
sotalol are not significantly reversed by exercise.