The efficacy and safety of
sotalol therapy for ventricular arrhythmias was evaluated in 133 patients with
drug-refractory ventricular arrhythmias. All patients had baseline electrophysiologic studies before and after oral
sotalol therapy. Sixty-six patients were discharged home, treated with
sotalol (52 patients without inducible
ventricular tachycardia or fibrillation and 14 patients with hemodynamically stable inducible
ventricular tachycardia). The mean follow-up period was 41 +/- 27 months for the 14 patients with hemodynamically stable
ventricular tachycardia.
Sotalol was effective in 8 of these 14 patients. Recurrent nonlethal
ventricular tachycardia occurred in 3 patients; 2 patients had
sudden death; and 1 patient had adverse side effects. The 52 patients without inducible
ventricular tachycardia were followed up for a mean period of 36 +/- 30 months. Thirty-five of 52 patients were successfully treated. Two patients had recurrent
ventricular tachycardia; both of these episodes of
ventricular tachycardia occurred within the first year. Four patients had
sudden cardiac death; three of these deaths occurred within the first month, and the last episode of
sudden death occurred after 8 years of
sotalol therapy. The actuarial incidence of
sotalol efficacy was 76% at 1 year, 72% at 2 years, 64% at 4 years, and 52% at 5 years. Approximately 46% of patients receiving long-term
sotalol treatment reported side effects. Side effects severe enough to warrant withdrawal of
sotalol occurred in 7 (11%) patients. The results of our study suggest that
sotalol is effective for selected patients with
drug refractory ventricular arrhythmias. Although the incidence of side effects are high, patients appear to tolerate long-term
sotalol therapy well.