The short- and long-term efficacies of various antiarrhythmic agents were retrospectively and prospectively analyzed in 81 patients (mean age, 39 +/- 14 years; range, 16-68 years; 61.7% males) with arrhythmogenic right ventricular disease. In 42 patients with inducible
ventricular tachycardia during programmed ventricular stimulation, the following efficacy rates were obtained: class Ia and Ib drugs (n = 18), 5.6%; class Ic drugs (n = 25), 12%; beta-blockers (n = 8), 0%;
sotalol (n = 38), 68.4%;
amiodarone (n = 13), 15.4%;
verapamil (n = 5), 0%; and
drug combinations (n = 26), 15.4%. Only one of the 10 patients not responding to
sotalol was treated effectively by
amiodarone, whereas the remaining nine patients proved to be
drug refractory toward all other drugs tested (3.8 +/- 2.3 drugs, including
amiodarone in five cases) and underwent nonpharmacological
therapy. During a follow-up of 34 +/- 25 months, three of the 31 patients (9.7%) discharged on pharmacological
therapy had nonfatal recurrences of
ventricular tachycardia after 0.5, 51, and 63 months, respectively. In 39 patients with noninducible
ventricular tachycardia during programmed ventricular stimulation, the following efficacy rates were observed: class Ia and Ib drugs (n = 16), 0%; class Ic agents (n = 23), 17.4%; beta-blockers (n = 7), 28.6%;
sotalol (n = 35), 82.8%;
amiodarone (n = 4), 25%;
verapamil (n = 24), 50%; and
drug combinations (n = 11), 9.1%. During a follow-up of 14 +/- 13 months, four of 33 patients (12.1%) discharged on
antiarrhythmic drugs had nonfatal relapses of their clinical ventricular
arrhythmia.
CONCLUSIONS: Thus, in arrhythmogenic right ventricular disease,
sotalol proved to be highly effective in patients with inducible as well as noninducible
ventricular tachycardia. Patients with inducible
ventricular tachycardia not responding to
sotalol are likely to not respond to other
antiarrhythmic drugs and should be considered for nonpharmacological
therapy without further
drug testing.
Amiodarone did not prove to be more effective than
sotalol and may not be an alternative because of frequent side effects during long-term
therapy, especially in young patients.
Verapamil and beta-blockers were effective in a considerable number of patients with noninducible
ventricular tachycardia and may be a therapeutic alternative in this subgroup. Class I agents appear to be rarely effective in the treatment of both inducible and noninducible
ventricular tachycardia in arrhythmogenic right ventricular disease.