This Article Full Text Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Bocker, D. Articles by Breithardt, G. Search for Related Content PubMed PubMed Citation Articles by Bocker, D. Articles by Breithardt, G. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Medline Plus Health Information Pacemakers and Implantable Defibrillators

(Circulation. 1996;94:151-157.)
© 1996 American Heart Association, Inc.

Articles

Comparison of d,l-Sotalol and Implantable Defibrillators for Treatment of Sustained Ventricular Tachycardia or Fibrillation in Patients With Coronary Artery Disease

Dirk Bocker, MD; Wilhelm Haverkamp, MD; Michael Block, MD; Martin Borggrefe, MD; Dieter Hammel, MD; Gunter Breithardt, MD

Westfalische Wilhelms-University, Department of Cardiology, Cardiothoracic Surgery (D.H.), and the Institute for Research in Arteriosclerosis, Munster, Germany.

Correspondence to Dr Dirk Bocker, Universitatsklinik Munster, Innere Medizin C, D-48129 Munster, Germany.

Background Implantable cardioverter-defibrillators (ICDs) and d,l-sotalol are widely used to treat ventricular tachyarrhythmia and ventricular fibrillation (VT/VF). The purpose of this study was to compare the long-term efficacy of d,l-sotalol and ICDs in patients with coronary artery disease.

Methods and Results In a case-control study, 50 patients treated with oral d,l-sotalol were matched to 50 patients treated with ICDs. Both groups were matched for sex (82 men), age (58±10 years), ejection fraction (40±12%), extent of coronary artery disease, presenting arrhythmia, and year that treatment began. In all patients in the sotalol group, VT/VF was inducible in the drug-free electrophysiological study. Induction of sustained VT/VF was suppressed by d,l-sotalol (438±95 mg/d). In the ICD group, either VT/VF was not inducible (n=5) or inducible sustained VT/VF was refractory to antiarrhythmic drug treatment (n=45). Sotalol treatment led to a marked reduction in arrhythmic events. Whereas 83% of the patients in the sotalol group were free of sudden death and nonfatal VT at 3 years, only 33% of the ICD patients did not receive appropriate ICD therapies (P<.005). Actuarial rates for absence of sudden death at 3 years were 85% in the sotalol group and 100% in the ICD group (P<.005). Actuarial rates for overall survival at 3 years were 75% in the sotalol group and 85% in the ICD group (P=.02).

Conclusions In this case-control study, ICD therapy was more effective than electrophysiologically guided antiarrhythmic treatment with d,l-sotalol in prevention of sudden death and reduction of total mortality in patients with coronary artery disease. Prospective studies are needed to confirm these results.

Key Words: tachyarrhythmias • sotalol • defibrillation

This article has been cited by other articles:

				Committee Members, G. Gregoratos, J. Abrams, A. E. Epstein, R. A. Freedman, D. L. Hayes, M. A. Hlatky, R. E. Kerber, G. V. Naccarelli, M. H. Schoenfeld, et al. ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices--Summary Article: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/NASPE Committee to Update the 1998 Pacemaker Guidelines) J. Am. Coll. Cardiol., November 6, 2002; 40(9): 1703 - 1719. [Full Text] [PDF]

				G. Gregoratos, J. Abrams, A. E. Epstein, R. A. Freedman, D. L. Hayes, M. A. Hlatky, R. E. Kerber, G. V. Naccarelli, M. H. Schoenfeld, M. J. Silka, et al. ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices: Summary Article: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/NASPE Committee to Update the 1998 Pacemaker Guidelines) Circulation, October 15, 2002; 106(16): 2145 - 2161. [Full Text] [PDF]

				S.G. Priori, E. Aliot, C. Blomstrom-Lundqvist, L. Bossaert, G. Breithardt, P. Brugada, A.J. Camm, R. Cappato, S.M. Cobbe, C. Di Mario, et al. Task Force on Sudden Cardiac Death of the European Society of Cardiology Eur. Heart J., August 2, 2001; 22(16): 1374 - 1450. [PDF]

				R.N.W. Hauer, E. Aliot, M. Block, A. Capucci, B. Luderitz, M. Santini, and P.E. Vardas Indications for implantable cardioverter defibrillator (ICD) therapy. Study Group on Guidelines on ICDs of the Working Group on Arrhythmias and the Working Group on Cardiac Pacing of the European Society of Cardiology Eur. Heart J., July 1, 2001; 22(13): 1074 - 1081. [PDF]

				R. N. W. Hauer, E. Aliot, M. Block, A. Capucci, B. Luderitz, M. Santini, and P. E. Vardas Indications for implantable cardioverter defibrillator (ICD) therapy: Study Group on Guidelines on ICD of the Working Group on Arrhythmias and the Working Group on Cardiac Pacing of the European Society of Cardiology Europace, January 1, 2001; 3(3): 169 - 176. [PDF]

				G. R. Haddow and M. Neville Anesthetic Implications for Patients With Implantable Cardioverter Defibrillators Seminars in Cardiothoracic and Vascular Anesthesia, September 1, 2000; 4(3): 187 - 195. [Abstract] [PDF]

				Ömeroglu S. N., K. Kirali, M. Guler, M. Erdem Toker, and C. Yakut Midterm angiographic assessment of coronary artery bypass grafting without cardiopulmonary bypass Ann. Thorac. Surg., September 1, 2000; 70(3): 844 - 849. [Abstract] [Full Text] [PDF]

				B Brembilla-Perrot, P Houriez, O Claudon, J-P Preiss, and D Beurrier Predicting the effect of D,L-sotalol on ventricular tachycardia inducibility from the RR variability response Heart, September 1, 1999; 82(3): 307 - 311. [Abstract] [Full Text] [PDF]

				J. J. Goldberger Treatment and Prevention of Sudden Cardiac Death: Effect of Recent Clinical Trials Arch Intern Med, June 28, 1999; 159(12): 1281 - 1287. [Abstract] [Full Text] [PDF]

				V. Kuhlkamp, C. Mewis, J. Mermi, R. F. Bosch, and L. Seipel Suppression of sustained ventricular tachyarrhythmias: a comparison of d,l-sotalol with no antiarrhythmic drug treatment J. Am. Coll. Cardiol., January 1, 1999; 33(1): 46 - 52. [Abstract] [Full Text] [PDF]

				J. R. Elbeery, P. M. Brown, and W. R. Chitwood Jr Intraoperative MIDCABG arteriography via the left radial artery: a comparison with doppler ultrasound for assessment of graft patency Ann. Thorac. Surg., July 1, 1998; 66(1): 51 - 55. [Abstract] [Full Text] [PDF]

				C. H. Selzman, T. A. Whitehill, B. D. Shames, E. J. Pulido, B. C. Cain, and A. H. Harken The Biology of Estrogen-Mediated Repair of Cardiovascular Injury Ann. Thorac. Surg., March 1, 1998; 65(3): 868 - 874. [Abstract] [Full Text] [PDF]

				J. R. Elbeery and W. R. Chitwood Jr Intraoperative Catheterization of the Left Internal Mammary Artery via the Left Radial Artery Ann. Thorac. Surg., December 1, 1997; 64(6): 1840 - 1842. [Abstract] [Full Text]

				d,l-Sotalol vs. ICDs for Arrhythmia Journal Watch Cardiology, September 1, 1996; 1996(901): 6 - 6. [Full Text]