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European Heart Journal 1989 10(12):1084-1089;
Copyright © 1989 by the European Society of Cardiology.
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© 1989 The European Society of Cardiology

Mechanisms of termination of supraventricular tachycardias by intravenous class III antiarrhythmic agents. A comparison of amiodarone and sotalol

A. WALEFFE, K. NZAYINAMBAHO, L. M. RODRIGUEZ, A. DEHARENG and H. E. KULBERTUS

Department of Cardiology, Hôpital Universitaire, University of Liège Liège, Belgium

Received 23 January 1989; revised 24 April 1989; .

Address for reprints: André Waleffe, MD, Cardiology Division, Chu-Sart-Tilman, B-4000, Liege, Belgium

Abstract

The effects of amiodarone and sotalol were studied with programmed electrical stimulation of the heart in 19 patients with inducible tachycardia (AV nodal tachycardia: 10 cases, circus movement tachycardia: 9 cases). Amiodarone was administered intravenously at a dose of 300 mg over 2min and sotalol at a dose of 1.5 mg kg–1 over 10min. Both i.v. amiodarone and sotalol lengthened the transnodal conduction time, the effective refractory period of the AV node and the AV nodal Wenckebach cycle length. Only sotalol significantly lengthened the effective refractory periods of the right atrium and the right ventricle. Infused intravenously during tachycardia, amiodarone interrupted arrhythmia in five of six patients and sotalol in seven often cases. Tachycardia was stopped by blockade of the impulse into the AV node in three amiodarone patients and in five sotalol patients. In the remaining four cases, the weak link of the circuit was the accessory pathway. Thus i.v. sotalol exhibits electrophysiologic effects consistent with both class II and III activity, whereas the effects of i.v. amiodarone are the result of different activities throughout all areas of the cardiac tissue.

Key Words: Sotalol • amiodarone • intravenous class III antiarrhythmic agents • supraventricular re-entrant tachycardia


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