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European Heart Journal 1993 14(Supplement H):67-73; doi:10.1093/eurheartj/14.suppl_H.67
Copyright © 1993 by the European Society of Cardiology.
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© 1993 The European Society of Cardiology

Clinical role of d-sotalol and d,l-sotalol in supraventricular arrhythmias, including pre-excitation

C. Daubert, P. Mabo, D. Gras and C. Leclerco

Service de Cardiologie, Hotel Dieu/Centre Hospitalier Regional et Universitaire 35033 Rennes Cedex, France

Correspondence: Pr J. Claude Daubert, Service de Cardiologie, Hotel Dieu/Centre Hospitalier Regional et Universitaire, 35033 Rennes Cedex, France

Numerous trials performed over the last 20 years, although uncontrolled, have shown the racemic d,l-sotalol is effective for the acute conversion and for long-term prevention of recurrences of supraventricular tachyarrhythmias. Sotalol appeared to be moderately effective in atrial fibrillation or atrial flutter, having somewhat greater efficacy in the case of atrioventricular (AV) nodal re-entrant tachycardia due to Wolff-Parkinson-White syndrome or concealed accessory pathway. These effects may stem from the combined class II and class III electrophysiologic properties of this drug. However, studies comparing d,l-sotalol to pure beta blockers in different ‘models’, especially postsurgical arrhythmias and Wolff-Parkinson-White syndrome, have suggested that the observed clinical benefit may be related to d,l-sotalol's class III properties. Thus, d-sotalol may be efficacious in these indications. Its precise efficacy should be defined in controlled clinical trials.

Key Words: d-Sotalol • d,l-sotalol • supraventricular arrhythmia • atrial fibrillation • atrial flutter • Wolff-Parkinson-White syndrome


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