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European Heart Journal 1993 14(Supplement H):78-84; doi:10.1093/eurheartj/14.suppl_H.78
Copyright © 1993 by the European Society of Cardiology.
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© 1993 The European Society of Cardiology

Comparative efficacy of sotalol and class I antiarrhythmic agents in patients with ventricular tachycardia or fibrillation: Results of the Electrophysiology Study Versus Electrocardiographic Monitoring (ESVEM) Trial

Richard C. Klein and The Esvem Investigators*

University of Utah Medical Center, Salt Lake City Utah, U.S.A.

Correspondence: Richard C. Klein, MD, Cardiology Division, University of Utah Medical Center, 50 N Medical Drive, Salt Lake City, UT84132, U.S.A.

The ESVEM Trial was a randomized prospective study to compare the predictive accuracy of electrophysiologic testing (EPS) to ambulatory electrocardiographic monitoring (Hotter monitoring—HM) for long-term drug therapy of sustained ventricular tachyarrhythmias. 486 patients with documented ventricular tachycardia or resuscitated sudden death were randomized to EPS (n = 242) or HM (n = 244) and underwent serial drug testing with up to six antiarrhythmics; in the EPS limb a drug efficacy prediction was achieved in 108 patients (45%), comparted to 188 (77%) in the HM limb (P < 0.001). Efficacy predictions were most frequent with sotalol therapy. During long-term follow-up of the 296 patients discharged on a drug predicted to be effective, there were 151 recurrrences of an arrhythmic event; there were no differences in actuarial rates of arrhythmia recurrence between EPS and HM. With multivariate testing of 14 variables, only sotalol therapy and absence of prior antiarrhythmic therapy were associated with a significant reduction in risk of arrhythmia recurrence.

Key Words: Ventricular tachycardia • antiarrhythmic therapy • electrophysiologic testing vs ECG monitoring

* See Appendix for list of investigators.


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