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European Heart Journal 1999 20(5):364-374; doi:10.1053/euhj.1998.1279
Copyright © 1999 by the European Society of Cardiology.
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Comparison of sotalol with amiodarone for long-term treatment of spontaneous sustained ventricular tachyarrhythmia based on coronary artery disease

P. Kovoor, V. Eipper, K. Byth, M.J. Cooper, UtherJ.B. and D.L. Rossf1

Department of Cardiology, Westmead Hospital, Westmead, Sydney, Australia

revised August 11, 1998; accepted August 18, 1998

Abstract

Aim

To compare the efficacy of sotalol versus amiodarone for long-term treatment of ventricular tachyarrhythmias.

Methods

Patients (n=75) with spontaneous, sustained ventricular tachyarrhythmias secondary to remote myo-cardial infarction were studied. After intravenous electrophysiological testing, both sotalol and amiodarone were predicted to be ineffective in 50 (67%) patients. Five patients were excluded. Forty-five patients were randomized to receive sotalol (n=22) or amiodarone (n=23) for maintenance therapy. The primary outcome variable was the time to first recurrence of sustained ventricular tachyarrhythmia.

Results

At 36 months, 75% of those allocated sotalol remained free of ventricular tachyarrhythmia compared with 38% of those allocated amiodarone (P=0·05). On multivariate analysis the risk of recurrence of ventricular tachyarrhythmia for patients on amiodarone was 5·9 times higher (P=0·008) than that for patients on sotalol.

Conclusion

Sotalol is superior to amiodarone for long-term treatment of ventricular tachyarrhythmia secondary to coronary artery disease when both drugs have been predicted to be ineffective at intravenous electrophysiological testing. Randomized trials in larger numbers of patients with ventricular tachyarrhythmia need to be performed comparing the two agents directly.

Key Words: Sotalol • amiodarone • ventricular tachyarrhythmia • ventricular tachycardia • coronary artery disease

f1 Correspondence:Professor D. L. Ross, Department of Cardiology, Westmead Hospital, Westmead, New South Wales, 2145, Australia.

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