Comparison of sotalol with amiodarone for long-term treatment of spontaneous sustained ventricular tachyarrhythmia based on coronary artery disease

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.