索他洛尔治疗慢性室性和室上性心律失常44例

Sotalol for treatment of patients with chronic refractory ventricular and supraventricular arrhythmias

目的 :观察索他洛尔 (So)治疗难治性慢性室性早搏 (VPC)和症状性阵发性心房颤动 (PAF)的疗效、作用特点和不良反应。方法 :2 8例慢性 VPC患者和 16例 PAF患者接受 So治疗 ,起始剂量 12 0～ 16 0 m g/ d,无效则递增 ,最大剂量 32 0 mg/ d。根据 2 4h Holter监测的早搏数量减少评价 VPC疗效 ,以立方根法计算 QTc间期。结果 :So治疗 VPC的总有效率为 78.6 % ,短期 (8wk)内预防 PAF发作的有效率为 31.3% ,伴有 SBP降低、HR减慢和 QT间期、QTc间期延长、QT间期离散度 (QTd)明显缩短 (P<0 .0 1) ,但缩短程度在治疗有效和无效者差异不显著 (P>0 .0 5 )。全组未见心律失常恶化 ,但 13.6 % (6 / 44 )的患者出现持续性窦性心动过缓 ,仅有的 1例慢性充血性心力衰竭患者于服药 wk 2出现心衰恶化。其余不良反应较少。结论 :So治疗难治性 VPC的作用较好 ,可作为一线抗心律失常药物使用 ,但预防 PAF发作的疗效较差。

AIM: To observe the efficacies characteristic and side effects of sotalol in controlling chronic refractory ventricular premature contraction (VPC) and in preventing the attacks of symptomatic paroxysmal atrial fibrillation (PAF). METHODS: Sotalol was given to 28 patients with chronic VPC and 16 patients with PAF. The initial doses were 120-160 mg/d and increased to the maximum of 320 mg/d in steps if ineffective. The therapy lasted 4 wk for VPC and 8 wk for PAF. The 24 h Holter monitoring and the standard electrocardiogram was used as criterion of effectiveness. RESULTS: The efficacy rates for VPC and PAF were 78 6% and 31 3% respectively. The therapy resulted in marked decrease in both systolic blood pressure and heart rate, and significant prolongation of QT and QTc intervals, and also apparent decrease of QT dispersion but the extent of which being insignificantly different between effective and ineffective patients. No worsening of arrhythmia was found but persistent sinus bradycardia was noted in 13 6%(6/44) of all the patients. The only patient with chronic congestive heart failure in the group showed deterioration in global function during the wk 2 of treatment on 160 mg/d. Other side effects were minor. CONCLUSION: Low to moderate doses of sotalol are reliable in controlling refractory VPC and can be used as first line drug, but being weak in maintaining sinus rhythm in PAF.