Tachycardia: Sotalol increased conversion to sinus rhythm.

Clinical bottom line (level 1b)

  1. Patients who had supraventricular tachycardia and were given 1.0 mg/kg sotalol, were more likely to have conversion to sinus rhythm than those given placebo (NNT = 2 at 30 minutes) .
  2. Patients with supraventricular tachycardia who were given 1.5 mg/kg sotalol were more likely to have conversion to sinus rhythm (NNT = 2 at 30 minutes) .
Sung et al: American Heart Journal 1995; 129: 739-748
Expires October 2000

The study

Double-blinded ?concealed randomised trial with intention-to-treat
Setting: 12 study centres, USA

45 patients (aged range 19 to 72 years, mean 42, 62% male) supraventricular tachycardia

Excluded if
  • <5 minutes duration
  • >7 days duration
  • ventricular rate <120 beats per minute
  • clinically significant congestive heart failure
  • asthma or chronic obstructive lung disease
  • sick sinus syndrome
  • history of second- and third-degree atrioventricular block
  • unstable angina, myocardial infarction or coronary artery bypass surgery within preceding 2 months
  • severe hypertension (diastolic blood pressure >115 mmHg) or hypotension (systolic blood pressure <100 mmHg)
  • serum creatinine >2.5 mg per dl, significant liver dysfunction
  • administration of drugs that prolong QT interval, beta-adrenergic receptor blocking agents or verapamil, diltiazem or other antiarrhythmic agents within the preceding 24 hours
  • amiodarone therapy within the preceding 3 months
  • history of drug-induced torsade de pointes
  • electrolyte imbalance
  • pregnancy


    • Control Group: (n = 15, 14 analysed): placebo
    Experimental Group: (n = 15, 15 analysed): 1.0 mg per kg sotalol
    Experimental Group: (n = 15, 15 analysed): 1.5 mg per kg sotalol

    100% followed for 30 minutes

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    conversion to sinus rhythm (with 1.0 mg per kg sotalol) 30 minutes 2
    (14.3%)    		 10
    (66.7%)    		 61%
    (18% to 82%)    		 52.4%
    (22.30% to 82.47%)    		 2
    (1 to 4)
    conversion to sinus rhythm (with 1.5 mg per kg sotalol) 30 minutes 2
    (14.3%)    		 10
    (66.7%)    		 61%
    (18% to 82%)    		 52.38%
    (22.3% to 82.47%)    		 2
    (1 to 4)

    Comments

    1. Sotalol 1.0 mg/kg is as effective as 1.5 mg/kg.
    2. Adverse events included hypotension and dyspnoea, but no patients died.

    Citation

    1. Sung RJ, Tan HL, Karagounis L, et al: Intravenous sotalol for the termination of supraventricular tachycardia and atrial fibrillation and flutter: A multicenter, randomized, double-blind, placebo-controlled study. American Heart Journal 1995; 129: 739-748
    Contributor: Clare Wotton and Musab Hayatli, October 1999
    Reviewer:

    Clinical Question.
    Patient supraventricular tachycardia
    Intervention or Exposure sotalol
    Comparison placebo
    Outcome conversion to sinus rhythm