Tachycardia: Sotalol increased return to normal sinus rhythm.

Clinical bottom line (level 2b)

  1. Patients with paroxysmal supraventricular tachycardia who were given sotalol, were more likely to have conversion to normal sinus rhythm than those given placebo (NNT = 1 at 30 minutes)
Jordaens et al: American Journal of Cardiology 1991; 68: 35-40
Expires March 2004

The study

Double-blinded ?concealed quasi-randomised trial without intention-to-treat
Setting: University hospital, Belgium

43 patients (aged mean 43 years, 63% female) spontaneous paroxysmal supraventricular tachycardia, defined as tachycardia with a narrow QRS complex (<0.12 second) of > or = 15 minutes' duration and a ventricular rate of >120 beats per minute

Excluded if
  • pregnancy
  • chronic obstructive pulmonary disease
  • second or third degree atrioventricular block
  • hypotension (systolic blood pressure <80 mmHg)
  • heart failure
  • recent myocardial infarction (<1 month)
  • recent coronary artery bypass graft surgery
  • active pericarditis or myocarditis or both
  • digitalis toxicity
  • sick sinus syndrome
  • abnormally prolonged QTc interval (>0.45 second)
  • diastolic blood pressure >115 mmHg
  • previous treatment failure with sotalol (1.5 mg per kg i.v. and = 320 mg per day orally)
  • therapy in the last 6 hours with verapamil, diltiazem, disopyramide, flecainide, ß -adrenoceptor blockers and quinidine
  • treatment with diuretics without potassium supplements or tri- or tetracyclic antidepressant therapy


    • Control Group: (n = 20, 20 analysed): saline given over 10 minutes
    Experimental Group: (n = 23, 18 analysed): sotalol 1.5 mg per kg over 10 minutes

    88% followed for 30 minutes

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    return to normal sinus rhythm 30 minutes 3
    (15.0%)    		 15
    (83.3%)    		 -456%
    (-1509% to -92.0%)    		 -68.3%
    (-91.6% to -45.1%)    		 1
    (1 to 2)

    Comments

    1. There was only one adverse effect, hypotension, which was severe enough to stop the study drug (placebo).
    2. 5 post-randomisation exclusions are not included in this analysis, all from the sotalol group. This may well exaggerate the apparent effectiveness of sotalol.

    Citation

    1. Jordaens L, Gorgels A, Stroobandt R, et al: Efficacy and safety of intravenous for termination of paroxysmal supraventricular tachycardia. American Journal of Cardiology 1991; 68: 35-40
    Contributor: Clare Wotton and Bob Phillips, Unknown Month 1999
    Reviewer:

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