Tachycardia: Metoprolol was better than sotalol at decreasing the likelihood of recurrence

Clinical bottom line (level 1b)

  1. Patients with ventricular tachyarrhythmias needing a implantation defibrillator who were given sotalol, were more likely to have a recurrence than those given metoprolol (NNH = 4 at 26 months)
  2. Patients given sotalol had no clear difference in total mortality than those given metoprolol.
Seidl et al: American Journal of Cardiology 1998; 82: 744-748
Expires August 2004

The study

Unblinded ?concealed randomised trial with intention-to-treat
Setting: General hospital, Germany

70 patients (aged mean 62 years, 89% male) ventricular tachyarrhythmia with clinical indication for an implantable cardioverter/ defibrillator; plus a history of = 1 unsuccessful previous trial of suppressive antiarrhythmic therapy or with clinically documented tachyarrhythmia which could not be induced during baseline electrophysiologic study.

Excluded if
  • <18 years old
  • acute myocardial infarction within 1 week
  • contraindications for ß -blockers
  • history of proarrhythmia caused by sotalol
  • prophylactic use of an implantable cardioverter/ defibrillator


    • Control Group: (n = 35, 35 analysed): metoprolol-initial dose of 50 mg per day
    Experimental Group: (n = 35, 35 analysed): d,l-sotalol-initial dose of 80 mg per day
    The dose of drug was individually increased to the highest well-tolerated dose. All patients not inducible or drug refractory during programmed ventricular stimulation were fitted with an implantable cardioverter/ defibrillator for treatment of their tachyarrhythmia (programmed individually), prior to drug therapy.
    100% followed for 26 months mean (+/- 13 months)

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNH
    (95% CI)
    recurrence of ventricular tachycardia treated with antitachycardia pacing 26 months 7
    (20.0%)    		 17
    (48.6%)    		 -143%
    (-412% to -15.0%)    		 -28.6%
    (-49.8% to -7.36%)    		 4
    (2 to 14)
    total mortality 26 months 3
    (8.57%)    		 6
    (17.1%)    		 -100%
    (-637% to 46.0%)    		 -8.57%
    (-24.1% to 6.98%)    		 12
    (NNT = 14 to infinity;
    NNH = 4 to infinity)

  • Metoprolol was discontinued in 6 patients and sotalol in 10 patients. Defibrillator complications requiring intervention occurred in 14 patients.

    • Comments

    1. Sotalol post-ICD has been shown to reduce the need for further shocks (Pacifico 99).

    Citation

    1. Seidl K, Hauer B, Schwick NG, et al: Comparison of metoprolol and sotalol in preventing ventricular tachyarrhythmias after the implantation of a cardioverter/ defibrillator. American Journal of Cardiology 1998; 82: 744-748
    Contributor: Clare Wotton and Bob Phillips, Unknown Month 1999
    Reviewer:

    Clinical Question.
    Patient ventricular tachyarrhythmia with recently implanted cardiovertor/ defibrillator
    Intervention or Exposure sotalol
    Comparison metoprolol
    Outcome total mortality