Tachycardia: Sotalol increased termination of arrhythmia.

Clinical bottom line (level 1b)

  1. Patients with sustained ventricular tachycardia who were given sotalol, were more likely to have termination of the tachycardia than those given lignocaine (NNT = 2 at 15 minutes) .
Ho et al: Lancet 1994; 344: 18-23
Expires October 2004

The study

Double-blinded ?concealed randomised trial with intention-to-treat
Setting: 3 hospitals, Australia

33 patients (aged mean 65 years, 79% male) sustained broad complex tachycardias judged to be ventricular tachycardia on the basis of clinical history and a 12-lead ECG in conscious patients in the wards or emergency rooms

Excluded if
  • previously entered into trial
  • received lignocaine or sotalol in previous 24 hours
  • poor haemodynamic status which was judged to require early DC shock
  • had torsades de pointes
  • ventricular tachycardia was interrupted by runs of sinus rhythm during the period from first documentation of sustained tachycardia to commencement of trial drugs


    • Control Group: (n = 17, 17 analysed): 100 mg lignocaine (made up to 10 mL as a clear liquid) hand injected over 5 minutes at a rate of 2 mL per minute
    Experimental Group: (n = 16, 16 analysed): 100 mg sotalol (made up to 10 mL as a clear liquid) injected over 5 minutes at a rate of 2 mL per minute
    If 15 minutes after the first drug was given ventricular tachycardia persisted, the other drug was given in a crossover manner. DC countershock was given if the patient's haemodynamic status deteriorated at any stage.
    100% followed for 15 minutes
    Outcome notes:
    • tachycardia terminated : initial randomised drugs only

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    tachycardia terminated 15 minutes 3
    (17.7%)    		 11
    (68.8%)    		 -290%
    (-1046% to -32%)    		 -51.1%
    (-80.2% to -22.1%)    		 2
    (1 to 5)

    Comments

    1. One patient in each group became hypotensive after the first drug, lost consciousness and required cardioversion. One patient in each group died.
    2. Two patients randomised to lignocaine were subsequently found to have a supraventricular tachycardia with aberration.

    Citation

    1. Ho DSW, Zecchin RP, Richards DAB, et al: Double-blind trial of lignocaine versus sotalol for acute termination of spontaneous sustained ventricular tachycardia. Lancet 1994; 344: 18-23
    Contributor: Clare Wotton and Bob Phillips, October 1999
    Reviewer:

    Clinical Question.
    Patient ventricular tachycardia
    Intervention or Exposure sotalol
    Comparison lignocaine
    Outcome termination of tachycardia