Effects of Intravenous Sotalol on the Q-T Interval and Incidence of Ventricular Arrhythmias Early in Acute Myocardial Infarction

Abstract

Sixty-two patients with acute myocardial infarction were randomized within 12 h to either intravenous (120 mg) and oral (320 mg daily) sotalol (n = 27) or a control group (n = 35). At 20 min, heart rate and systolic blood pressure fell significantly in sotalol-treated patients (from 78 ± 13 to 59 ± 8 beats/min and from 131 ± 18 to 109 ± 21 mmHg; mean ± SD) compared to controls (from 79 ± 16 to 81 ± 15 beats/min and from 133 ± 22 to 131 ±26 mm Hg; p < 0.001). At 30 min, QTc had increased by 16.7% in sotalol-treated patients and by 3.7% in controls (p < 0.001). Twenty-four-hour ECG monitoring showed that the total number of ventricular premature beats (135 vs. 238; p < 0.05) and R on T ventricular premature beats (2.5 v.s. 7.0; p = 0.004) were fewer in sotalol-treated than in control patients. However, the frequency of ventricular couplets, triplets, and bouts of ventricular tachycardia was similar in both groups. Adverse effects of sotalol were infrequent. A large study is required to assess any prophylatic effect on primary ventricular fibrillation.