Predicting the effect of D,L-sotalol on ventricular tachycardia inducibility from the RR variability response
B Brembilla-Perrot, P Houriez, O Claudon, J-P Preiss, D Beurrier
Cardiology, CHU
Brabois, 54500 Vandoeuvre, France
Correspondence to: Dr Brembilla-Perrot.
Accepted for publication 29 March 1999
AIM
To find a rapid
way of identifying non-responders to D,L-sotalol in
patients with ventricular tachycardia.
METHODSProgrammed
ventricular stimulation and RR variability were studied in the
control state and 10 days after treatment with 160 to 320 mg of
D,L-sotalol in 36 consecutive patients with ventricular tachycardia.
RESULTSIn 14 patients
(group I) D,L-sotalol suppressed ventricular tachycardia
inducibility. In 22 patients (group II) sustained ventricular
tachycardia remained inducible during D,L-sotalol treatment. The ventricular tachycardia rate was slowed in eight patients and unchanged or accelerated in 14. At baseline, heart rate
variability was similar in both groups. During treatment with
D,L-sotalol, variables reflecting parasympathetic activity (pNN50, rMSSD, and high frequency amplitude (HF)) increased in both
groups: HF increased from (mean (SD)) 75 (68) to 146 (134) in group I
(p < 0.05) and from 60 (49) to 125 (79) in group II (p < 0.05).
Other variables were unchanged in group I. In group II, the variables
associated with sympathetic activity (coefficient of variance (CV),
ratio of low frequency amplitude (LF) to HF) decreased significantly:
CV decreased from 13 (4) to 9 (2) (p < 0.001) and LF/HF from 4.74 (3.02) to 3.00 (2.02) (p < 0.05).
CONCLUSIONSThe 
blocking effect of D,L-sotalol produced a significant
improvement over control values in indices of parasympathetic tone in
all treated patients. However, the heart rate variability indices
related to sympathetic activity were decreased only in non-responders.
This effect of D,L-sotalol on heart rate variability could
help detect non-responders to the drug and avoid an
electrophysiological study.
Keywords: sotalol; ventricular tachycardia; heart rate variability
© 1999 by Heart
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