Efficacy of Sotalol in Preventing Arrythmia

28 year old male - ICD implanted in 2003 due to suspected ARVC based on family history. This was a prophylactic treatment as I did not have any documented episodes of VT, etc prior to implant.

Have only had one shock since then (going on almost four years) - shcok was for fast VT (approx 260 bpm).

My question relates to medications. After the shock (January 2006) doc rx'ed atenolol (25 mg once a day). On average, this dropped my heart rate into the 50's and I had no complaints due to the low heart rate.

However, due to an increase in PVCs recently, my cardiologist suggested we try sotalol (was at my request as PVCs were bothersome). I have been taking 80 mg twice a day for approximately 3 months now.

I have two questions regarding the sotalol:

(1) Originally, like the atenolol, the sotalol reduced my heart rate into the 50's. However, the past month or so my heart rate is back up into the 70's?? Can the beta blocking effects of sotalol wane over time? Also, does this mean the drug is no longer working to reduce probability of arrythmia (i.e. is the drug still acting to prolong refractory period?)

(2) Also, how effective is sotalol at decreasing the incidence of ventricular arrtyhtmias (i.e. are there any studies, etc?) I ask becasue I am considering going back to atenolol!

Regards
ICD_2003

[CCF-M.D.-MJM]

Hello,

(1) Can the beta blocking effects of sotalol wane over time?

Your body can adapt to the dose and you may require more.  If you aren't having a lot of pvcs or vt, I would not increase it or change dose because your basal rate increased.

Does this mean the drug is no longer working to reduce probability of arrythmia (i.e. is the drug still acting to prolong refractory period?)

The best marker for this is the arrhythmia itself.  If you aren't having VT, I wouldn't increase.

(2) Also, how effective is sotalol at decreasing the incidence of ventricular arrtyhtmias (i.e. are there any studies, etc?) I ask becasue I am considering going back to atenolol!

If you have only had one episode of VT, it is reasonable to be on atenolol.  I would use sotalol for someone that has frequent VT, not necessarily only one episode.  If  you develop frequent VT, sotalol is a reasonable choice and possibly even at higher doses.

I hope this helps.  Thanks for posting.

[wmac]

I wonder what the doc means by frequent vt? Like everyday or just once a month or what?
wmac

[Giorg]

I take Sotalol. It is ok in preventing ventricular arrhymias. especially on high dosage. After 18 months of assumption my ICD recorded only a few Vtachs, while when I was on Coreg I had at least one Vtach a week. The problem is not everybody can go on high doses: Sotalol takes down blood pressure and bpm, more then other betablockers. It is tough to tolerate.
But it is also good to reduce bothering PVCs.

Why do you want to go back to Atenol? Your bpm and bp seem just ok. You want them lower? You can go higher with dosage, you can arrive also to 320 mg per day of Sotalol. What is your problem with Sotalol?

[wmac]

How often did you get vt? was yours sustained or what was happening with you for you to get an icd?
wmac

[Giorg]

I have dilated cardiomyopathy with conduction disorders.