u There was no difference in outcome between a rate control strategy and an antiarrhythmic conversion strategy in post operative atrial fibrillation

Patients with atrial fibrillation of > 1 hour duration after cardiac surgery were randomized to a strategy of antiarrhythmic therapy (Sotalol, Propafenone, Procainamide, Amiodarone) ± electrical cardioversion or ventricular rate control (Diltiazem, Metoprolol, Atenolol, Digoxin).
Choice of drug therapy was individualized.

Results:

[Lee J.K. et al. JACC 1999, 33: 103A-104A]

u In patients with an implanted cardioverter / defibrillators (ICD), Sotalol results in a significantly longer time to first all-cause ICD shock or death.

Sotalol-ICD trial was conducted to evaluate the effects of Sotalol (80-160 mg BID) in patients with life threatening ventricular tachyarrhythmias who were fitted with an ICD.
151 of 302 patients were randomized to receive either placebo or Solalol (mean daily dose: 207 ± 55 mg).
LVEF averaged 39 ± 14% in the placebo and 37 ± 12% in the Sotalol group.
Follow-up was 12 months.
The relative risk (RR) for shock/ death for Sotalol group compared to the placebo group was 0.52 (95% CI: 0.36-0.74).
Patients with EF < 0.30 and > 0.30 have benefited similarly from Sotalol treatment (RR 0.49 e 0.51).
The incidence of nonfatal serious side effects was comparable between the two groups.
Drugs discontinuation rates due to adverse effects or lack of efficacy were 29% for Sotalol and 26% for placebo.

[Hohnloser S.H. et al. JACC 1999; 33: 115A]

u The incidence of sudden death is increased 2.1 times in young competitive athletes as compared with non-athletes.
Arrhythmogenic right ventricular cardiomyopathy and anomalous coronary artery origin are the cardiovascular conditions significantly associated with sudden death in the athletes.

In the Veneto Region (Italy) from January 1978 to June 1998 there were 300 sudden death: 55 among competitive athletes and 245 among nonathletes.
The relative risk of sudden death among athletes as compared with non athletes was 2.1 (95% CI: 1.5-2.8; p < 0.0001).
Main causes of sudden death in young athletes vs non athletes:

[Corrado D. et al. JACC 1999, 33: 119A]

u Out-of-hospital cardiac arrest: basic life support delays the transition of ventricular fibrillation to asystole.

A prospective study over 26 months included 1036 pts.
Ventricular fibrillation (VF) was recorded in 514 pts (50%) and asystole in 255 pts (25%). Basic life support (BLS) was performed in 50% of all patients, 61% had VF and 38% asystole as initial rhythm.

BLS, maintaining coronary perfusion, protects the myocardium.

[Waalewijn R.A. et al JACC 1999; 33: 118A-119A]

u Atrial fibrillation (AF) patients discharged from hospital have a two-seven fold risk for stroke.
Stroke risk is further increased in AF patients with hypertension, diabetes, ischemic heart disease, congestive heart failure and peripheral arteriosclerosis.

27,202 patients, aged 50-89 year with a diagnosis of atrial fibrillation in the Danish National Hospital Discharge Register during the period 1980-1993 have been studied.
Endpoint : first diagnosis of stroke (fatal and non-fatal) after discharge with AF diagnosis.

[Frost L. et al. JACC 1999; 33: 128A]

u Low dose Sotalol is superior to Metoprolol in the prevention of supraventricular arrhythmias after cardiac surgery.

191 consecutive patients (mean age 64 years) have been randomized to receive Metoprolol or Sotalol, in a double blind fashion, within 24-48 hours following extubation.

Dosage:

Results:

[Abdulrahman O. et al. JACC 1999; 33: 132A-133A]

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