Adjunctive antiarrhythmic drug therapy in patients with implantable cardioverter defibrillators: a systematic review

Ferreira‐González, Ignacio; Dos‐Subirà, Laura; Guyatt, Gordon

doi:10.1093/eurheartj/ehl478

Cited by 47 publications

(23 citation statements)

References 17 publications

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“…Similarly, in that meta-analysis, sotalol was found to be superior to placebo (HR 0.55, 95 % CI 0.40-0.78), but not to other b-blockers (HR 0.61, 95 % CI 0.37-1.00]). 15 This metaanalysis was largely supported by the results of the OPTIC study. Given the tendency towards a greater effect of sotalol over b-blockers in the OPTIC study and a statistically significant effect of sotalol in the trial by Pacifico et al, it appears reasonable to keep both substances in mind for shock prevention, realising that amiodarone is most effective (see Figure 1).…”

Section: Amiodarone and Sotalolmentioning

confidence: 85%

“…In an observational study of 55 patients evaluating the incidence of inappropriate shocks after ICD implantation, amiodarone was most effective in reducing the rate of inappropriate shocks and was superior to b-blockers. 21 The finding of amiodarone being the most potent antiarrhythmic drug for overall shock reduction is supported by a meta-analysis of 1889 15 This report pooled data from the abovementioned prospective trials with several retrospective observational studies, and found that the risk of overall ICD shocks was reduced when comparing amiodarone plus b-blocker with b-blocker alone (HR 0.27, 95 % CI 0.14-0.52). Similarly, in that meta-analysis, sotalol was found to be superior to placebo (HR 0.55, 95 % CI 0.40-0.78), but not to other b-blockers (HR 0.61, 95 % CI 0.37-1.00]).…”

Section: Amiodarone and Sotalolmentioning

confidence: 94%

“…The meta-analysis by Ferreira-Gonzalez et al looked at trials of patients treated with class III substances azimilide or dofetilide for shock reduction. 15 It failed to document a relevant effect of these two drugs on shock reduction in comparison with placebo (azimilide: HR 0.78, 95 % CI 0.58-1.04, and dofetilide: HR 0.67, 95 % CI 0.43-1.04).…”

Section: Azimilide and Dofetilidementioning

confidence: 99%

“…However, after addition of data from several smaller dose-ranging studies these effects could no longer be observed. 15 In contrast to azimilide, dofetilide is available in several countries.…”

Section: Azimilide and Dofetilidementioning

confidence: 99%

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Antiarrhythmic Drug Therapy to Avoid Implantable Cardioverter Defibrillator Shocks

Abboud

Ehrlich

2016

Arrhythmia &Amp; Electrophysiology Review

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Implantable cardioverter defibrillators (ICDs) have been used for over 30 years to prevent sudden cardiac death (SCD). The first indications for ICD placement were secondary prevention; later trials demonstrated a primary prevention benefit of ICD therapy in patients at risk of SCD. ICD therapy prolongs life in both patient populations. 1 However, the efficacy of an ICD depends on its ability to correctly detect ventricular arrhythmia and deliver antitachycardia pacing or shocks. In cases of inadequate arrhythmia classification by the device, atrial fibrillation (AF) with rapid conduction to the ventricles can lead to inappropriate shocks. The ability of an ICD to correctly detect this arrhythmia is essential to avoid shock delivery. Furthermore, technical problems such as lead fractures, oversensing of myopotentials or external noise can lead to shock application. ICD shocks can be painful if experienced in the awake state and may reduce quality of life in affected patients.2 Shocks, whether appropriate or not, tend to occur frequently after the implantation of an ICD and avoiding shocks is a reasonable therapeutic target. 3 Current evidence suggests that ICD shocks increase the risk of mortality.4 It remains a matter of debate if this finding depends on the context of a specific cardiac substrate or the shock per se.5 Of less controversy is the fact that patients who receive ICD shocks experience reduced quality of life. This has been a consistent finding in published studies that was already evident from data in the first available trials, such as the Antiarrhythmics Versus ICDs (AVID) trial. The occurrence of ICD shocks was associated with reduced physical functioning and decreased mental wellbeing. Another study reported that patients who experienced an ICD shock did not adapt well to living with an ICD and were generally more anxious than ICD recipients who received no shock.6 Accordingly, shock reduction by medical, interventional or technical means is a desirable goal. General MeasuresMost patients receiving ICDs for primary prevention of SCD are affected by heart failure with reduced left ventricular ejection fraction (LVEF <35 %). Should these patients meet the criteria for cardiac resynchronisation therapy (CRT), implantation is indicated to achieve mortality and morbidity benefits. 7 In addition, CRT responders exhibit fewer ventricular tachycardia/ventricular fibrillation (VT/VF) episodes after implantation than patients not receiving CRT.8 In general, care should be taken to keep these patients on optimal medical therapy including high-dose b-blockers, as these drugs lead to a reduction in rates of SCD and overall mortality in patients with ischaemic and non-ischaemic cardiomyopathy. If such treated patients develop arrhythmias despite b-blocker treatment, an additional anti-arrhythmic treatment will be necessary. In clinical practice, an adjunctive antiarrhythmic is administered to more than half of patients who have an ICD. Serum Potassium LevelsBesides pharmacological interventions, simple meth...

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Section: Amiodarone and Sotalolmentioning

confidence: 85%

Section: Amiodarone and Sotalolmentioning

confidence: 94%

Section: Azimilide and Dofetilidementioning

confidence: 99%

Section: Azimilide and Dofetilidementioning

confidence: 99%

See 2 more Smart Citations

Antiarrhythmic Drug Therapy to Avoid Implantable Cardioverter Defibrillator Shocks

Abboud

Ehrlich

2016

Arrhythmia &Amp; Electrophysiology Review

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show abstract

“…It is important to remember that these discriminators don't work in the VF zone and hence adjusting detection intervals and therapy zones more carefully may reduce recurrent shocks. In addition, the use of medications and/or appropriate ablation procedure may prevent recurrences of SVT [19,29].…”

Section: Inappropriate Icd Shockmentioning

confidence: 99%

Emergencies of Implantable Cardioverter Defibrillator

Buğan¹

2012

Current Issues and Recent Advances in Pacemaker Therapy

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Amiodarone versus other pharmacological interventions for prevention of sudden cardiac death

Claro

Cândia

Rada

et al. 2009

Cochrane Database of Systematic Reviews

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Adjunctive antiarrhythmic drug therapy in patients with implantable cardioverter defibrillators: a systematic review

Abstract: Amiodarone is the most effective treatment to reduce ICD shock therapies. The benefit of other antiarrhythmics is limited to secondary outcomes.

Cited by 47 publications

References 17 publications

Antiarrhythmic Drug Therapy to Avoid Implantable Cardioverter Defibrillator Shocks

Antiarrhythmic Drug Therapy to Avoid Implantable Cardioverter Defibrillator Shocks

Emergencies of Implantable Cardioverter Defibrillator

Amiodarone versus other pharmacological interventions for prevention of sudden cardiac death

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