Amiodarone and “primary” prevention of sudden death: critical review of a decade of clinical trials

ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death

“…The overall long-term survival benefit from amiodarone is controversial, with most studies showing no clear advantage over placebo. A few studies and one meta-analysis of several large studies have shown reduction in SCD using amiodarone for LV dysfunction due to prior MI and nonischemic DCM (245)(246)(247), but the SCD-HeFT trial showed no survival benefit from amiodarone compared with placebo (7a,248). Chronic administration of amiodarone is associated with complex drug interactions and a host of adverse side effects involving the lung, liver, thyroid, and skin.…”

EHRA/HRS/APHRS expert consensus on ventricular arrhythmias

“…The presence of SHD increases the risk of pro-arrhythmia from membrane-active AADs, such that they are generally used only with the added protection afforded by an ICD [43]. There is no evidence that antiarrhythmic therapy alone improves survival in patients with sustained MMVT [135][136][137]. Sotalol has been demonstrated to reduce the frequency of sustained MMVT recurrences [138,139] in patients with SHD.…”

Kommentar zu den „ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death – executive summary“

“…In den meisten Studien konnte kein eindeutiger Vorteil gegenüber einer Placebobehandlung gezeigt werden. Wenige Studien und eine Metaanalyse haben eine Reduktion des plötzlichen Herztodes unter Amiodarontherapie bei mittel-, hochgradig eingeschränkter linksventrikulärer Funktion auf dem Boden eines abgelaufenen Herzinfarktes sowie einer nichtischämischen, dilatativen Kardiomyopathie gezeigt [12,20,61]. Auf der anderen Seite hat die SCD-HeFT-Studie keinen Über-lebensvorteil durch die Gabe von Amiodaron nachweisen können [11].…”