Amiodarone in Patients with Congestive Heart Failure and Asymptomatic Ventricular Arrhythmia

Singh, Steven; Fletcher, Ross D.; Fisher, Susan G.; Singh, Bramah N.; Lewis, H. Daniel; Deedwania, Prakash; Massie, Barry M.; Colling, Cindy; Lazzeri, Diane

doi:10.1056/nejm199507133330201

Cited by 1,095 publications

(445 citation statements)

References 27 publications

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“…One of the randomized trials demonstrated that the mortality and quality of life in NICM patients with a reduced LVEF were similar between those receiving amiodarone, and those with an ICD implantation for nonsustained VT 3. Although anti‐arrhythmic drug therapy has never been clearly shown to reduce SCD in NICM patients experiencing life‐threatening VAs, amiodarone, rather than sodium channel blockers, reduces the occurrence of VAs without the expense of an increase in the mortality in patients with postmyocardial infarction and heart failure 35, 36. In patients with an ICD implantation, amiodarone, especially in conjunction with beta‐blockers, significantly reduces ICD interventions 37.…”

Section: Management Of Vt In Nicmmentioning

confidence: 99%

Ventricular arrhythmias in nonischemic cardiomyopathy

Chung

Lin

et al. 2018

Journal of Arrhythmia

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Nonischemic cardiomyopathies (NICMs) are composed of variable disease entities, including primary and secondary cardiomyopathies. Determining the etiology of NICM provides pivotal roles of not only the understanding of the individual pathogenesis, but also the clinical management, such as risk stratification, pharmacological treatment, and intervention therapies. Despite the diverse causes of NICM, these cases mostly require clinical attention owing to progressive myocardial injury, resulting in ventricular dysfunction and heart failure. The interaction between the diseased ventricular substrates and systemic/neurophysiological factors contributes to the cornerstones responsible for ventricular arrhythmogenesis and sudden cardiac death (SCD). Prevention of SCD and diminishing ventricular tachyarrhythmias are the important mainstays for the management of NICM patients. Given the understanding of the abnormal ventricular substrates and advancement of navigation systems, radiofrequency catheter ablation (RFCA) has become an adjunctive or alternative strategy for NICM patients who experience drug‐refractory ventricular tachycardias (VTs). Successful ablation can frequently be achieved at the expense of an epicardial intervention. A recent study has proven the survival benefits for NICM patients who are free from recurrent VTs after a successful RFCA, regardless of the New York Heart Association (NYHA) functional class status or left ventricular ejection fraction. Additionally, recent evidence has highlighted the better delineation of a diseased myocardium through the incorporation of cardiovascular magnetic resonance imaging (CMRI) and 3D mapping systems, which can facilitate the identification of critical ventricular arrhythmogenic substrates in NICM patients.

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Section: Management Of Vt In Nicmmentioning

confidence: 99%

Ventricular arrhythmias in nonischemic cardiomyopathy

Chung

Lin

et al. 2018

Journal of Arrhythmia

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“…[7][8][9] Sotalol is not recommended in the overt HF population given its negative inotropic and proarrhythmic potential.…”

Section: Recommendations For Antiarrhythmic Drug Selectionmentioning

confidence: 99%

Antiarrhythmic drug therapy for atrial fibrillation: Are the guidelines guiding clinical practice?

Reiffel

Naccarelli

2006

Clin Cardiol

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Summary:The AFFIRM study showed no clear survival advantage for a rhythm versus rate control strategy in patients with atrial fibrillation (AF). However, rhythm control with antiarrhythmic drugs (AADs) is appropriate in a large number of patients with AF. The American College of Cardiology/ American Heart Association/European Society of Cardiology AF management guidelines include a safety-based algorithm for selection of AAD therapy. Class 1C agents are recommended as first-line therapy in patients without or with minimal structural heart disease. However, market research and clinical study data indicate a growing use of class III agents (mainly amiodarone) despite long-term safety and tolerability concerns, suggesting that clinical practice does not adhere to current guidelines.

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“…Singh et a1. 62 found no significant effect of lowdose amiodarone on sudden death or overall mortality, although there appeared to be a favorable trend toward survival benefit in the treatment of DCM. In smaller trials examining both ischemic and DCM populations, the use of amiodarone significantly reduced ventricular ectopy on ambulatory ECG m0nitoring,6~.…”

Section: Am I Od a Ro N Ementioning

confidence: 75%

Sudden death in dilated cardiomyopathy

Das

1999

Clinical Cardiology

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Summary:The purpose of this review is to examine the potential contribution of arrhythmia to the occurrence of sudden death in dilated cardiomyopathy (DCM) and to discuss current treatment options. We performed a search of the MED-LINE database from 1985 to the present and the reference citations of selected articles pertaining to the prognostic significance, management, and pathophysiology of arrhythmias in DCM. A large proportion of patients with DCM die suddenly, most secondary to ventricular arrhythmia and a smaller proportion due to bradyarrhythmia. The presence and severity of ventricular ectopy may predict risk for sudden death, but the role of electrophysiologic study and signal-averaged electrocardiography in further risk stratifying patients remains uncertain. Abnormalities of the autonomic nervous system and renin-angiotensin-aldosterone axis appear to promote the occurrence of ventricular arrhythmias. Angiotensinconverting enzyme inhibitors improve overall mortality in congestive heart failure, and the use of direct angiotensin-receptor antagonists is currently being studied. In addition, beta-receptor antagonists appear to improve morbidity and may prove to improve mortality in heart failure as well. Other interventions still under investigation include amiodarone and the implantable cardioverter-defibrillator. The underlying pathophysiology of sudden death in DCM involves primarily ventricular tachyarrhythmia. Angiotensin-converting enzyme inhibitors remain a mainstay of improving overall mortality, while further study on the roles for newer drugs and devices is ongoing.

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Amiodarone in Patients with Congestive Heart Failure and Asymptomatic Ventricular Arrhythmia

Cited by 1,095 publications

References 27 publications

Ventricular arrhythmias in nonischemic cardiomyopathy

Ventricular arrhythmias in nonischemic cardiomyopathy

Antiarrhythmic drug therapy for atrial fibrillation: Are the guidelines guiding clinical practice?

Sudden death in dilated cardiomyopathy

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