Amiodarone Therapy in Patients Implanted With Cardioverter-Defibrillator for Life-Threatening Ventricular Arrhythmias

Sato, Kazuhiro; Kurita, Takashi; Takatsuki, Seiji; Yokoyama, Yasuhiro; Chinushi, Masaomi; Tsuboi, Nobuyuki; Nitta, Takashi; Shoda, Morio; Mitamura, Hideo

doi:10.1253/circj.70.977

Cited by 22 publications

(16 citation statements)

References 26 publications

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“…Therefore, the development of a ICD algorithm that monitors the magnitude of TWA might be warranted for detecting the high-risk condition of VT/VF and to evaluate the effects of antiarrhythmic drugs in patients with ICD storm. [38][39][40] …”

Section: Discussionmentioning

confidence: 99%

Defibillator Electrogram T Wave Alternans as a Predictor of Spontaneous Ventricular Tachyarrhythmias in Defibrillator Recipients

Kim

Pak

Park

et al. 2009

Circ J

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wave alternans (TWA), which is characterized by changes in the contour, amplitude or polarity of the T wave with regular rhythmicity, represents a temporal dispersion of repolarization. 1 Previous studies show that TWA is a marker of electrical instability in humans and is associated with life-threatening ventricular tachyarrhythmias (VTs). 2 TWA is known to be associated with various conditions, such as long QT syndrome, 3 Prinzmetal angina, 4 acute ischemia, 5 marked electrolyte abnormalities, 6 and hypertrophic cardiomyopathy. 7 The duration from the peak of the T wave to the end of the T wave (Tpte) is associated with transmural dispersion of repolarization, which is also related to the vulnerability to ventricular arrhythmias. 8 Tsai et al reported that TWA was a predictor of VT in a canine model of sudden cardiac death using intracardiac electrograms obtained from an implantable cardioverter defibrillator (ICD). 9 However, no one has previously investigated whether TWA and Tpte immediately precede or follow spontaneous VT in the human ambulatory setting. We hypothesized that TWA and the Tpte interval measured from the stored electrograms of ICD recipients would become prominent immediately before the spontaneous onset of clinical VTs. The purpose of this study was to determine whether TWA and the Tpte interval were measurable in the electrograms from ICD recipients, and if they were closely related to clinical VT. MethodsThis study was approved by the Institutional Review Board of Korea University Anam Hospital, and informed consent was given by each patient. Patient EnrollmentWe included 74 patients (age 55.3±12.2 years, males 79.7%) who had implanted ICDs. All patients had the transvenous-type ICD, and 5 of them underwent cardiac resynchronization therapy with a defibrillator. The ICD profiles were as follows: VENTAK MINI (Guidant Inc, Indianapolis, IN, USA), PRISM2 (Guidant Inc), GEM 7227 (Medtronic Inc, Minneapolis, MN, USA), GEM DR 7271 (Medtronic Inc), and Profile MD (St Jude Inc, Saint Paul, MN, USA). At a mean follow-up duration of 32.2±18.6 months, 17 patients had experienced 161 appropriate ICD therapies, and 5 patients received 6 inappropriate ICD shocks. Four patients with appropriate ICD therapies experienced ICD storms (>20 episodes per day). 10 Classification of ICD ElectrogramsThe total number of acquired stored ICD electrograms with tachycardia events was 167 (161 appropriate therapies, 6 inappropriate therapies). Taken together with 205 episodes of ICD shocks recorded during the measurement of (Received March 26, 2008; revised manuscript received August 22, 2008; accepted August 26, 2008; released online November 27, 2008 Defibillator Electrogram T Wave Alternans as a Predictor of Spontaneous Ventricular Tachyarrhythmias in Defibrillator RecipientsJin Won Kim, MD, PhD; Hui-Nam Pak, MD, PhD; Jae Hyung Park, BSc; Gi-Byoung Nam, MD, PhD*; Sook Kyoung Kim, MSc; Hyun Soo Lee, MPH;Jin Kun Jang, MD; Jong Il Choi, MD; Young-Hoon Kim, MD, PhDBackground Although T wave alternans (TWA) and the T ...

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Section: Discussionmentioning

confidence: 99%

Defibillator Electrogram T Wave Alternans as a Predictor of Spontaneous Ventricular Tachyarrhythmias in Defibrillator Recipients

Kim

Pak

Park

et al. 2009

Circ J

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“…5 The screening may also prevent living family members from suffering possible sudden death by appropriate medication or lifestyle changes. [25][26][27][28][29] We have also discussed the possibility that the RyR2 mutation may be associated with status thymicolymphaticus.…”

Section: Discussionmentioning

confidence: 99%

Postmortem Molecular Screening for Cardiac Ryanodine Receptor Type 2 Mutations in Sudden Unexplained Death R420W Mutated Case With Characteristics of Status Thymico-Lymphaticus

Nishio

Iwata

Suzuki

2006

Circ J

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“…13 The efficacy of amiodarone for reducing inappropriate ICD therapies in patients with structural heart disease has been reported previously 14 and more recently, it was reported that amiodarone is effective for preventing inappropriate ICD therapies in selected patients with atrial fibrillation (AF). 15 However, the exact background to the reduction in inappropriate therapies provided by amiodarone has still not been fully investigated.…”

Section: Editorial P 1290mentioning

confidence: 92%

“…The OPTIC trial suggested that amiodarone and β-antagonists could prevent inappropriate ICD therapy and our study has emphasized that result. However, β-blocker use was only 44% in a large cohort study in Japan, 21 indicating it is not frequently administered in the Japanese patient population with structural heart disease and ICD implantation. We could not confirm the reason for the relatively lower use of β-blockers in our study.…”

Section: Study Limitationsmentioning

confidence: 99%

Relationship Between Oral Amiodarone and Inappropriate Therapy From an Implantable Cardioverter Defibrillator

Nagai

Sato

Noda

et al. 2010

Circ J

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Background: This study evaluated the efficacy of amiodarone for avoiding inappropriate therapies by implantable cardioverter defibrillators (ICDs). Methods and Results:A total of 232 patients with structural heart disease (58±13 years; 78% males) who underwent an initial ICD implantation were retrospectively investigated to compare baseline characteristics and event rates of inappropriate ICD therapy delivery between patients with oral amiodarone therapy (amiodarone group, n=116) and those without (non-amiodarone group, n=116). During a mean follow-up of 29±21 months, inappropriate therapies occurred less frequently in the amiodarone group than in the non-amiodarone group (12% vs 27%, P=0.0068). As a cause of inappropriate ICD therapy, only atrial fibrillation (AF) significantly differed between the groups (3% vs 12%, P=0.01). The results of multivariate logistic regression analysis showed that amiodarone therapy (odds ratio (OR) 0.38, 95% confidence interval (CI) 0.19-0.77, P=0.0073) and no history of spontaneous AF (OR 0.27, 95%CI 0.13-0.57, P=0.0007) were independent predictors of a lower risk of inappropriate ICD therapy. Conclusions:In the present group of ICD patients with structural heart disease, inappropriate therapy delivery occurred predominantly in those with spontaneous AF and/or without amiodarone. (Circ J 2010; 74: 1302 - 1307

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Amiodarone Therapy in Patients Implanted With Cardioverter-Defibrillator for Life-Threatening Ventricular Arrhythmias

Cited by 22 publications

References 26 publications

Defibillator Electrogram T Wave Alternans as a Predictor of Spontaneous Ventricular Tachyarrhythmias in Defibrillator Recipients

Defibillator Electrogram T Wave Alternans as a Predictor of Spontaneous Ventricular Tachyarrhythmias in Defibrillator Recipients

Postmortem Molecular Screening for Cardiac Ryanodine Receptor Type 2 Mutations in Sudden Unexplained Death R420W Mutated Case With Characteristics of Status Thymico-Lymphaticus

Relationship Between Oral Amiodarone and Inappropriate Therapy From an Implantable Cardioverter Defibrillator

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