Amiodarone versus implantable cardioverter-defibrillator:randomized trial in patients with nonischemicdilated cardiomyopathy and asymptomaticnonsustained ventricular tachycardia—AMIOVIRT

Strickberger, S. Adam; Hummel, John D.; Bartlett, Thomas G.; Frumin, Howard; Schuger, Claudio; Beau, Scott L.; Bitar, Cynthia; Morady, Fred

doi:10.1016/s0735-1097(03)00297-3

Cited by 514 publications

(182 citation statements)

References 26 publications

Supporting

Mentioning

161

Contrasting

Unclassified

Order By: Relevance

“…Nonetheless, previous reports were frequently confounded by a nonuniform patient population 33, 34. 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.…”

Section: Management Of Vt In Nicmmentioning

confidence: 99%

“…The clinical manifestation varies, including dyspnea, exertional intolerance, or a consequence of ventricular dysfunction and heart failure. Growing evidence has directed the clinical significance to the prevention of sudden cardiac death (SCD) in NICM patients, which is usually attributed to ventricular tachyarrhythmias arising from a diseased ventricular substrate 2, 3, 4. Therefore, in the risk stratification of NICM patients, given the potential specific therapies and risk prevention strategies for the nonuniform entities of NICM, the identification of the underlying pathogenesis is of clinical relevance.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Ventricular arrhythmias in nonischemic cardiomyopathy

Chung

Lin

et al. 2018

Journal of Arrhythmia

View full text Add to dashboard Cite

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.

show abstract

Section: Management Of Vt In Nicmmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Ventricular arrhythmias in nonischemic cardiomyopathy

Chung

Lin

et al. 2018

Journal of Arrhythmia

View full text Add to dashboard Cite

show abstract

“…First, most of the earlier trials were published during the period of evolving medical therapy; therefore, most of the heart failure patients in different studies were not optimally treated according to the current standards. For instance, the use of beta‐blockers was low in CAT and AMIOVIRT and only DANISH and COMPANION used aldosterone receptor blockers in approximately half of the study population 6, 7, 12, 13. Similarly, angiotensin‐converting enzyme inhibitors/angiotensin receptor blockers were not used uniformly across all the studies.…”

Section: Discussionmentioning

confidence: 99%

“…The six primary prevention trials were the Cardiomyopathy Trial (CAT); the Amiodarone vs Implantable Cardioverter‐Defibrillator Randomized Trial (AMIOVIRT); the Defibrillators in Nonischemic Cardiomyopathy Treatment Evaluation (DEFINITE) Trial; the SCD‐HeFT trial; the Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) Trial; and, more recently, the DANISH trial 5, 6, 7, 12, 13, 14. These trials display noticeable qualitative heterogeneities with regard to study design, comorbidity burden, and follow‐up duration.…”

Section: Discussionmentioning

confidence: 99%

“…Among primary prevention trials, the CAT, AMIOVIRT, DEFINITE, and DANISH trials exclusively enrolled patients with NICM, while SCD‐HeFT and COMPANION comprised patients with both ICM and NICM. CAT, AMIOVIRT, and DEFINITE randomized patients to ICD or medical therapy, while in DANISH, patients were randomized to ICD and usual care and about 58% of patients in both the groups received CRT device 7, 12, 13, 14. Furthermore, DANISH trial utilized maximum medical therapy in both groups and so far is the only trial which included NT pro‐BNP levels for enrollment 7.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Implantable cardioverter defibrillator in nonischemic cardiomyopathy: A systematic review and meta‐analysis

Khan

Ghimire

Talluri

et al. 2017

Journal of Arrhythmia

View full text Add to dashboard Cite

The evidence to support implantable cardioverter defibrillator (ICD) in subjects with nonischemic cardiomyopathy (NICM) for primary prevention of sudden cardiac death (SCD) is not robust. This meta‐analysis intends to assess the impact of routine ICD implantation for primary prevention of mortality due to SCD in NICM based on all the published randomized clinical trials (RCTs). Six RCTs were selected using PubMed/Medline, EMBASE, and CENTRAL from inception to December 2016. Outcomes were calculated as random‐effects relative risk (RR) and risk difference (RD) with 95% confidence interval (CI). Patients were randomized to ICD arm and control arm (usual care, medical treatment, and anti‐arrhythmic drugs). ICD significantly reduced all‐cause mortality in NICM patients (RR, 0.74, 95% CI, 0.56‐0.97, P = .03, I2 = 40). Mortality benefit was achieved due to a significant reduction in sudden cardiac death (SCD) (RR, 0.47, 95% CI, 0.30‐0.73, P < .001, I2 = 0). There were no statistical differences between two groups with regard to risk of noncardiac mortality, non‐SCD, cardiac arrest, cardiac transplant, sustained ventricular tachycardia (VT), and VT requiring medical treatment. Our results support efficacy of ICDs at reducing all‐cause mortality due to a reduction in SCD.

show abstract

Bayesian Classification of Clinical Practice Guidelines

Diamond

Kaul²

2009

Arch Intern Med

View full text Add to dashboard Cite

Clinical practice guidelines are generally constructed from an admixture of expert consensus opinion, case-control studies, and randomized controlled trials (RCTs) and are categorized according to the methodological quality of the underlying data (level of evidence) and the trade-off between the benefits and risks of treatment (class of recommendation). The process is driven principally by conventional statistical significance and does not specifically consider the clinical importance of the alternative treatment effects. We herein propose a more formal quantitative algorithm for the construction of guidelines using Bayes's theorem to integrate the clinical trial evidence with a range of prior belief representing the skeptical point of view embodied in the null hypothesis (to the effect that treatment can be expected to produce no reduction in risk), and the enthusiastic point of view embodied in the alternative hypothesis (to the effect that treatment can be expected to produce a specified clinically important reduction in risk). The operative practical utility of this algorithm is illustrated by application to a representative meta-analysis of RCTs. We conclude that this quantitative schema has the potential to improve the quality and cost of evidence-based clinical management.

show abstract

Amiodarone versus implantable cardioverter-defibrillator:randomized trial in patients with nonischemicdilated cardiomyopathy and asymptomaticnonsustained ventricular tachycardia—AMIOVIRT

Abstract: Mortality and quality of life in patients with NIDCM and NSVT treated with amiodarone or an ICD are not statistically different. There is a trend towards a more beneficial cost profile and improved arrhythmia-free survival with amiodarone therapy.

Cited by 514 publications

References 26 publications

Ventricular arrhythmias in nonischemic cardiomyopathy

Ventricular arrhythmias in nonischemic cardiomyopathy

Implantable cardioverter defibrillator in nonischemic cardiomyopathy: A systematic review and meta‐analysis

Bayesian Classification of Clinical Practice Guidelines

Contact Info

Product

Resources

About