Five-year follow-up of 589 patients treated with amiodarone

Long-Term Comparison of the Implantable Cardioverter Defibrillator Versus Amiodarone

“…This combined end point is comparable to the drug failure rate (defined as the occurrence of either sudden death or sustained ventricular arrhythmia or the need to discontinue the drug due to side effects) of 50% by year 5 reported by Weinberg et al 14 Weinberg et al 14 also reported a 32% probability of remaining alive and receiving amiodarone at 5 years. These rates are also comparable to the arrhythmia recurrence rate (defined as recurrence of VT/VF or sudden cardiac death) of 43% per year at 5 years reported by Herre et al 8 In the meta-analysis of the CIDS, AVID, and CASH trials, the mortality in the amiodarone arm at 5 years was approximately 40%.…”

Evidence-Based Analysis of Amiodarone Efficacy and Safety

“…The largest follow-up report of amiodarone treatment included 589 patients with supraventricular arrhythmia, 83% of whom had VT or VF (17% nonsustained VT). 36 The 5-year cumulative risk of sudden death was 22%; of total death, 46%. The cumulative risk of drug failure, defined as sudden death, ventricular arrhythmia recurrence, or drug discontinuation at 5 years, was 50%.…”

“…However, early concern about its noncardiac side effects 24,29 -31 has been replaced by appreciation of its low cardiovascular toxicity. 36,55 To help understand the evidence that amiodarone is relatively safe, one should understand the safety concerns regarding other antiarrhythmic drugs. On the basis of the results of several clinical trials and subsequent meta-analysis, considerable evidence accumulated in the early 1990s that many antiarrhythmic drugs increase the risk of death in the very patients who could benefit most from effective arrhythmia prevention, those with serious underlying myocardial and coronary artery disease.…”

“…Many large follow-up studies have reported no cases, 8,29,31 including the 2 largest (with 462 and 589 patients, respectively). 35,36 Use of programmed electrical stimulation can define a different type of potential proarrhythmic effect of antiarrhythmic drugs. Whereas amiodarone usually slows the rate of VT, faster VT has been reported after amiodarone in some cases.…”

Editorial: Rise and Fall of Guided Antiarrhythmic Therapy for Ventricular Tachycardia and Fibrillation

“…Amiodarone is a complex compound that has a low efficacy for preventing inducibility of V T N F by PES but that is an exceedingly potent agent for suppressing premature ventricular contractions and nonsustained VT (13). Over a decade or more, it has been widely accepted that when cases of V T N F are not controlled well with class I agents using guided therapy, empiric amiodarone chronically administered is likely to control 60-80% of such patients (14). In this context, the data from the randomized controlled study in cardiac arrest survivors-Cardiac Arrest in Seattle: Conventional Versus Amiodarone Drug Evaluation Study (CAS-CADE)-are of great importance (15).…”