Risk stratification and prognosis of patients treated with amiodarone for malignant ventricular tachyarrhythmias after myocardial infarction

Abstract

Seventy-seven consecutive patients (mean age 62 years) with episodes of sustained ventricular tachycardia (VT) or ventricular fibrillation (VF) after acute myocardial infarction (AMI) were evaluated to assess the long-term efficacy of first-line amiodarone treatment and to identify clinical and laboratory factors associated with a high risk of death or arrhythmia recurrence. The presenting arrhythmia was VT in 41 cases (53%) and VF in 36 (47%). VT or VF occurred between the 4th and 90th day after AMI in 45 cases (58%) and later (more than 90 days) in the remaining 32 (42%). The mean number of arrhythmic episodes was 4.2. Forty patients (52%) were in New York Heart Association (NYHA) class I or II, and 37 (48%) were in class III or IV. Mean left ventricular ejection fraction was 32%; ventricular aneurysm was present in 41 subjects. Most patients had multivessel coronary artery disease. Amiodarone was administered as a first-choice drug in all patients, in combination with other antiarrhythmic drugs in 14. By ventricular stimulation after loading doses of amiodarone, sustained VT was inducible in 46 (62%) and noninducible in 28 (38%). During a mean follow-up of 28 months the incidence of cardiac mortality at 1, 3, and 5 years was 21%, 37%, and 47%; of sudden death was 7%, 19%, and 23%; of nonfatal VT recurrence was 13%, 13%, and 24%, respectively. The overall incidence of amiodarone side effects was 35%.2+ was a weak predictor only by univariate analysis (p = 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Do We Need a Randomized Trial of Defibrillator Therapy in Every Subset of Patients with Increased Risk of Sudden Death?

“…The concept of using PES following amiodarone loading to select patients at high risk for life‐threatening arrhythmias is not new. Patients with ischemic LV systolic dysfunction and inducible VT following amiodarone loading have been shown to have high rates of mortality and sudden cardiac arrest 21–23 . The use of PES to identify patients with chagasic cardiomyopathy, a group with relatively preserved LV function, is less established.…”

Proteomics study and protein biomarkers of malignant ventricular arrhythmia in acute myocardial infarction patients

“…The diagnostics criteria of AMI were defined as previously reported. 4,5 The characteristics of the patients are presented in Table S1.…”