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Cardioverter-Defibrillator Reduces Sudden Death Compared With Amiodarone

An implantable cardioverter-defibrillator produces better survival rates than does amiodarone therapy in sustained ventricular tachyarrhythmias after heart attack.

This conclusion was the result of a study of 84 patients, carried out by Dr J Schläpfer and colleagues at the Division of Cardiology, University Hospital (CHUV), Lausanne, Switzerland. The patients who had experienced myocardial infarction had a mean left ventricular ejection fraction of about 36 percent.

Roughly half the patients were found to be responders to amiodarone therapy. The non responders were eventually treated with an implantable cardioverter-defibrillator.

The investigators found that during a mean follow-up period of 63 months, the sudden cardiac death rate and total mortality rate were significantly higher in the amiodarone-treated patients.

Dr Schläpfer concluded, "The long-term survival of patients with sustained ventricular tachyarrhythmias after myocardial infarction, with depressed left-ventricular function, is significantly better with an implantable cardioverter-defibrillator than with amiodarone therapy."

This finding on long-term survival was true even when patients were stratified according to the results of electrophysiological studies at base line and after a loading dose of amiodarone. "These patients should benefit from early implantable cardioverter-defibrillator, and previous amiodarone treatment seems to have no additional value."
Journal of the American College of Cardiology 2002;39(11):1813-1819. "Electrophysiologically guided amiodarone therapy versus the implantable cardioverter-defibrillator for sustained ventricular tachyarrhythmias after myocardial infarction: Results of long-term follow-up"

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