Concomitant amiodarone and the implantable cardioverter-defibrillator: is there a place?
OBJECTIVE
To discuss the controversy surrounding concomitant therapy with amiodarone and the implantable cardioverter-defibrillator (ICD).


METHODS
A MEDLINE search identified English-language literature sources, including nonhuman studies.


METHODS
Studies included those that specifically addressed the use of amiodarone plus the ICD as well as reviews of the ICD.


METHODS
Studies were evaluated for design, type of defibrillation electrode or defibrillator, method of defibrillation, amiodarone loading and maintenance dosages, duration of amiodarone therapy, and study endpoints.


RESULTS
Because the ICD functions by delivering energy to depolarize a mass of myocardium, concomitant use of antiarrhythmic agents that elevate the defibrillation threshold (DFT) beyond an ICD's energy capability may adversely effect patient outcome. Amiodarone has been shown to both increase and decrease the DFT. Trials examining the use of amiodarone plus the ICD have not provided strong evidence that amiodarone will decrease the number of ICD discharges or favorably affect the mortality rate. Amiodarone is also expensive and toxic. Although the cost of the ICD is relatively high, continuing improvements in battery life will decrease long-term costs.


CONCLUSIONS
Controlled trials are required to substantiate the improved survival rate with the ICD and to determine the role of antiarrhythmic agents in conjunction with the device. At present, there are no data to support the combination of amiodarone and an ICD in terms of improved quality or duration of life.
McCollam
P L
PL
Department of Hospital Pharmacy Practice & Administration, College of Pharmacy, Medical University of South Carolina, Charleston 29425.
Nappi
J M
JM
D000638:Amiodarone / Q000627:therapeutic use*; D000818:Animals; D003131:Combined Modality Therapy; D016757:Death, Sudden, Cardiac / Q000517:prevention & control; D017147:Defibrillators, Implantable / Q000145:classification; D004554:Electric Countershock / Q000379:methods*; D006801:Humans; D017180:Tachycardia, Ventricular / Q000628:therapy; D014693:Ventricular Fibrillation / Q000628:therapy
D000638:Amiodarone