Role of amiodarone in the era of the implantable cardioverter defibrillator.
Amiodarone is one of the most frequently used antiarrhythmic drugs in clinical practice. In patients with atrial fibrillation, in whom rhythm control is judged desirable, amiodarone is the most effective therapy. Amiodarone effectively prevents atrial fibrillation and may improve quality of life, but there is no evidence that it decreases mortality or severe morbidity in atrial fibrillation. In patients at risk for life-threatening ventricular arrhythmias, amiodarone may decrease mortality to a small degree, but the evidence for this benefit is incomplete. Patients with implantable cardioverter defibrillators frequently require antiarrhythmic drug therapy, especially to treat electrical storm. Amiodarone is useful in these patients; however, it may increase defibrillation thresholds in some patients. In patients with out-of-hospital DC shock-resistant VF, amiodarone is the most effective antiarrhythmic drug available to assist in resuscitation. Amiodarone is a complicated drug, and its optimal use requires careful patient surveillance with respect to potential adverse effects.
Dorian
Paul
P
Cardiology Division, St Michael's Hospital, Toronto, Ontario, Canada. dorianp@smh.toronto.on.ca
Mangat
Iqwal
I
D000638:Amiodarone / Q000627:therapeutic use*; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001145:Arrhythmias, Cardiac / Q000150:complications / Q000188:drug therapy / Q000517:prevention & control* / Q000628:therapy*; D002986:Clinical Trials as Topic; D003131:Combined Modality Therapy / Q000379:methods; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000517:prevention & control*; D004554:Electric Countershock / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D010138:Pacemaker, Artificial; D016896:Treatment Outcome
D000889:Anti-Arrhythmia Agents; D000638:Amiodarone