Are implantable cardioverter-defribrillators always superior to amiodarone?
The beneficial effects of amiodarone in preventing sudden cardiac death may predominantly be in patients without coronary artery disease. The AMIOdarone Versus Implantable CardioveRTer-defibrillator trial (AMIOVIRT) compared amiodarone and an implantable cardioverter-defribrillator (ICD) in non-ischaemic dilated cardiomyopathy with non-sustained ventricular arrhythmia. The trial was discontinued at the first interim analysis, as the prospective rule for inability to demonstrate statistical significance was reached. There were 7 deaths (5 cardiac, 2 sudden) in the amiodarone group (n = 52) and 6 (4 cardiac, 1 sudden) in the ICD group (n = 51). The cost of total medical care was lower in the amiodarone group than the ICD group. A reasonable approach may be to use the cheaper amiodarone initially in patients with non-ischaemic cardiomyopathy with non-sustained ventricular arrhythmias and when near syncope occurs, to insert an ICD.
Doggrell
Sheila A
SA
Doggrell Biomedical Communications, 47 Caronia Crescent, Lynfield, Auckland, New Zealand. s_doggrell@yahoo.com
D000368:Aged; D000638:Amiodarone / Q000191:economics / Q000627:therapeutic use*; D000889:Anti-Arrhythmia Agents / Q000191:economics / Q000627:therapeutic use*; D001145:Arrhythmias, Cardiac / Q000188:drug therapy; D002311:Cardiomyopathy, Dilated / Q000188:drug therapy; D003362:Cost-Benefit Analysis; D016757:Death, Sudden, Cardiac / Q000517:prevention & control*; D017147:Defibrillators, Implantable / Q000191:economics; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life
D000889:Anti-Arrhythmia Agents; D000638:Amiodarone