Mortality benefit of implantable cardioverter-defibrillator therapy in patients with persistent malignant ventricular arrhythmias despite amiodarone treatment

The American Journal of Cardiology
H V BarronM D Lesh

Abstract

Implantable cardioverter defibrillators (ICDs) are very effective in preventing sudden cardiac death. However, debate continues as to whether ICD implantation is superior to amiodarone in prolonging survival in patients with life-threatening ventricular arrhythmias. Of 442 consecutive patients treated with amiodarone, we identified 48 patients with symptomatic ventricular arrhythmias who met all of the following inclusion criteria: (1) had inducible sustained ventricular tachycardia at baseline electrophysiologic study, (2) had an oral amiodarone load of at least 10 g over 10 to 14 days, (3) remained inducible with a hemodynamically unstable ventricular arrhythmia at follow-up electrophysiologic study, and (4) were advised to continue amiodarone therapy and undergo ICD implantation. Patients who agreed to undergo ICD implantation (n = 28) had a lower ejection fraction (29 +/- 9% vs 40 +/- 12% p <0.005) and were younger (61.0 +/- 10 vs 69 +/- 7 years, p <0.01) than patients who refused device implantation (n = 20). Using a Cox proportional-hazards model, defibrillator therapy was the strongest independent predictor of improved survival in patients with an ejection fraction < or =40% (RR = 0.42; 95% confidence interval 0.22 to 0....Continue Reading

References

Apr 1, 1992·The American Journal of Cardiology·D NewmanJ C Griffin
Sep 15, 1991·The American Journal of Cardiology·S L PinskiR G Trohman
Dec 1, 1989·Pacing and Clinical Electrophysiology : PACE·E P Veltri
May 1, 1989·Journal of the American College of Cardiology·R A WinkleT Shipman
Aug 1, 1987·Journal of the American College of Cardiology·M EldarM M Scheinman
Apr 1, 1986·Annals of Internal Medicine·F E MarchlinskiM E Josephson
May 1, 1983·Annals of Internal Medicine·M MirowskiM L Weisfeldt
Mar 1, 1993·Pacing and Clinical Electrophysiology : PACE·R N Fogoros
Apr 1, 1994·Circulation·M O Sweeney, J N Ruskin
May 15, 1993·The American Journal of Cardiology·S G Kim

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Citations

Feb 4, 2010·Quality of Life Research : an International Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation·Chi-Wen KaoSue A Thomas
Jun 13, 2000·Cardiology Clinics·J M MillerL R Scott
Feb 5, 2002·Expert Opinion on Pharmacotherapy·S A Doggrell

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