Amiodarone: what have we learned from clinical trials?

Clin Cardiol. 2000 Feb;23(2):73-82. doi: 10.1002/clc.4960230203.

Abstract

Amiodarone is an antiarrhythmic agent commonly used in the treatment of supraventricular and ventricular tachyarrhythmias. This paper reviews clinical trials in which amiodarone was used in one of the treatment arms. Key post-myocardial infarction trials include EMIAT and CAMIAT, both of which demonstrated that amiodarone reduced arrhythmic but not overall mortality. In patients with congestive heart failure (CHF), amiodarone was associated with a neutral survival in CHF/STAT and improvement in survival in GESICA. In patients with nonsustained ventricular tachycardia, the MADIT trial demonstrated that therapy with an implantable cardioverter-defibrillator (ICD) improved survival compared with the antiarrhythmic drug arm in such patients, most of whom were taking amiodarone. In sustained VT/VF patients, the CASCADE trial demonstrated that empiric amiodarone lowered arrhythmic recurrence rates compared with other drugs guided by serial Holter or electrophysiologic studies. Several trials including AVID, CIDS, and CASH have demonstrated the superiority of ICD therapy compared with empiric amiodarone in improving overall survival. Clinical implications of these trials are discussed.

Publication types

  • Review

MeSH terms

  • Amiodarone / therapeutic use*
  • Anti-Arrhythmia Agents / therapeutic use*
  • Clinical Trials as Topic
  • Death, Sudden, Cardiac / etiology
  • Death, Sudden, Cardiac / prevention & control
  • Defibrillators, Implantable
  • Heart Failure / complications
  • Humans
  • Multicenter Studies as Topic
  • Myocardial Infarction / complications
  • Randomized Controlled Trials as Topic
  • Tachycardia, Ventricular / etiology
  • Tachycardia, Ventricular / therapy
  • Ventricular Dysfunction, Left / etiology
  • Ventricular Dysfunction, Left / therapy

Substances

  • Anti-Arrhythmia Agents
  • Amiodarone