Munther K. Homoud, MD, FACP, FACC, FHRS
In patients with cardiomyopathy, does amiodarone prevent sudden cardiac death (SCD)?
Included studies compared amiodarone for > 30 days with placebo or inactive control in patients with cardiomyopathy, had follow-up ≥ 6 months, and reported all-cause mortality. Studies were excluded if patients were < 18 years of age, had shock-refractory ventricular arrhythmia or out-of-hospital cardiac arrest, or had implantable cardioverter defibrillators (ICDs) unless such patients were in both treatment and control groups. Outcomes included SCD, cardiovascular death (CVD), all-cause mortality, drug toxicities, and drug discontinuation.
MEDLINE (to 2007), Cochrane Controlled Trials Register, US Food and Drug Administration Web site, ClinicalTrials.gov, and bibliographies of reviews were searched for randomized controlled trials (RCTs). 15 RCTs met the selection criteria (n = 8522, mean age 57 to 68 y, 68% to 99% men). 80% of selected RCTs were high quality (score ≥ 6) as evaluated with the Delphi Consensus Criteria.
Amiodarone decreased the incidence of SCD and CVD but not all-cause mortality (Table). Pulmonary, thyroid, and hepatic toxicity and bradyarrhythmia were more common with amiodarone (Table). Patients receiving amiodarone were more likely to discontinue treatment (Table).
In patients with cardiomyopathy, amiodarone reduces risk for sudden cardiac death and cardiovascular death but does not affect all-cause mortality and increases risk for toxicities.
Amiodarone vs placebo or control in patients with cardiomyopathy*
*Abbreviations defined in Glossary. RRR, RRI, NNT, NNH, and CI calculated from data in article using a random-effects model.
†Compared with placebo.
Homoud MK. Review: Amiodarone reduces risk for sudden cardiac death but not all-cause mortality in cardiomyopathy. Ann Intern Med. ;151:JC4–13. doi: 10.7326/0003-4819-151-8-200910200-02013
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Published: Ann Intern Med. 2009;151(8):JC4-13.
Cardiology, Rhythm Disorders and Devices.
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