Beneficial effects of low dose amiodarone in patients with congestive cardiac failure: a placebo-controlled trial

Department of Cardiology, Repatriation General Hospital, Heidelberg, Victoria, Australia.

The effects of amiodarone in a low dosage (200 mg every 8 h for 2 weeks, then 200 mg/day) was assessed in a double-blind placebo-controlled trial in 34 patients with a history of severe congestive heart failure but no sustained ventricular arrhythmia. Left ventricular ejection fraction, treadmill exercise tolerance and 48 h electrocardiographic monitoring were assessed before and repeatedly after beginning amiodarone or placebo therapy over 6 months, and side effects were monitored. In patients receiving amiodarone, the ejection fraction increased significantly from 19 +/- 7 to 29 +/- 15% at 6 months (p less than 0.01 from baseline), but not significantly in 14 placebo-treated patients (18 +/- 5 to 22 +/- 9%). Exercise tolerance increased significantly in amiodarone-treated patients (median 433 s to 907 s, p less than 0.05), but not significantly in placebo-treated patients (757 to 918 s). Nonsustained ventricular tachycardia was present in 88% of amiodarone-treated patients before, but in only 21% of patients after 6 months of treatment (p = 0.06); it was seen in 43% of placebo-treated patients at baseline and in 50% after 6 months. Fifty percent of amiodarone-treated patients had side effects (principally nausea) and the drug was withdrawn in 28% of cases; no life-threatening effects were seen. Low dose amiodarone appears to have a multifaceted potential to produce benefits in arrhythmia control, exercise tolerance and ventricular function in patients with a history of severe congestive heart failure, but better control of side effects (principally nausea) appears essential. Effects on mortality could not be determined from this study; such assessment requires a larger cohort of patients.

This article has been cited by other articles:

				J. W. Schrickel, J. O. Schwab, A. Yang, H. Bielik, A. Bitzen, B. Luderitz, and T. Lewalter Pro-arrhythmic effects of amiodarone and concomitant rate-control medication Europace, June 1, 2006; 8(6): 403 - 407. [Abstract] [Full Text] [PDF]

				S. E. Shoaf, M. V. Elizari, Z. Wang, K. Sekar, L. R. Grinfeld, N. A. Barbagelata, J. Lerman, S. L. Bramer, J. Tronge, and C. Orlandi Tolvaptan Administration Does Not Affect Steady State Amiodarone Concentrations in Patients With Cardiac Arrhythmias Journal of Cardiovascular Pharmacology and Therapeutics, July 1, 2005; 10(3): 165 - 171. [Abstract] [PDF]

				A Y Patwala and D J Wright Device based treatment of heart failure Postgrad. Med. J., May 1, 2005; 81(955): 286 - 291. [Abstract] [Full Text] [PDF]

				A. Ferro, C. Duilio, M. Santomauro, and A. Cuocolo Walk test at increased levels of heart rate in patients with dual-chamber pacemaker and with normal or depressed left ventricular function Eur. Heart J., December 1, 2003; 24(23): 2123 - 2132. [Abstract] [Full Text] [PDF]

				G. D. Sanders, M. A. Hlatky, N. R. Every, K. M. McDonald, P. A. Heidenreich, L. S. Parsons, and D. K. Owens Potential Cost-Effectiveness of Prophylactic Use of the Implantable Cardioverter Defibrillator or Amiodarone after Myocardial Infarction Ann Intern Med, November 20, 2001; 135(10): 870 - 883. [Abstract] [Full Text] [PDF]

				S.G. Priori, E. Aliot, C. Blomstrom-Lundqvist, L. Bossaert, G. Breithardt, P. Brugada, A.J. Camm, R. Cappato, S.M. Cobbe, C. Di Mario, et al. Task Force on Sudden Cardiac Death of the European Society of Cardiology Eur. Heart J., August 2, 2001; 22(16): 1374 - 1450. [PDF]

				B. N. Singh and J. S. M. Sarma Mechanisms of Action of Antiarrhythmic Drugs Relative to the Origin and Perpetuation of Cardiac Arrhythmias Journal of Cardiovascular Pharmacology and Therapeutics, March 1, 2001; 6(1): 69 - 87. [PDF]

				G. Cice, E. Tagliamonte, L. Ferrara, and A. Iacono Efficacy of carvedilol on complex ventricular arrhythmias in dilated cardiomyopathy: double-blind, randomized, placebo-controlled study Eur. Heart J., August 1, 2000; 21(15): 1259 - 1264. [Abstract] [PDF]

				S. J. Connolly Evidence-Based Analysis of Amiodarone Efficacy and Safety Circulation, November 9, 1999; 100(19): 2025 - 2034. [Full Text] [PDF]

				K. Katariya, E. DeMarchena, and H. Bolooki Oral amiodarone reduces incidence of postoperative atrial fibrillation Ann. Thorac. Surg., November 1, 1999; 68(5): 1599 - 1603. [Abstract] [Full Text] [PDF]

				P S Macdonald, A M Keogh, C Aboyoun, M Lund, R Amor, and D McCaffrey Impact of concurrent amiodarone treatment on the tolerability and efficacy of carvedilol in patients with chronic heart failure Heart, November 1, 1999; 82(5): 589 - 593. [Abstract] [Full Text]

				P. C. Deedwania, B. N. Singh, K. Ellenbogen, S. Fisher, R. Fletcher, and S. N. Singh Spontaneous Conversion and Maintenance of Sinus Rhythm by Amiodarone in Patients With Heart Failure and Atrial Fibrillation : Observations from the Veterans Affairs Congestive Heart Failure Survival Trial of Antiarrhythmic Therapy (CHF-STAT) Circulation, December 8, 1998; 98(23): 2574 - 2579. [Abstract] [Full Text] [PDF]

				E. G. Daoud, S. A. Strickberger, K. C. Man, R. Goyal, G. M. Deeb, S. F. Bolling, F. D. Pagani, C. Bitar, M. D. Meissner, and F. Morady Preoperative Amiodarone as Prophylaxis against Atrial Fibrillation after Heart Surgery N. Engl. J. Med., December 18, 1997; 337(25): 1785 - 1791. [Abstract] [Full Text] [PDF]

				I. Sim, K. M. McDonald, P. W. Lavori, C. M. Norbutas, and M. A. Hlatky Quantitative Overview of Randomized Trials of Amiodarone to Prevent Sudden Cardiac Death Circulation, November 4, 1997; 96(9): 2823 - 2829. [Abstract] [Full Text]

				A. Matsumori, K. Ono, R. Nishio, Y. Nose, and S. Sasayama Amiodarone Inhibits Production of Tumor Necrosis Factor-{alpha} by Human Mononuclear Cells : A Possible Mechanism for its Effect in Heart Failure Circulation, September 2, 1997; 96(5): 1386 - 1389. [Abstract] [Full Text]

				B. M. Massie, S. G. Fisher, P. C. Deedwania, B. N. Singh, R. D. Fletcher, and S. N. Singh Effect of Amiodarone on Clinical Status and Left Ventricular Function in Patients With Congestive Heart Failure Circulation, June 15, 1996; 93(12): 2128 - 2134. [Abstract] [Full Text]

				M. Grimm, G. Wieselthaler, R. Avanessian, G. Grimm, H. Schmidinger, W. Schreiner, A. Podczeck, E. Wolner, and G. Laufer THE IMPACT OF IMPLANTABLE CARDIOVERTER-DEFIBRILLATORS ON MORTALITY AMONG PATIENTS ON THE WAITING LIST FOR HEART TRANSPLANTATION J. Thorac. Cardiovasc. Surg., August 1, 1995; 110(2): 532 - 539. [Abstract] [Full Text]

				S. N. Singh, R. D. Fletcher, S. G. Fisher, B. N. Singh, H. D. Lewis, P. C. Deedwania, B. M. Massie, C. Colling, D. Lazzeri, and The Survival Trial of Antiarrhythmic Therapy in Co Amiodarone in Patients with Congestive Heart Failure and Asymptomatic Ventricular Arrhythmia N. Engl. J. Med., July 13, 1995; 333(2): 77 - 82. [Abstract] [Full Text] [PDF]

				G. W. Dec and V. Fuster Idiopathic Dilated Cardiomyopathy N. Engl. J. Med., December 8, 1994; 331(23): 1564 - 1575. [Full Text]