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CLINICAL STUDY

Electrophysiologically guided amiodarone therapy versus the implantable cardioverter-defibrillator for sustained ventricular tachyarrhythmias after myocardial infarction

Results of long-term follow-up

^* Division of Cardiology, University Hospital (CHUV), Lausanne, Switzerland

Manuscript received February 9, 2000; revised manuscript received February 25, 2002, accepted February 28, 2002.

^* Reprint requests and correspondence to: Dr. Jürg Schläpfer, Division of Cardiology, CHUV, 1011 Lausanne, Switzerland.
Jurg.Schlaepfer{at}chuv.hospvd.ch

OBJECTIVES: We sought to compare the long-term survival rates of patients with sustained ventricular tachyarrhythmia after myocardial infarction (MI) who were treated according to the results of electrophysiological (EP) study either with amiodarone or an implantable cardioverter-defibrillator (ICD).

BACKGROUND: Patients with sustained ventricular tachyarrhythmias after MI are at high risk of sudden cardiac death (SCD). However, data comparing the long-term survival rates of patients treated with amiodarone or ICD, according to the results of EP testing, are lacking.

METHODS: Patients underwent a first EP study at baseline and a second one after a loading dose of amiodarone of 14 ± 2.9 g. According to the results of the second EP study, patients were classified either as responders or non-responders to amiodarone; non-responders were eventually treated with an ICD.

RESULTS: Eighty-four consecutive patients with MI (78 men; 21–77 years old; mean left ventricular (LV) ejection fraction 36 ± 11%) were consecutively included. Forty-three patients (51%) were responders, and 41 patients (49%) were non-responders to amiodarone therapy. During a mean follow-up period of 63 ± 30 months, SCD and total mortality rates were significantly higher in the amiodarone-treated patients (p = 0.03 and 0.02, respectively).

CONCLUSIONS: The long-term survival of patients with sustained ventricular tachyarrhythmias after MI, with depressed LV function, is significantly better with an ICD than with amiodarone therapy, even when stratified according to the results of the EP study. These patients should benefit from early ICD placement, and any previous amiodarone treatment seems to have no additional value.

Abbreviations and Acronyms   ACE   angiotensin-converting enzyme   EP   electrophysiological/electrophysiologically   ICD   implantable cardioverter-defibrillator   LV   left ventricle   LVEF   left ventricular ejection fraction   MI   myocardial infarction   NYHA   New York Heart Association   SCD   sudden cardiac death   VERP   ventricular effective refractory period   VF   ventricular fibrillation   VT   ventricular tachycardia

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