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J Am Coll Cardiol, 2003; 41:1707-1712, doi:10.1016/S0735-1097(03)00297-3
© 2003 by the American College of Cardiology Foundation
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CLINICAL RESEARCH

Amiodarone versus implantable cardioverter-defibrillator:randomized trial in patients with nonischemicdilated cardiomyopathy and asymptomaticnonsustained ventricular tachycardia—AMIOVIRT

S. Adam Strickberger, MD, FACC*,*, John D. Hummel, MD, FACC{dagger}, Thomas G. Bartlett, MD, FACC{ddagger}, Howard I. Frumin, MD, FACC§, Claudio D. Schuger, MD, FACC||, Scott L. Beau, MD, FACC, Cynthia Bitar, RN#, Fred Morady, MD, FACC# AMIOVIRT Investigators

* Washington Hospital Center, Washington, DC, USA
{dagger} Mid-Ohio Cardiology Consultants, Columbus, Ohio, USA
{ddagger} Northwest Ohio Cardiology Consultants, Toledo, Ohio, USA
§ Northpointe Heart Center, Berkley, Michigan, USA
|| Henry Ford Hospital, Detroit, Michigan, USA
Blandford Physician Center, Little Rock, Arkansas, USA
# University of Michigan, Ann Arbor, Michigan, USA

Manuscript received July 1, 2002; revised manuscript received December 10, 2002, accepted January 9, 2003.

* Reprint requests and correspondence: Dr. S. Adam Strickberger, Washington Hospital Center, 110 Irving Street, NW, #5A-12, Washington, DC 20010-3455, USA.
strickberger{at}medstar.net

OBJECTIVES: The purpose of this multicenter randomized trial was to compare total mortality during therapy with amiodarone or an implantable cardioverter-defibrillator (ICD) in patients with nonischemic dilated cardiomyopathy (NIDCM) and nonsustained ventricular tachycardia (NSVT).

BACKGROUND: Whether an ICD reduces mortality more than amiodarone in patients with NIDCM and NSVT is unknown.

METHODS: One hundred three patients with NIDCM, left ventricular ejection fraction ≤0.35, and asymptomatic NSVT were randomized to receive either amiodarone or an ICD. The primary end point was total mortality. Secondary end points included arrhythmia-free survival, quality of life, and costs.

RESULTS: The study was stopped when the prospective stopping rule for futility was reached. The percent of patients surviving at one year (90% vs. 96%) and three years (88% vs. 87%) in the amiodarone and ICD groups, respectively, were not statistically different (p = 0.8). Quality of life was also similar with each therapy (p = NS). There was a trend with amiodarone, as compared to the ICD, towards improved arrhythmia-free survival (p = 0.1) and lower costs during the first year of therapy ($8,879 vs. $22,039, p = 0.1).

CONCLUSIONS: Mortality and quality of life in patients with NIDCM and NSVT treated with amiodarone or an ICD are not statistically different. There is a trend towards a more beneficial cost profile and improved arrhythmia-free survival with amiodarone therapy.

Abbreviations and Acronyms
  CAD
  coronary artery disease
  ICD
  implantable cardioverter-defibrillator
  NIDCM
  nonischemic dilated cardiomyopathy
  NSVT
  nonsustained ventricular tachycardia
  SCD
  sudden cardiac death
  VF
  ventricular fibrillation
  VT
  ventricular tachycardia




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