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

doi:10.1016/S0735-1097(03)00297-3

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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, Thomas G. Bartlett, MD, FACC, 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
Mid-Ohio Cardiology Consultants, Columbus, Ohio, USA
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 comparetotal mortality during therapy with amiodarone or an implantablecardioverter-defibrillator (ICD) in patients with nonischemicdilated cardiomyopathy (NIDCM) and nonsustained ventriculartachycardia (NSVT).

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

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

RESULTS: The study was stopped when the prospective stopping rule forfutility was reached. The percent of patients surviving at oneyear (90% vs. 96%) and three years (88% vs. 87%) in the amiodaroneand 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 tothe 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 NSVTtreated with amiodarone or an ICD are not statistically different.There is a trend towards a more beneficial cost profile andimproved 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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