PubMed · 10436909
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J L Wemeau. 1999. [Iatrogenic thyroid disorders].. https://doi.org/10.1016/s0248-8663(99)80128-3
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Review of available data suggests that serial drug testing in patients with a history of sustained ventricular tachyarrhythmias using various antiarrhythmic drugs including amiodarone is able to identify subgroups with favorable and unfavorable outcome (patient groups with suppression vs. no suppression of inducibility of VT/VF). These results more likely reflect patient selection rather than drug effects, thus limiting the role of electrophysiologically guided antiarrhythmic therapy to actively modify outcome. All major and actual antiarrhythmic drug trials including an amiodarone arm, have chosen to deliver this drug empirically in both patients with asymptomatic as well as severely symptomatic life-threatening sustained ventricular tachyarrhythmias instead of a guided approach. The empiric approach is therefore adequate until new valid data comparing the empiric with the guidedor the invasive with the non invasiveapproach tell us otherwise.
AIMS: The objective of this study was to ascertain the effect of intravenous and oral amiodarone on morbidity and mortality in patients during the first hours after the onset of an acute myocardial infarction. METHODS AND RESULTS: A cohort of 1073 patients admitted to the CCU within 24 h of the onset of symptoms of an acute myocardial infarction and heart failure (Killip and Kimball A-B) were randomized to receive amiodarone (n=542) or placebo (n=531) for 6 months. Because of the higher mortality, on an interim analysis, from a 'high dose' of amiodarone or placebo (516 patients) the protocol was changed to a 'low dose' or placebo (557 patients). Mortality with high doses of amiodarone was 16.30% vs 10.16% in the placebo group (P=0.04), whereas mortality with low doses was 6.61% vs 9.47% in the control group (P=0.20). Several non-fatal adverse effects were observed in 108 and 73 patients treated with amiodarone and placebo, respectively. CONCLUSION: This study demonstrated that early administration of amiodarone in low doses to patients with an acute myocardial infarction may be used only if life-threatening arrhythmia justify its prescription. Conversely, when given in high doses, it might increase mortality.