Electrophysiologic study-guided amiodarone for sustained ventricular tachyarrhythmias associated with structural heart diseases.

Abstract

BACKGROUND:

Although an electrophysiologic study (EPS) and Holter-monitoring are often helpful in evaluating the efficacy of antiarrhythmic drugs in patients with ventricular tachyarrhythmias (ventricular tachycardia/fibrillation (VT/VF)), the efficacy of EPS- or Holter-guided oral amiodarone therapy in Japanese patients is still unclear.

METHODS AND RESULTS:

EPS was performed 1 month after starting amiodarone, and Holter-monitoring was recorded before and 1 month after amiodarone in 188 patients with sustained VT/VF because of structural heart diseases. In spite of the judgment of EPS (n=89) or Holter (n=75), all patients continued amiodarone. Patients were followed up to 3 years and the primary endpoint was VT/VF recurrence and secondary endpoint was death by all cause. Kaplan-Meier estimated the risk of VT/VF recurrence was significantly smaller with EPS-guided amiodarone (p<0.01) but not with Holter-guided amiodarone. Multivariate Cox hazard analysis revealed that EPS-guided amiodarone was an independent factor suppressing the recurrence of VT/VF (p<0.05, 95% confidence interval =0.15 to 0.96). In the subgroup analysis, EPS-guided amiodarone was effective in patients with relatively well-preserved left ventricular ejection fraction (LVEF > or =0.30) but not in patients with lower LVEF (LVEF <0.30).

CONCLUSION:

EPS-guided amiodarone was useful for preventing recurrence of VT/VF in patients with a relatively well-preserved LVEF, but not always beneficial in patients with a lower LVEF.

• Authors: Takeshi Aiba, Kenichiro Yamagata, Wataru Shimizu, Atsushi Taguchi, Kazuhiro Satomi, Takashi Noda, Hideo Okamura, Kazuhiro Suyama, Naohiko Aihara, Shiro Kamakura, Takashi Kurita
• Journal: Circulation journal : official journal of the Japanese Circulation Society (Circ J) Vol. 72 Issue 1 Pg. 88-93 (Jan 2008) ISSN: 1346-9843 [Print] Japan
• PMID: 18159106 (Publication Type: Clinical Trial, Comparative Study, Journal Article)

Chemical References

• Amiodarone

Topics

• Aged
• Amiodarone (administration & dosage)
• Death
• Electrocardiography, Ambulatory
• Electrophysiologic Techniques, Cardiac
• Female
• Heart Diseases
• Humans
• Male
• Middle Aged
• Recurrence
• Stroke Volume
• Tachycardia, Ventricular (drug therapy)
• Treatment Outcome