The clinical efficacy of
amiodarone in the management of patients with complex
cardiac arrhythmias refractory to
therapy with two or more conventional or other investigational
anti-arrhythmic agents was studied by long-term follow-up of patients who had received the
drug for a period of at least three months. A total of 181 patients, classified into four groups (Group 1--supraventricular arrhythmias, n = 42; Group 2--frequent VPBs, n = 46; Group 3--nonsustained V-tach, n = 16; and Group 4--sustained V-tach, n = 77) received a daily maintenance dose of 200-800 mg of
Amiodarone for a period of up to 30 months. There were a total of 26 deaths (14%). Ten of these were classified as probable arrhythmic deaths; however, all had either good or excellent response to
therapy over a mean follow-up period of 14.9 months prior to death. The
drug had to be permanently discontinued due to side effects only in three patients and in the majority of patients with side effects symptoms could be alleviated with adjustment of dosage, thyroid replacement
therapy or transient cessation of
therapy. We conclude that
amiodarone is highly effective in the management of high-risk patients with complex refractory
cardiac arrhythmias and that close monitoring and prompt recognition of side effects and appropriate adjustment of dosage or institution of supplemental or replacement
therapy (in less than 5% of patients) will allow continuation of
amiodarone. The benefit of suppression of symptomatic arrhythmias and the potential of prevention of
sudden death, far outweighs the incidence of severe side effects.