Amiodarone did not significantly differ from an implantable cardioverter-defibrillator for total mortality, with 3-year survival rates of 88% versus 87% (p=0.8).
RCT (n=103)
randomized
Yes
Absolute Event Rate: 88% vs 87%
p-value: p=0.8
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 < or =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 US dollars vs. 22, 039 US dollars, 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.
“Thus far, there had been no single trial with non-ischemic HF in which the ICD showed clear benefit. The first lesson I think is that for an ICD to provide benefits>harms, there has to be a high enough baseline risk of cardiac arrest.”
Strickberger et al. (Thu,) conducted a rct in Nonischemic dilated cardiomyopathy and nonsustained ventricular tachycardia (n=103). Amiodarone vs. Implantable cardioverter-defibrillator (ICD) was evaluated on Total mortality (p=0.8). Amiodarone did not significantly differ from an implantable cardioverter-defibrillator for total mortality, with 3-year survival rates of 88% versus 87% (p=0.8).
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