An implantable cardioverter defibrillator reduced total mortality compared to amiodarone (27% vs 47%; HR of amiodarone vs ICD 2.011, 95% CI 1.087-3.721) over a mean follow-up of 5.6 years.
RCT (n=120)
Randomly assigned
No
Does an implantable cardioverter defibrillator reduce total mortality compared to amiodarone in patients with a prior history of sustained ventricular tachycardia/ventricular fibrillation or cardiac arrest?
Long-term follow-up demonstrates that ICD therapy significantly reduces mortality compared to amiodarone for secondary prophylaxis of sudden cardiac death, while amiodarone is associated with high rates of adverse effects and discontinuation.
Hazard Ratio: 2.011 (95% CI 1.087–3.721)
Absolute Event Rate: 27% vs 47%
p-value: p=0.0261
BACKGROUND: The implantable cardioverter defibrillator (ICD) is superior to amiodarone for secondary prophylaxis of sudden cardiac death. However, the magnitude of this benefit over long-term follow-up is not known. Thus, our objective was to evaluate the long-term consequences of using amiodarone versus an ICD as first-line monotherapy in patients with a prior history of sustained ventricular tachycardia/ventricular fibrillation or cardiac arrest. METHODS AND RESULTS: A total of 120 patients were enrolled at St Michael's Hospital in the Canadian Implantable Defibrillator Study (CIDS) and were randomly assigned to receive either amiodarone (n=60) or an ICD (n=60). The treatment strategy was not altered after the end of CIDS unless the initial assigned therapy was not effective or was associated with serious side effects. After a mean follow-up of 5.6+/-2.6 years, there were 28 deaths (47%) in the amiodarone group, compared with 16 deaths (27%) in the ICD group (P=0.0213). Total mortality was 5.5% per year in the amiodarone group versus 2.8% per year in the ICD group (hazard ratio of amiodarone: ICD, 2.011; 95% confidence interval, 1.087 to 3.721; P=0.0261). In the amiodarone group, 49 patients (82% of all patients) had side effects related to amiodarone, of which 30 patients (50% of all patients) required discontinuation or dose reduction; 19 patients crossed over to ICD because of amiodarone failure (n=7) or side effects (n=12). CONCLUSIONS: In a subset of CIDS, the benefit of the ICD over amiodarone increases with time; most amiodarone-treated patients eventually develop side effects, have arrhythmia recurrences, or die.
Bokhari et al. (Wed,) conducted a rct in Prior history of sustained ventricular tachycardia/ventricular fibrillation or cardiac arrest (n=120). Implantable cardioverter defibrillator (ICD) vs. Amiodarone was evaluated on Total mortality (HR 2.011, 95% CI 1.087 to 3.721, p=0.0261). An implantable cardioverter defibrillator reduced total mortality compared to amiodarone (27% vs 47%; HR of amiodarone vs ICD 2.011, 95% CI 1.087-3.721) over a mean follow-up of 5.6 years.