Lee, Chang Hoon; Nam, Gi-Byoung; Park, Hyun-Gu; Kim, Hyung Yong; Park, Kyoung-Min; Kim, Jun; Choi, Kee-Joon; Kim, You-Ho
Circulation journal : official journal of the Japanese Circulation Society
2008Jan ; 72 ( 1 ) :102-5.
PMID : 18159108
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Lee, Chang Hoon -
Nam, Gi-Byoung -
Park, Hyun-Gu -
Kim, Hyung Yong -
Park, Kyoung-Min -
Kim, Jun -
Choi, Kee-Joon -
Kim, You-Ho -
ABSTRACT
BACKGROUND: Patients with atrial fibrillation (AF) or congestive heart failure (CHF) are more vulnerable to inappropriate shocks from implantable cardioverter-defibrillators (ICDs), but the effect of antiarrhythmic drugs in these patients remains unknown. METHODS AND
RESULTS: A total of 55 patients with AF and/or CHF (New York Heart Association functional class > or =III) who had ICDs were divided into 3 groups [amiodarone (n=24), sotalol (n=12), beta-blocker (n=19)] and the cumulative rates of inappropriate shocks were compared. The baseline characteristics of the 3 groups were not significantly different. The 4-year event rate of inappropriate shocks was 27.3% in the amiodarone group, 54.3% in the sotalol group, and 70.6% in the beta-blocker group (amiodarone vs beta-blocker: log-rank p=0.003; sotalol vs beta-blocker: log-rank p=0.16; amiodarone vs sotalol: log-rank p=0.29). Amiodarone reduced the risk of inappropriate shocks significantly as compared with beta-blockers (hazard ratio (HR) 0.17; 95% confidence interval (CI) 0.05-0.64; p=0.008), whereas sotalol did not (HR 0.57; 95%CI 0.19-1.68; p=0.3). Amiodarone was discontinued in 4 patients (16.7%) because of pulmonary toxicity and the dose was reduced in 4 patients (16.7%) because of a thyroid function abnormality.
CONCLUSIONS: Amiodarone is more effective than sotalol or beta-blockers in preventing inappropriate ICD shocks in patients with AF or CHF, but it has a significant risk of drug-related adverse effects.
Implantable cardioverter-defibrillator; antiarrhythmic drugs [amiodarone, sotalol, ¥â-blocker]
MESH
Adrenergic beta-Antagonists/administration & dosage/pharmacology/toxicity, Aged, Amiodarone/administration & dosage/pharmacology/toxicity, Anti-Arrhythmia Agents/*administration & dosage/pharmacology/toxicity, Atrial Fibrillation/therapy, Defibrillators, Implantable/*adverse effects, Electric Injuries/drug therapy/etiology/*prevention & control, Female, Heart Failure/therapy, Humans, Lung Diseases/chemically induced, Male, Middle Aged, Shock/prevention & control, Sotalol/administration & dosage/pharmacology/toxicity
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