Published Online
on July 6, 2004

A more recent version of this article appeared on July 13, 2004

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Submitted on November 3, 2003
Revised on March 16, 2004
Accepted on March 19, 2004

Long-Term Comparison of the Implantable Cardioverter Defibrillator Versus Amiodarone. Eleven-Year Follow-Up of a Subset of Patients in the Canadian Implantable Defibrillator Study (CIDS)

Fayez Bokhari MD, FRCPC, David Newman MD, FRCPC, Mary Greene RN, MSc, ACNP, Victoria Korley MD, FRCPC, Iqwal Mangat MD, FRCPC, and Paul Dorian MD, FRCPC^*

From the Terrence Donnelly Heart Center, Department of Medicine, St Michael’s Hospital, Toronto, Ontario, Canada.

^* To whom correspondence should be addressed. E-mail: dorianp{at}smh.toronto.on.ca.

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.

Key words: arrhythmia • antiarrhythmia agents • defibrillator, implantable

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