Published online before print July 6, 2004, doi: 10.1161/01.CIR.0000134957.51747.6E
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(Circulation. 2004;110:112-116.)
© 2004 American Heart Association, Inc.
Original Articles |
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)
From the Terrence Donnelly Heart Center, Department of Medicine, St Michael’s Hospital, Toronto, Ontario, Canada.
Correspondence to Paul Dorian, MD, FRCPC, St Michael’s Hospital, 30 Bond St, 7-050Q, Toronto, ON M5B 1W8, Canada. E-mail dorianp{at}smh.toronto.on.ca
Received November 3, 2003; de novo received December 23, 2003; revision received March 16, 2004; accepted March 19, 2004.
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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