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(Circulation. 2006;114:104-109.)
© 2006 American Heart Association, Inc.

Arrhythmia/Electrophysiology

Effect of Amiodarone and Sotalol on Ventricular Defibrillation Threshold

The Optimal Pharmacological Therapy in Cardioverter Defibrillator Patients (OPTIC) Trial

Stefan H. Hohnloser, MD; Paul Dorian, MD; Robin Roberts, MTech; Michael Gent, MSc; Carsten W. Israel, MD; Eric Fain, MD; Jean Champagne, MD; Stuart J. Connolly, MD

From the Department of Medicine, J.W. Goethe University (S.H.H., C.W.I.), Frankfurt, Germany; Department of Medicine, University of Toronto (P.D.), Toronto, Ontario, Canada; Department of Clinical Epidemiology and Biostatistics (R.R., M.G.) and Department of Medicine (S.J.C.), McMaster University, Hamilton, Ontario, Canada; St Jude Medical (E.F.), Sunnyvale, Calif; and Department of Medicine, University de Laval (J.C.), Quebec City, Quebec, Canada.

Correspondence to Stefan H. Hohnloser, MD, J.W. Goethe University, Department of Medicine, Division of Cardiology, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany. E-mail Hohnloser{at}em.uni-frankfurt.de

Received February 3, 2006; revision received April 26, 2006; accepted April 28, 2006.

Background— Many patients with implanted cardioverter defibrillators (ICDs) receive adjunctive antiarrhythmic drug therapy, most commonly amiodarone or sotalol. The effects of these drugs on defibrillation energy requirements have not been previously assessed in a randomized controlled trial.

Methods and Results— The Optimal Pharmacological Therapy in Cardioverter Defibrillator Patients (OPTIC) trial was a randomized clinical trial evaluating the efficacy of amiodarone plus ß-blocker and sotalol versus ß-blocker alone for reduction of ICD shocks. Within OPTIC, a prospectively designed substudy evaluated the effects of the 3 treatment arms on defibrillation energy requirements. Defibrillation thresholds (DFTs) were measured (binary step-down protocol) at baseline and again after 8 to 12 weeks of therapy in 94 patients, of whom 29 were randomized to receive ß-blocker therapy (control group), 35 to amiodarone plus ß-blocker, and 30 to sotalol. In the control group, the mean DFT decreased from 8.77±5.15 J at baseline to 7.13±3.43 J (P=0.027); in the amiodarone group, DFT increased from 8.53±4.29 to 9.82±5.84 J (P=0.091). In the sotalol group, DFT decreased from 8.09±4.81 to 7.20±5.30 J (P=0.21). DFT changes in the ß-blocker and the amiodarone group were significantly different (P=0.006). In all patients, adequate safety margins for defibrillation were maintained. No clinical variable predicted baseline DFT or changes in DFT on therapy.

Conclusion— Although amiodarone increased DFT, the effect size with modern ICD systems is very small. Therefore, DFT reassessment after the institution of antiarrhythmic drug therapy with amiodarone or sotalol is not routinely required.

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CLINICAL PERSPECTIVE

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