Naccarelli G V, Wolbrette D L, Dell'Orfano J T, Patel H M, Luck J C
Section of Cardiology, Penn State University College of Medicine, Milton S. Hershey Medical Center, PennState Geisinger Health System, Hershey 17033, USA.
Clin Cardiol. 2000 Feb;23(2):73-82. doi: 10.1002/clc.4960230203.
Amiodarone is an antiarrhythmic agent commonly used in the treatment of supraventricular and ventricular tachyarrhythmias. This paper reviews clinical trials in which amiodarone was used in one of the treatment arms. Key post-myocardial infarction trials include EMIAT and CAMIAT, both of which demonstrated that amiodarone reduced arrhythmic but not overall mortality. In patients with congestive heart failure (CHF), amiodarone was associated with a neutral survival in CHF/STAT and improvement in survival in GESICA. In patients with nonsustained ventricular tachycardia, the MADIT trial demonstrated that therapy with an implantable cardioverter-defibrillator (ICD) improved survival compared with the antiarrhythmic drug arm in such patients, most of whom were taking amiodarone. In sustained VT/VF patients, the CASCADE trial demonstrated that empiric amiodarone lowered arrhythmic recurrence rates compared with other drugs guided by serial Holter or electrophysiologic studies. Several trials including AVID, CIDS, and CASH have demonstrated the superiority of ICD therapy compared with empiric amiodarone in improving overall survival. Clinical implications of these trials are discussed.
胺碘酮是一种常用于治疗室上性和室性快速心律失常的抗心律失常药物。本文回顾了将胺碘酮用于其中一个治疗组的临床试验。心肌梗死后的关键试验包括EMIAT和CAMIAT，两者均表明胺碘酮可降低心律失常死亡率，但不能降低总死亡率。在充血性心力衰竭（CHF）患者中，胺碘酮在CHF/STAT试验中与生存中性相关，在GESICA试验中与生存率改善相关。在非持续性室性心动过速患者中，MADIT试验表明，与抗心律失常药物组相比，植入式心脏复律除颤器（ICD）治疗可改善此类患者的生存率，其中大多数患者正在服用胺碘酮。在持续性室性心动过速/心室颤动患者中，CASCADE试验表明，与根据连续动态心电图或电生理研究指导使用的其他药物相比，经验性使用胺碘酮可降低心律失常复发率。包括AVID、CIDS和CASH在内的多项试验表明，与经验性使用胺碘酮相比，ICD治疗在改善总体生存率方面具有优越性。本文讨论了这些试验的临床意义。
