Tags

Type your tag names separated by a space and hit enter

Amiodarone in patients with congestive heart failure and asymptomatic ventricular arrhythmia. Survival Trial of Antiarrhythmic Therapy in Congestive Heart Failure.
N Engl J Med. 1995 Jul 13; 333(2):77-82.NEJM

Abstract

BACKGROUND

Asymptomatic ventricular arrhythmias in patients with congestive heart failure are associated with increased rates of overall mortality and sudden death. Amiodarone is now used widely to prevent ventricular tachycardia and fibrillation. We conducted a trial to determine whether amiodarone can reduce overall mortality in patients with congestive heart failure and asymptomatic ventricular arrhythmias.

METHODS

We used a double-blind, placebo-controlled protocol in which 674 patients with symptoms of congestive heart failure, cardiac enlargement, 10 or more premature ventricular contractions per hour, and a left ventricular ejection fraction of 40 percent or less were randomly assigned to receive amiodarone (336 patients) or placebo (338 patients). The primary end point was overall mortality, and the median follow-up was 45 months (range, 0 to 54).

RESULTS

There was no significant difference in overall mortality between the two treatment groups (P = 0.6). The two-year actuarial survival rate was 69.4 percent (95 percent confidence interval, 64.2 to 74.6) for the patients in the amiodarone group and 70.8 percent (95 percent confidence interval, 65.7 to 75.9) for those in the placebo group. At two years, the rate of sudden death was 15 percent in the amiodarone group and 19 percent in the placebo group (P = 0.43). There was a trend toward a reduction in overall mortality among the patients with nonischemic cardiomyopathy who received amiodarone (P = 0.07). Amiodarone was significantly more effective in suppressing ventricular arrhythmias and increased the left ventricular ejection fraction by 42 percent at two years.

CONCLUSIONS

Although amiodarone was effective in suppressing ventricular arrhythmias and improving ventricular function, it did not reduce the incidence of sudden death or prolong survival among patients with heart failure, except for a trend toward reduced mortality among those with nonischemic cardiomyopathy.

Authors+Show Affiliations

Department of Cardiology, Veterans Affairs Medical Center, Washington, D.C. 20422, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

7539890

Citation

Singh, S N., et al. "Amiodarone in Patients With Congestive Heart Failure and Asymptomatic Ventricular Arrhythmia. Survival Trial of Antiarrhythmic Therapy in Congestive Heart Failure." The New England Journal of Medicine, vol. 333, no. 2, 1995, pp. 77-82.
Singh SN, Fletcher RD, Fisher SG, et al. Amiodarone in patients with congestive heart failure and asymptomatic ventricular arrhythmia. Survival Trial of Antiarrhythmic Therapy in Congestive Heart Failure. N Engl J Med. 1995;333(2):77-82.
Singh, S. N., Fletcher, R. D., Fisher, S. G., Singh, B. N., Lewis, H. D., Deedwania, P. C., Massie, B. M., Colling, C., & Lazzeri, D. (1995). Amiodarone in patients with congestive heart failure and asymptomatic ventricular arrhythmia. Survival Trial of Antiarrhythmic Therapy in Congestive Heart Failure. The New England Journal of Medicine, 333(2), 77-82.
Singh SN, et al. Amiodarone in Patients With Congestive Heart Failure and Asymptomatic Ventricular Arrhythmia. Survival Trial of Antiarrhythmic Therapy in Congestive Heart Failure. N Engl J Med. 1995 Jul 13;333(2):77-82. PubMed PMID: 7539890.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Amiodarone in patients with congestive heart failure and asymptomatic ventricular arrhythmia. Survival Trial of Antiarrhythmic Therapy in Congestive Heart Failure. AU - Singh,S N, AU - Fletcher,R D, AU - Fisher,S G, AU - Singh,B N, AU - Lewis,H D, AU - Deedwania,P C, AU - Massie,B M, AU - Colling,C, AU - Lazzeri,D, PY - 1995/7/13/pubmed PY - 1995/7/13/medline PY - 1995/7/13/entrez SP - 77 EP - 82 JF - The New England journal of medicine JO - N Engl J Med VL - 333 IS - 2 N2 - BACKGROUND: Asymptomatic ventricular arrhythmias in patients with congestive heart failure are associated with increased rates of overall mortality and sudden death. Amiodarone is now used widely to prevent ventricular tachycardia and fibrillation. We conducted a trial to determine whether amiodarone can reduce overall mortality in patients with congestive heart failure and asymptomatic ventricular arrhythmias. METHODS: We used a double-blind, placebo-controlled protocol in which 674 patients with symptoms of congestive heart failure, cardiac enlargement, 10 or more premature ventricular contractions per hour, and a left ventricular ejection fraction of 40 percent or less were randomly assigned to receive amiodarone (336 patients) or placebo (338 patients). The primary end point was overall mortality, and the median follow-up was 45 months (range, 0 to 54). RESULTS: There was no significant difference in overall mortality between the two treatment groups (P = 0.6). The two-year actuarial survival rate was 69.4 percent (95 percent confidence interval, 64.2 to 74.6) for the patients in the amiodarone group and 70.8 percent (95 percent confidence interval, 65.7 to 75.9) for those in the placebo group. At two years, the rate of sudden death was 15 percent in the amiodarone group and 19 percent in the placebo group (P = 0.43). There was a trend toward a reduction in overall mortality among the patients with nonischemic cardiomyopathy who received amiodarone (P = 0.07). Amiodarone was significantly more effective in suppressing ventricular arrhythmias and increased the left ventricular ejection fraction by 42 percent at two years. CONCLUSIONS: Although amiodarone was effective in suppressing ventricular arrhythmias and improving ventricular function, it did not reduce the incidence of sudden death or prolong survival among patients with heart failure, except for a trend toward reduced mortality among those with nonischemic cardiomyopathy. SN - 0028-4793 UR - https://www.unboundmedicine.com/medline/citation/7539890/Amiodarone_in_patients_with_congestive_heart_failure_and_asymptomatic_ventricular_arrhythmia__Survival_Trial_of_Antiarrhythmic_Therapy_in_Congestive_Heart_Failure_ L2 - https://www.nejm.org/doi/10.1056/NEJM199507133330201?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -