Springer Nature is making Coronavirus research free. View research | View latest news | Sign up for updates

Risk stratification and prognosis of patients treated with amiodarone for malignant ventricular tachyarrhythmias after myocardial infarction

  • 18 Accesses

  • 5 Citations

Summary

Seventy-seven consecutive patients (mean age 62 years) with episodes of sustained ventricular tachycardia (VT) or ventricular fibrillation (VF) after acute myocardial infarction (AMI) were evaluated to assess the long-term efficacy of first-line amiodarone treatment and to identify clinical and laboratory factors associated with a high risk of death or arrhythmia recurrence. The presenting arrhythmia was VT in 41 cases (53%) and VF in 36 (47%). VT or VF occurred between the 4th and 90th day after AMI in 45 cases (58%) and later (more than 90 days) in the remaining 32 (42%). The mean number of arrhythmic episodes was 4.2. Forty patients (52%) were in New York Heart Association (NYHA) class I or II, and 37 (48%) were in class III or IV. Mean left ventricular ejection fraction was 32%; ventricular aneurysm was present in 41 subjects. Most patients had multivessel coronary artery disease. Amiodarone was administered as a first-choice drug in all patients, in combination with other antiarrhythmic drugs in 14. By ventricular stimulation after loading doses of amiodarone, sustained VT was inducible in 46 (62%) and noninducible in 28 (38%). During a mean follow-up of 28 months the incidence of cardiac mortality at 1, 3, and 5 years was 21%, 37%, and 47%; of sudden death was 7%, 19%, and 23%; of nonfatal VT recurrence was 13%, 13%, and 24%, respectively. The overall incidence of amiodarone side effects was 35%. Factors independently associated with mortality for all causes and cardiac mortality included NYHA class III or IV (p<0,01), ejection fraction ⩽-35% (p<0,01), and age ⩾-65 years (p=0,03). History of cardiac arrest was a weak predictor only by univariate analysis (p=0.05). No single variable was consistently related to an increased risk of sudden death and nonfatal VT recurrence, not even inducibility of sustained VT during electropharmacologic studies (18% of incidence in responders and 30% in nonresponders, p = ns). In this study, amiodarone treatment of patients with life-threatening ventricular tachyarrhythmias after myocardial infarction confirmed its beneficial, but not uniform, efficacy. Severe left ventricular dysfunction, age, and, less significantly, history of cardiac arrest, were independent predictors of death. Identification of patients at high risk of arrhythmia recurrence and sudden death remains undefined during amiodarone treatment.

This is a preview of subscription content, log in to check access.

References

  1. 1.

    Heger JJ, Prystowsky EW, Jackman WM, et al. Amiodarone clinical efficacy and electrophysiology during long-term therapy for recurrent ventricular tachycardia or ventricular fibrillation.N Engl J Med 1981;305:539–545.

  2. 2.

    Waxman HL, Groh WC, Marchilinski FE, et al. Amiodarone for control of sustained ventricular tachyarrhythmias: Clinical and electrophysiologic effects in 51 patients.Am J Cardiol 1982;50:1066–1074.

  3. 3.

    Morady F, Saure MJ, Malone P, et al. Long-term efficacy and toxicity of high-dose amiodarone therapy for ventricular tachycardia or ventricular fibrillation.Am J Cardiol 1983;52:975–979.

  4. 4.

    Zipes DP, Prystowsky EN, Heger JJ. Amiodarone: Electrophysiologic actions, pharmacokinetics and clinical effects.J Am Coll Cardiol 1984;3:1059–1061.

  5. 5.

    McGovern B, Garan H, Malacoff RF, et al. Long-term clinical outcome of ventricular tachycardia or fibrillation treated with amiodarone.Am J Cardiol 1984;53:1558–1563.

  6. 6.

    Naccarelli GV, Fineberg NS, Zipes DP, et al. Amiodarone: Risk factors for recurrences of symptomatic ventricular tachycardia identified at electrophysiologic study.J Am Coll Cardiol 1985;6:814–821.

  7. 7.

    Horowitz LN, Greensplan AM, Spielman SR, et al. Usefulness of electrophysiologic testing in evaluation of amiodarone therapy for sustained ventricular tachyarrhythmias associated with coronary heart disease.Am J Cardiol 1985;55:367–371.

  8. 8.

    Fisher JD, Kim SG, Waspe Le, et al. Amiodarone: Value of programmed electrical stimulation and Holter monitoring.PACE 1986;9:422–435.

  9. 9.

    Yazaki Y, Haffajee CI, Gold RL, et al. Electrophysiologic predictors of long-term clinical outcome with amiodarone for refractory ventricular tachycardia secondary to coronary artery disease.Am J Cardiol 1987;60:293–297.

  10. 10.

    Klein LS, Fineberg N, Heger JJ. Prospective evaluation of a discriminant function for prediction of recurrent symptomatic ventricular tachycardia or ventricular fibrillation in coronary artery disease patients receiving amiodarone and having inducible ventricular tachycardia at electrophysiologic study.Am J Cardiol 1988;61:1024–1030.

  11. 11.

    Greenspan AJ, Volosin KJ, Greenberg RM, et al. Amiodarone therapy: Role of early and late electrophysiologic studies.J Am Coll Cardiol 1988;11:117–123.

  12. 12.

    Herre JM, Sauve MJ, Malone P, et al. Long-term results of amiodarone therapy in patients with recurrent sustained ventricular tachycardia or ventricular fibrillation.J Am Coll Cardiol 1989;13:442–449.

  13. 13.

    Manolis AS, Uricchio F, Estes NAM III. Prognostic value of early electrophysiologic studies for ventricular tachycardia recurrence in patients with coronary artery disease treated with amiodarone.Am J Cardiol 1989;63:1052–1057.

  14. 14.

    Strasberg B, Kusniec J, Zlotikamien B, et al. Long-term follow-up of postmyocardial infarction patients with ventricular tachycardia or ventricular fibrillation treated with amiodarone.Am J Cardiol 1990;15:673–678.

  15. 15.

    Myers M, Peter, T, Weiss D, et al. Benefit and risks of long-term amiodarone therapy for sustained ventricular tachycardia/fibrillation: Minimum of three-year follow-up in 145 patients.Am Heart J 1990;119:8–14.

  16. 16.

    Di Carlo LA Jr., Morady F, Sauvem J, et al. Cardiac arrest and sudden death in patients treated with amiodarone for sustained ventricular tachycardia or ventricular fibrillation: Risk stratification based on clinical variables.Am J Cardiol 1985;55:372–374.

  17. 17.

    CASCADE Investigators, Green HL (Corresp). Cardiac arrest in Seattle: Conventional versus amiodarone drug evaluation (The CASCADE Study).Am J Cardiol 1991;67:578–584.

  18. 18.

    Cairns JA, Connolly SJ, Gent M, et al. Post-myocardial infarction mortality in patients with ventricular permature depolarizations. Canadian Amiodarone Myocardial Infarction Arrhythmia Trial Pilot Study.Circulation 1991;84:550–557.

  19. 19.

    Burkart F, Pfisterer M, Kiowski W, et al. Effect of antiarrhythmic therapy on mortality in survivors of myocardial infarction with asymptomatic complex ventricular arrhythmias. Basel Antiarrhythmic Study of Infarct Survival (BASIS).J Am Coll Cardiol 1990;16:1711–1718.

  20. 20.

    Teo KK, Yusuf S, Furberg CD. Effect of antiarrhythmic drug therapy on mortality following myocardial infarction (abstr).Circulation 1990;82(Suppl III):III-197.

  21. 21.

    Ceremuzynski L, Kleczar E, Krzeminska-Pakula M, et al. Effect of amiodarone on mortality after myocardial infarction: A double-blind, placebo-controlled, pilot study.J Am Coll Cardiol 1992;20:1056–1062.

  22. 22.

    Wellens HJJ, Bar FW, Vanagt EJ, et al. Medical treatment of ventricular tachycardia: Consideration in the selection of patients for surgical treatment.Am J Cardiol 1982;49:186–193.

  23. 23.

    Di Marco JP, Lerman BB, Kron IL, et al. Sustained ventricular tachyarrhythmias within 2 months of acute myocardial infarction: Results of medical and surgical therapy in patients resuscitated from the initial episode.J Am Coll Cardiol 1985;6:759–768.

  24. 24.

    Kleiman RB, Miller JM, Buxton AE, et al. Prognosis following sustained ventricular tachycardia occurring early after myocardial infarction.Am J Cardiol 1988;62:528–533.

  25. 25.

    Proclemer A, Facchin D, Fresco C, et al. Contribution of the study of malignant ventricular arrhythmias in the subacute and late phases of myocardial infarction. Clinical-arrhythmological characteristics and prognostic value.G Ital Cardiol 1990;5:400–411.

  26. 26.

    Willems AR, Tijssen JG, van Capelle FJL, et al. Determinants of prognosis in symptomatic ventricular tachycardia or ventricular fibrillation late after myocardial infarction.J Am Coll Cardiol 1990;16:521–530.

  27. 27.

    Moosvi AR, Goldstein S, VanderBrug Medendorp S, et al. Effect of empiric antiarrhythmic therapy in resuscitated out-of-hospital cardiac arrest victims with coronary artery disease.Am J Cardiol 1990;65:1192–1197.

  28. 28.

    Waller TJ, Kay HR, Spielman SR, et al. Reduction in sudden death and total mortality by antiarrhythmic therapy evaluated by electrophysiologic drug testing: Criteria of efficacy in patients with sustained ventricular tachyarrhythmia.J Am Coll Cardiol 1987;10:83–89.

  29. 29.

    Wilber DJ, Garan H, Finkelstein D, et al. Out-of-hospital cardiac arrest. Use of electrophysiologic testing in the prediction of long-term outcome.N Engl J Med 1988;318:19–24.

  30. 30.

    Lampert S, Lown B, Graboys TD, et al. Determinants of survival in patients with malignant ventricular arrhythmia associated with coronary artery disease.Am J Cardiol 1988;61:791–797.

  31. 31.

    Brugada P, Talajic M, Smeets J, et al. The value of the clinical history to assess prognosis of patients with ventricular tachycardia or ventricular fibrillation after myocardial infarction.Eur Heart J 1989;10:747–752.

  32. 32.

    Brugada P, Lemery R, Talajic M, et al. Treatment of patients with ventricular tachycardia or ventricular fibrillation: First lessons from the “parallel study.” In: Brugada P, Wellens HJJ (eds). Cardiac arrhythmias: Where to go from here? Mount Kisco, NY: Futura Publishing, 1987:457–470.

  33. 33.

    Poole JE, Mathisen TL, Kudenchuk PJ, et al. Long-term outcome in patients who survive out of hospital ventricular fibrillation and undergo electrophysiologic studies: Evaluation by electrophysiologic subgroups.J Am Coll Cardiol 1990;16:657–665.

  34. 34.

    Kadish AH, Buxton AE, Waxman HL, et al. Usefulness of electrophisiologic study to determine the clinical tolerance of arrhythmia recurrences during amiodarone therapy.J Am Coll Cardiol 1987;10:90–95.

  35. 35.

    Levine JH, Mellits ED, Baumgardner RA, et al. Predictors of first discharge and subsequent survival in patients with automatic implantable cardioverter-defibrillators.Circulation 1991;84:558–566.

  36. 36.

    Newman D, Sauve MJ, Herre J, et al. Survival after implantation of the cardioverter defibrillator.Am J Cardiol 1992;69:899–903.

Download references

Author information

Correspondence to Dr. Alessandro Proclemer.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Proclemer, A., Facchin, D., Vanuzzo, D. et al. Risk stratification and prognosis of patients treated with amiodarone for malignant ventricular tachyarrhythmias after myocardial infarction. Cardiovasc Drug Ther 7, 683–689 (1993). https://doi.org/10.1007/BF00877822

Download citation

Key Words

  • ventricular tachycardia
  • ventricular fibrillation
  • myocardial infarction
  • amiodarone