Abstract
Sudden cardiac death remains a major public health care problem, generally occurring in patients with ventricular dysfunction. Beta-blockers, already of proven benefit for patients after myocardial infarction, have recently been shown to improve functional status and mortality outcomes in patients with heart failure. Amiodarone, a potent antiarrhythmic drug, was recently studied in a number of randomized clinical trials involving patients with heart failure and patients after myocardial infarction. Routine use of amiodarone cannot be recommended in these patient groups, but serious adverse outcomes were not observed. When antiarrhythmic drug therapy is required, amiodarone is the drug of choice for patients with structural heart disease.
Similar content being viewed by others
References and Recommended Reading
Myerburg RJ, Castellanos A: Cardiac arrest and sudden cardiac death. In In Heart Disease: A Textbook of Cardiovascular Medicine. Edited by Braunwald E. Philadelphia: WB Saunders; 1997:742–779.
Friedman M, Manwaring JH, Rosenman RH, et al.: Instantaneous and sudden deaths: Clinical and pathological differentiation in coronary artery disease. JAMA 1973, 225:1319–1328.
Kuller KH, Perper JA, Dai WS, et al.: Sudden death and the decline in coronary artery disease mortality. J Chronic Dis 1986, 39:1001–1019.
Engelstein ED, Zipes DP: Sudden cardiac death. In The Heart, Arteries and Veins. Edited by Alexander RW, Schlant RC, Fuster V New York: McGraw-Hill; 1998 1081–1112.
Myerbur RJ, Kessler KM, Castellanos A, et al.: Sudden cardiac death: Epidemiology, transient risk, and intervention assessment. Ann Intern Med 1993, 119:1187–1197.
Myerbur R, Kessler KM, Bassett AL, et al.: A biological approach to sudden cardiac death: Structure, function and cause. Am J Cardiol 1989, 63:1512–1516.
Willich SN, Maclure M, Mittelman M, et al.: Sudden cardiac death: Support for a role of triggering in causation. Circulation 1993, 87:1442–1450.
Muller JE, Kaufmann PG, Luepker RV, et al., for the Mechanisms Precipitating Acute Cardiac Events Participants: Mechanisms precipitating acute cardiac events: review and recommendations of an NHLBI workshop. Circulation 1997, 96:3233–3239.
Green HL: Sudden arrhythmic cardiac death: Mechanisms, resuscitation and classification: The Seattle perspective. Am J Cardiol 1990, 65:4B-12B.
Bayes de Luna AB, Coumel P, Leclercq J, et al.: Ambulatory sudden cardiac death: Mechanism of production of fatal arrhythmia on the basis of data from 157 cases. Am Heart J 1989, 117:151–159.
Luu M, Stevenson WG, Stevenson LW, et al.: Diverse mechanisms of unexpected cardiac arrest in advanced heart failure. Circulation 1989, 80:1675–1680.
Janse MJ, Wit AL: Electrophysiologic mechanisms of ventricular arrhythmias resulting from myocardial ischemia and infarction. Physiol Rev 1989, 69:1049–1154.
Pogwizd SM, Corr PB: Mechanisms underlying the development of ventricular fibrillation during early myocardial ischemia. Circ Res 1990, 66:672–695.
Parker GW, Michael LH, Hartley CJ: Central beta-adrenergic mechanisms may modulate ischemic ventricular fibrillation in pigs. Circ Res 1990, 66:259–270.
Åblad B, Bjurö T, Björkman JA, et al.: Role of central nervous beta-adrenoceptors in the prevention of ventricular fibrillation through augmentation of cardiac vagal tone [abstract]. J Am Coll Cardiol 1991, 17(suppl A):165.
Bigger JT, La Rovere MT, Steinman RC, et al.: Comparison of baroreflex sensitivity and heart period variability after myocardial infarction. J Am Coll Cardiol 1989, 14:1511–1518.
Cerati D, Schwartz PJ: Single cardiac vagal fiber activity, acute myocardial ischemia, and risk for sudden death Circ Res 1991, 69. 1389–1401.
The MIAMI Trial Research Group: Metoprolol in Acut Myocardial Infarction (MIAMI): a randomized placebocontrolled international trial. Eur Heart J 1985, 6:199–226.
Beta-Blocker Heart Attack Trial Research Group: A randomized trial of propanolol in patients with acute myocardial infarction, I: mortality results. JAMA 1982, 247:1407–1414.
Hjalmarson Å, Elmfeldt D, Herlitz J, et al.: Effect on mortality of metoprolol in acute myocardial infarction: a double blind randomized trial. Lancet 1981, 2:823–827.
Rydén L, Arineigo R, Arnman K, et al.: A double-blind trial of metoprolol in acute myocardial infarction: effects on ventricular tachyarrhythmias N Engl J Med 1983, 308:614–618.
Ryan T, Anderson J, Antman E, et al.: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Acute Myocardial Infarction). Circulation 1996, 94:2341–2350.
Cohn JN, Johnson G, Ziesche S, et al.: A comparison of enalapril with hydralazine-isosorbide dinitrate in the treatment of chronic congestive heart failure. N Engl J Med 1991, 325:303–310.
Fonorow GC, Chelimsky-Fallick C, Stevenson LW, et al.: Effect of direct vasodilatation vs angiotensin-converting enzyme inhibition on mortality in advanced heart failure: the Hy-C trial. J Am Coll Cardiol 1992, 19:842–850.
Keogh AM, Baron DW, Hickie JB, et al.: Prognostic guides in patients with idiopathic or ischemic dilated cardiomyopathy assessed for cardiac transplantation. Am J Cardiol 1990, 65:903–908.
Waagstein F, Hjalmarson A, Varnauskas E, et al.: Effect of chronic beta-adrenergic blockade in congestive cardiomyopathy. Br. Heart J 1975, 37:1022–36.
Waagstein F, Bristow MR, Swedberg, et al.: Beneficial effects of metoprolol in idiopathic dilated cardiomyopathy. Lancet 1993, 342:1441–1446.
Fisher ML, Gottlieb SS, Plotnick GD, et al.: Beneficial effects of metoprolol in heart failure associated with coronary artery disease. J Am Coll Cardiol 1994, 23:943–950.
Eichhorn EJ, Heesch CM, Barnett JH, et al.: Effect of metoprolol on myocardial function and energetics in patients with nonischemic dilated cardiomyopathy: a randomized, double-blind, placebo-controlled study. J Am Coll Cardio 1994, 24 1310–1320.
CIBIS Investigators and Committees: A randomized trial of beta-blockade in heart failure: the Cardiac Insufficiency Bisoprolol Study (CIBIS). Circulation 1994, 90:1765–1773.
CIBIS-II Investigators and Committees: The Cardiac Insufficiency Bisoprolol Study II (CIBIS-II): a randomized trial. Lancet 1999, 353 9–13. This multicenter, double-blind, randomized study showed a significant reduction in all-cause mortality and sudden cardiac death for patients with symptomatic heart failure. The etiology of heart failure did not influence the results.
MERIT-HF Study Group: Effect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL Randomized Intervention Trial in Congestive Heart Failure (MERIT-HF). Lancet 1999, 353:2001–2007. This paper provided evidence that patients with chronic heart failure experience significant reduction of all-cause mortality, worsening heart failure and sudden cardiac death if metoprolol is added to an accepted heart failure regimen.
Packer M, Bristow MR, Cohn J, et al., for the US Carvedilol Heart Failure Study Group: The effect of carvedilol on morbidity and mortality in patients with chronic heart failure. N Engl J Med 1996, 334:1349–1355.
Australia-New Zealand Heart Failure Research Collaborative Group: Effects of carvedilol, a vasodilator-beta-blocker, in patients with congestive heart failure due to ischemic heart disease. Circulation 1995, 92:212–218.
Colucci WS, Packer M, Bristow MR, et al.: Carvedilol inhibits clinical progression in patients with mild heart failure. Circulation 1996, 94:2800–2806.
Bristow MR, Gilbert EM, Abraham WT, et al.: Carvedilol produces dose-related improvements in left ventricular function and survival in subjects with chronic heart failure. Circulation 1996, 94:2807–2816.
Gilbert E, Abraham W, Olsen S, et al.: Comparative hemodynamic, left ventricular functional, and antiadrenergic effects of chronic treatment with metoprolol versus carvedilol in the failing heart. Circulation 1996, 94:2817–2825.
Weinberg BA, Miles WM, Klein LS, et al.: Five-year follow-up of 589 patients treated with amiodarone. Am Heart J 1993, 125 109–120.
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.
Doval HC, Nul DR, Grancelli HO, et al.: Randomized trial of low-dose amiodarone in severe congestive heart failure. Grupo de Estudio de la Sobrevida en la Insuficiencia Cardiaca en Argentina (GESICA). Lancet 1994, 344:493–498.
Massie BM, Fisher SG, Radford M, et al.: Effect of amiodaron on clinical status and left ventricular function in patients with congestive heart failure. CHF-STAT Investigators. Circulation 1996, 93:2128–2134.
Singh SN, Fletcher RD, Fisher SG, et al.: Amiodarone in patients with congestive heart failure and symptomatic ventricular arrhythmia. Survival Trial of Antiarrhythmic Therap in Congestive Heart Failure. N Engl J Med 1995, 333 77–82.
The Cardiac Arrhythmia Suppresion Trial II Investigators: Effect of the antiarrhythmic agent moricizine on survival after myocardial infarction. N Engl J Med 1992, 327:227–233.
The Cardiac Arrhythmia Suppression Trial (CAST) Investigators: Preliminary report: effect of encainide and flecainide on mortality in a randomized trial of arrhythmia suppression after myocardial infarction. N Engl J Med 1989, 321:406–412.
Burkart F, Pfisterer M, Kiowski W, et al.: Effect of antiarrhythmic therapy on mortality of survivors of myocardial infarction with asymptomatic complex ventricular arrhythmias: Basel Antiarrhythmic Study of Infarct Survival (BASIS), J Am Coll Cardiol 1990, 16:1711–1718.
Cairns JA, Connolly SJ, Roberts R, et al.: Randomized trial of outcome after myocardial infarction in patients with frequent or repetitive ventricular premature depolarizations CAMIAT. Lancet 1997, 349:675–682.
Julian DG, Camm AJ, Frangin G, et al.: European Myocardial Infarct Amiodarone Trial Investigators. Randomized trial of effect of amiodarone on mortality in patients with left ventricular dysfunction after recent myocardial infarction: EMIAT. Lancet 1997, 349:667–674.
Janse MJ, Malik M, Camm AJ, et al.: Identification of post acute myocardial infarction patients with potential benefit from prophylactic treatment with amiodarone. A substud of EMIAT. Eur Heart J 1998, 9:85–95. This paper provides a post-hoc analysis of baseline parameters from patients in the EMIAT study. The authors attempt to identify subgroups that might benefit or be harmed from treatment with amiodarone.
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.
Klein H, Auricchio A, Reek S, et al.: New primary prevention trials of sudden cardiac death in patients with left ventricular dysfunction: SCD-HEFT and MADIT-II. Am J Cardiol 1999, 83:91D-97D. This study is aimed at evaluating whether patients with ischemic or nonischemic cardiomyopathy who are in NYHA II or III failure will experience a reduction in overall mortality if provided with an implantable defibrillator. Amiodarone will be used as alternative treatment modality.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Frankenberger, O., Steinber, J.S. Beta-blockers and amiodarone for the primary prevention of sudden cardiac death. Curr Cardiol Rep 1, 274–281 (1999). https://doi.org/10.1007/s11886-999-0050-8
Issue Date:
DOI: https://doi.org/10.1007/s11886-999-0050-8