USE OF AMIODARONE IN THE POSTMYOCARDIAL INFARCTION PATIENT

Amiodarone appears to be an effective antiarrhythmic agent for reducin g mortality in the postmyocardial infarction patient with ventricular ectopic activity. Such activity has long been recognized to have an ad verse effect on prognosis after acute myocardial infarction. When a st rong correlation between ectopic activity and left ventricular dysfunc tion was demonstrated ventricular ectopic activity was thought to be a consequence of underlying myocardial damage. However ventricular ecto pic activity is now considered to be as independent risk factor for mo rtality after myocardial infarction. Because of the basic premise that a positive correlation existed between arrhythmia suppression, and im proved survival, it had been common practice to use antiarrhythmic age nts to treat asymptomatic ventricular ectopic activity in the postinfa rction patient. After the results of the Cardiac Arrhythmia Suppressio n Trial (CAST) were released, this practice was largely abandoned. in the post-CAST era, however, amiodarone has appeared to improve surviva l in patients who have sustained myocardial infarctions, In this repor t, we briefly review the pharmacology of amiodarone and discuss the re sults of relevant clinical trials, Large, multicenter trials currently under way may clarify some of the unanswered questions surrounding th e use of this promising antiarrhythmic agent in postmyocardial infarct ion patients.