Amiodarone: What have we learned from clinical trials?

Amiodarone is an antiarrhythmic agent commonly used in the treatment of sup raventricular 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 demon strated that amiodarone reduced arrhythmic but not overall mortality. Tn pa tients with congestive heart failure (CI-IF), amiodarone was associated wit h a neutral survival in CHF/STAT and improvement in survival in GESICA. In patients with nonsustained ventricular tachycardia, the MADIT trial demonst rated that therapy with an implantable cardioverter-defibrillator (ICD) imp roved survival compared with the antiarrhythmic drug arm in such patients, most of whom were taking amiodarone. Tn sustained VT/VF patients, the CASCA DE trial demonstrated that empiric amiodarone lowered arrhythmic recurrence rates compared with other drugs guided by serial Holter or electrophysiolo gic studies. Several trials including AVID, CIDS, and CASH have demonstrate d the superiority of ICD therapy compared with empiric amiodarone in improv ing overall survival. Clinical implications of these trials are discussed.