Amiodarone: Maximising survival benefit with empiric or guided therapy

Review of available data suggests that serial drug testing in patients with a history of sustained ventricular tachyarrhythmias using various antiarrh ythmic drugs including amiodarone is able to identify subgroups with favora ble and unfavorable outcome (patient groups with suppression vs. no suppres sion of inducibility of VT/VF). These results more likely reflect patient s election rather than drug effects, thus limiting the role of electrophysiol ogically guided antiarrhythmic therapy to actively modify outcome. All majo r and actual antiarrhythmic drug trials including an amiodarone arm, have c hosen to deliver this drug empirically in both patients with asymptomatic a s well as severely symptomatic life-threatening sustained ventricular tachy arrhythmias instead of a guided approach. The empiric approach is therefore adequate until new valid data comparing the empiric with the guided-or the invasive with the non invasive-approach tell us otherwise.