Long-term follow-up of patients requiring intravenous amiodarone to suppress hemodynamically destabilizing ventricular arrhythmias

Background intravenous amiodarone is effective for the acute suppression of recurrent hemodynamically destabilizing ventricular arrhythmias. There are no follow-up data on patients undergoing long term therapy with intravenou s amiodarone. The objective of this investigation was to evaluate long-term outcome. Methods and Results We reviewed the clinical courses of 245 patients given intravenous amiodarone for sustained ventricular tachyarrhythmias. Of the 1 07 survivors (84% men; mean age 64 years) released from the hospital taking oral amiodarone, 41 were discharged with an empiric prescription for oral amiodarone. For 64 patients a decision regarding further therapy was based on results of an electrophysiologic study. Two patients were treated empiri cally with oral amiodarone and on implantable cardioverter defibrillator. C linical variables and survival curves were the same for the empirically tre ated group and the group whose treatment was based on electrophysiologic fi ndings (P = .89). Survival at 6, 12, and 18 months was 88%, 81% and 71% res pectively, for empirically treated patients, and 83%, 80% and 73%, respecti vely, For patients whose therapy was directed with on electrophysiologic st udy. Of the 64 patients who underwent electrophysiologic studies, 33 receiv ed an implantable cardioverter defibrillator. The Koplan-Meier survival cur ves for patients with and patients without on implantable cardioverter defi brillator were similar (P = .46). Conclusions Patients for whom recurrent ventricular tachycardia and fibrill ation are suppressed with intravenous amiodarone and who are discharged rec eiving oral amiodarone have an 80% 1-year survival rate. Although nor rando mized, our data suggested that among such patients, electrophysiologic test ing, implantation of a cardioverter defibrillator, or both may not be neces sary. Ascertaining the best management strategy for these patients will req uire a prospective randomized trial.