ICD-programmering: En handbok (Swedish Edition)

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Amiodarone has multiple mechanisms of antiarrhythmic action, with clinical activity against both ventricular arrhythmias and supraventricular arrhythmias. In addition to its myocardial antiarrhythmic effects, it has a direct effect on the sinus node, reducing heart rate, which also likely helped to prevent inappropriate shocks. All 3 mechanisms of action of amiodarone may have been important in reducing shocks.

The smaller randomized study by Seidl et al 7 reported that sotalol was less effective than metoprolol for reducing recurrence of ventricular arrhythmia events. However, this small study did not include inappropriate shocks that were a prominent feature in both our study and in the study by Pacifico et al.

Visia AF and Visia AF MRI

Patients with primary prevention ICD may have a lower risk of shocks due to ventricular arrhythmia than those enrolled in our study, although they may have a similar risk of inappropriate shocks. One cannot extrapolate from our study that patients with primary prevention ICD would benefit similarly from amiodarone or sotalol. Amiodarone therapy has well-characterized toxicity, including pulmonary, thyroid, and skin disorders, as well as sinus bradycardia. The rates of adverse effects and drug discontinuation with amiodarone in our study were similar to rates previously reported.

Decreased quality of life is a major consequence of ICD shocks.

Built for MRI

However, quality of life was not formally assessed. The effect of therapy on quality of life in this OPTIC trial would likely be determined by the balance of the benefit of shock reduction and the adverse effects of drug therapy. Should amiodarone or sotalol be administered immediately after ICD implantation or some time before a first shock occurs?

Description

By delaying therapy, one reduces the risk of drug-related adverse effects; however, this needs to be balanced against the adverse experience of receiving shock therapy. On the other hand, a majority of patients did not have a shock in the year of follow-up in this OPTIC trial. Therapeutic decisions should be individualized, taking into account possible improvements in quality of life and small but increased risks of drug-related adverse effects.

Dr Connolly had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Analysis and interpretation of data: Critical revision of the manuscript for important intellectual content: Administrative, technical, or material support: None of the other authors reported disclosures. Role of the Sponsor: St Jude Medical contributed in part to the design of the study but was not involved in data collection, management, analysis, or interpretation.

The sponsor reviewed the manuscript before submission and made suggestions. Sterns, MD, Andrew D. Connolly, MD, Anthony S.

Built for MRI

Kus, MD, Richard A. Mattioni, MD, David W. Overview of the implantable cardioverter secondary prevention trials. Quality of life in the Antiarrhythmics Versus Implatable Defibrillators trial: Evidence-based analysis of amiodarone efficacy and safety.

How-to Manual for Pacemaker and ICD Devices: Procedures and Programming

N Engl J Med. Prevention of implantable defibrillator shocks by treatment with sotalol. Implantable cardioverter defibrillator recipients: Amiodarone interaction with beta-blockers: Prospective randomized multicenter trial of empirical antitachycardia pacing versus shocks for spontaneous rapid ventricular tachycardia in patients with implatable cardioverter defibrillators.

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