Are implantable cardioverter-defribrillators always superior to amiodarone?

The beneficial effects of amiodarone in preventing sudden cardiac death may predominantly be in patients without coronary artery disease. The AMIOdarone Versus Implantable CardioveRTer-defibrillator trial (AMIOVIRT) compared amiodarone and an implantable cardioverter-defribrillator (ICD) in non-ischaemic dilated cardiomyopathy with non-sustained ventricular arrhythmia. The trial was discontinued at the first interim analysis, as the prospective rule for inability to demonstrate statistical significance was reached. There were 7 deaths (5 cardiac, 2 sudden) in the amiodarone group (n = 52) and 6 (4 cardiac, 1 sudden) in the ICD group (n = 51). The cost of total medical care was lower in the amiodarone group than the ICD group. A reasonable approach may be to use the cheaper amiodarone initially in patients with non-ischaemic cardiomyopathy with non-sustained ventricular arrhythmias and when near syncope occurs, to insert an ICD.