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[Amiodarone prophylaxis of ventricular tachycardia in ischemic cardiopathy]
Insights
Chronic amiodarone (A) effectively prevented sudden death in coronary heart disease (CHD) patients with ventricular tachycardia (VT). While some patients experienced VT recurrence, amiodarone demonstrated prophylactic benefits against fatal arrhythmias.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Sustained ventricular tachycardia (VT) in coronary heart disease (CHD) is a significant risk factor for sudden cardiac death.
- Effective prophylactic antiarrhythmic strategies are crucial for managing high-risk patients.
Purpose of the Study:
- To evaluate the prophylactic efficacy of chronic amiodarone (A) administration in preventing sustained VT in CHD patients.
- To monitor the trend of ventricular extrasystoles (VE) during amiodarone treatment.
Main Methods:
- A study involving 23 CHD patients (17 post-infarction, 6 mixed angina) with a history of sustained VT.
- Patients received oral amiodarone (800 mg/day initially, then 200-400 mg/day) for 7-67 months.
- Continuous 24-hour ECG monitoring was performed at baseline and every 6 months.
Main Results:
- No sudden cardiac deaths occurred during the follow-up period.
- Six patients died from non-arrhythmic causes.
- Four patients experienced a single sustained VT relapse between 6-11 months; two showed increased VE and Lown's class, while two had unchanged VE levels.
Conclusions:
- Chronic amiodarone administration appears to be effective in preventing sudden death in CHD patients with a history of sustained VT.
- Amiodarone can reduce the risk of fatal arrhythmias, although breakthrough VT events may still occur in a subset of patients.
- Further research is warranted to optimize amiodarone dosing and management strategies for VE and Lown's class in this population.
Abstract:
Sustained ventricular tachycardia (VT) in coronary heart disease (CHD) represents a major risk factor for sudden death. The Authors evaluated the prophylactic efficacy of the chronic administration of amiodarone (A) on this arrhythmia and simultaneously the trend of ventricular extrasystole during the antiarrhythmic treatment. Twenty-three patients were examined, 17 with post-infarction cardiopathy and 6 with mixed angina. They showed either 1 or more episodes (2 patients) of sustained VT involving hemodynamic difficulties. The ejection fraction (EF) ranged between 20 and 45% average (35.2 +/- 9). All patients underwent a basal 24 hour ECG 3 days after the VT cardioversion, and every 6 months. All subjects took A orally for a period ranging from 7 to 67 months (average 23.04 +/- 14) at the dose of 800 mg/day 7 for days, and then 200 or 400 mg/day according to the presence or absence of ventricular extrasystoles (VE) greater than or equal to 30/hr and/or Lown's class (L) greater than or equal to 3. No patients died suddenly during the follow-up; 6 of them died for causes other than arrhythmia. Four of them showed only 1 sustained VT relapse after a period of 6 to 11 months. Two of these 4 patients showed a persistent increase of the number of VE and L-class while, in the remaining 2 patients, the number of VE remained substantially unchanged.(ABSTRACT TRUNCATED AT 250 WORDS)