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Development of congestive heart failure and alterations in left ventricular function in patients with sustained
Insights
Amiodarone improved left ventricular ejection fraction (EF) in patients with ventricular tachyarrhythmias. However, baseline EF and developing congestive heart failure (CHF) impacted amiodarone
Area of Science:
- Cardiology
- Pharmacology
Background:
- Sustained ventricular tachyarrhythmias pose a significant risk.
- Left ventricular (LV) dysfunction is common in these patients.
- Amiodarone is a key antiarrhythmic drug.
Purpose of the Study:
- To assess amiodarone's efficacy and tolerance in relation to LV dysfunction.
- To evaluate the impact of baseline LV ejection fraction (EF) and congestive heart failure (CHF) on treatment outcomes.
Main Methods:
- 126 patients with sustained ventricular tachyarrhythmias were studied.
- Radionuclide angiography measured LV ejection fraction (EF) before and after 8-12 months of amiodarone.
- Clinical efficacy, tolerance, and development of CHF were monitored.
Main Results:
- Mean baseline EF was 25±13%, with 86 patients ≤30%.
- Amiodarone therapy showed a significant increase in EF (23% to 26%, p<0.05).
- Efficacy and tolerance were higher in patients with EF >30% (80%) versus ≤30% (60%).
- Development of new or worsened CHF occurred in 16 patients, impacting prognosis.
- Among those with new/worsened CHF, mortality was 38% and recurrent ventricular tachyarrhythmias were 56%.
Conclusions:
- Baseline LV dysfunction and development of CHF during amiodarone treatment significantly affect patient prognosis.
- Amiodarone can improve EF but requires careful monitoring for CHF development.
- Risk stratification based on baseline EF and CHF development is crucial for managing ventricular tachyarrhythmias with amiodarone.
Abstract:
The interaction between the efficacy and tolerance of amiodarone and the degree of left ventricular (LV) dysfunction was assessed in 126 patients with sustained ventricular tachyarrhythmias. In all patients radionuclide angiographic LV ejection fraction (EF) was measured before and after 8 to 12 months of amiodarone therapy. At baseline mean EF was 25 +/- 13% and 86 patients had an EF of 30% or less. In patients receiving amiodarone at steady state, there was a small but significant increase in EF (23 to 26%, p less than 0.05). Congestive heart failure (CHF) was present in 43 patients before amiodarone therapy. In 16 patients new (9 patients) or worsened (7 patients) CHF developed during the first year of amiodarone therapy. Development of CHF was not consistently related to a change in EF or heart rate. The clinical efficacy and tolerance of amiodarone were affected by the baseline EF and development of CHF. Efficacy and tolerance was 80% in patients with an EF of more than 30% and 60% in those with an EF of 30% or less. Among the 16 patients in whom new or worsened CHF developed, 6 (38%) died and 9 (56%) had recurrent ventricular tachyarrhythmias. Both baseline EF and development of CHF during amiodarone treatment significantly affect the prognosis in patients with ventricular tachyarrhythmias.