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Amiodarone and β-blocker combination therapy versus β-blocker monotherapy for ICD shock prevention: A meta-analysis

Vahid Yazdi1, Abdelmoniem Moustafa2, Mohamad Nawras1

  • 1University of Toledo College of Medicine and Life Sciences, Toledo, Ohio, USA.

Pacing and Clinical Electrophysiology : PACE
|June 17, 2024
PubMed

Insights

Combining amiodarone with beta-blockers (BB) for implantable cardioverter-defibrillator (ICD) patients did not significantly reduce shocks compared to BB monotherapy. This combination therapy also showed no additional benefits in preventing hospitalizations or mortality.

Area of Science:

  • Cardiology
  • Clinical Trials
  • Pharmacology

Background:

  • Implantable cardioverter-defibrillator (ICD) shocks, while life-saving, can impair patient quality of life.
  • Amiodarone and beta-blockers (BB) are frequently used together in ICD recipients.
  • The comparative efficacy of this combination versus BB monotherapy for shock prevention is not well-established.

Purpose of the Study:

  • To systematically review and meta-analyze the efficacy of combined amiodarone and BB therapy versus BB monotherapy in preventing ICD shock delivery.
  • To evaluate the impact of this combination therapy on hospitalizations and mortality in ICD patients.

Main Methods:

  • Comprehensive literature search across PubMed, Cochrane, and Web of Science databases.
  • Inclusion of four studies (three retrospective, one RCT) involving 5818 ICD patients.
  • Primary outcome: total number of ICD shocks; secondary outcomes: hospitalizations and mortality.

Main Results:

  • Combined amiodarone and BB therapy was not associated with a significant reduction in ICD shocks compared to BB monotherapy (OR, 0.76; 95% CI, 0.44-1.31; P = .32).
  • No significant differences were observed in rates of ICD shocks, hospitalizations, or mortality between the two treatment groups.

Conclusions:

  • Combination therapy with amiodarone and BB does not appear to offer additional benefits in reducing ICD shocks, hospitalizations, or mortality compared to BB monotherapy.
  • Further randomized controlled trials (RCTs) are recommended to confirm these findings.

Keywords:
ICDamiodaroneβ‐blocker

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