PMID- 30575185
OWN - NLM
STAT- MEDLINE
DCOM- 20200504
LR  - 20200505
IS  - 1540-8167 (Electronic)
IS  - 1045-3873 (Linking)
VI  - 30
IP  - 3
DP  - 2019 Mar
TI  - Amiodarone is associated with adverse outcomes in patients with sustained 
      ventricular arrhythmias upgraded to cardiac resynchronization 
      therapy-defibrillators.
PG  - 348-356
LID - 10.1111/jce.13828 [doi]
AB  - INTRODUCTION: Amiodarone reduces recurrent ventricular tachyarrhythmias (VTA) but 
      may worsen cardiovascular outcomes in heart failure (HF) patients. Cardiac 
      resynchronization therapy (CRT) may also be antiarrhythmic. When patients with 
      prior sustained VTA are upgraded to CRT defibrillators (CRT-D) from conventional 
      implantable cardioverter-defibrillators (ICDs), should concomitant amiodarone be 
      continued or is CRT's antiarrhythmic potential sufficient? METHODS AND RESULTS: 
      We identified 67 patients from a prospective CRT registry with spontaneous 
      sustained VTA, New York Heart Association (NYHA) II-IV HF, and left bundle-branch 
      block (LBBB) who were upgraded to CRT defibrillators from conventional ICDs. We 
      compared changes in QRS duration and left ventricular ejection fraction (LVEF) 
      pre- and post-CRT, time to death, transplant or ventricular assist device (VAD), 
      and time to recurrent VTA therapies between 37 patients continuing amiodarone 
      therapy and 30 amiodarone-naive patients. Amiodarone-treated patients had worse 
      renal function and a higher prevalence of prior VTA storm compared with 
      amiodarone-naive patients. After CRT, amiodarone-treated patients demonstrated 
      less QRS narrowing (8 vs 20 ms; P = 0.021) and less LVEF improvement (-2.7 vs 
      +5.2%; P = 0.006). Over 29 months, 31 (47%) patients died and 13 (20%) received 
      transplant or VAD. Risk of death, transplant, or VAD was greater in 
      amiodarone-treated than -naive patients (corrected hazard ratio [HR], 2.14; 95% 
      confidence interval [CI], 1.12-4.11; P = 0.022). Appropriate CRT-D therapies 
      occurred in 37 (55%) patients; amiodarone use was not associated time to first 
      therapy (HR, 1.13; 95% CI, 0.59-2.16; P = 0.72). CONCLUSION: In patients with 
      sustained VTA and LBBB upgraded from conventional ICDs to CRT defibrillators, 
      concomitant amiodarone use is associated with less QRS narrowing, less LVEF 
      improvement, greater risk of death, transplant, or VAD, and similar risk of 
      recurrent VTA.
CI  - (c) 2018 Wiley Periodicals, Inc.
FAU - Adelstein, Evan C
AU  - Adelstein EC
AUID- ORCID: 0000-0003-2230-4470
AD  - University of Pittsburgh Heart and Vascular Institute, Pittsburgh, Pennsylvania.
AD  - Division of Cardiology, Albany Medical Center, Albany, New York.
FAU - Althouse, Andrew D
AU  - Althouse AD
AD  - University of Pittsburgh Heart and Vascular Institute, Pittsburgh, Pennsylvania.
FAU - Davis, Lydia
AU  - Davis L
AD  - University of Pittsburgh Heart and Vascular Institute, Pittsburgh, Pennsylvania.
FAU - Schwartzman, David
AU  - Schwartzman D
AD  - University of Pittsburgh Heart and Vascular Institute, Pittsburgh, Pennsylvania.
AD  - Butler Hospital System, Cardiac Electrophysiology, Butler Memorial Hospital, 
      Butler, Pennsylvania.
FAU - Bazaz, Raveen
AU  - Bazaz R
AD  - University of Pittsburgh Heart and Vascular Institute, Pittsburgh, Pennsylvania.
FAU - Jain, Sandeep
AU  - Jain S
AUID- ORCID: 0000-0002-5815-370X
AD  - University of Pittsburgh Heart and Vascular Institute, Pittsburgh, Pennsylvania.
FAU - Wang, Norman
AU  - Wang N
AUID- ORCID: 0000-0002-8388-2146
AD  - University of Pittsburgh Heart and Vascular Institute, Pittsburgh, Pennsylvania.
FAU - Saba, Samir
AU  - Saba S
AUID- ORCID: 0000-0003-4669-803X
AD  - University of Pittsburgh Heart and Vascular Institute, Pittsburgh, Pennsylvania.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20190104
PL  - United States
TA  - J Cardiovasc Electrophysiol
JT  - Journal of cardiovascular electrophysiology
JID - 9010756
RN  - 0 (Anti-Arrhythmia Agents)
RN  - N3RQ532IUT (Amiodarone)
SB  - IM
MH  - Action Potentials
MH  - Aged
MH  - Amiodarone/*adverse effects
MH  - Anti-Arrhythmia Agents/*adverse effects
MH  - Arrhythmias, Cardiac/diagnosis/mortality/physiopathology/*therapy
MH  - *Cardiac Resynchronization Therapy/adverse effects/mortality
MH  - *Cardiac Resynchronization Therapy Devices
MH  - Databases, Factual
MH  - *Defibrillators, Implantable
MH  - Electric Countershock/adverse effects/*instrumentation/mortality
MH  - Female
MH  - Heart Failure/diagnosis/mortality/physiopathology/*therapy
MH  - Heart Rate/*drug effects
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Retrospective Studies
MH  - Risk Assessment
MH  - Risk Factors
MH  - Time Factors
MH  - Treatment Outcome
OTO - NOTNLM
OT  - amiodarone
OT  - cardiac resynchronization therapy
OT  - implantable cardioverter-defibrillator
OT  - mortality
OT  - ventricular tachycardia
EDAT- 2018/12/24 06:00
MHDA- 2020/05/06 06:00
CRDT- 2018/12/22 06:00
PHST- 2018/08/22 00:00 [received]
PHST- 2018/11/30 00:00 [revised]
PHST- 2018/12/03 00:00 [accepted]
PHST- 2018/12/24 06:00 [pubmed]
PHST- 2020/05/06 06:00 [medline]
PHST- 2018/12/22 06:00 [entrez]
AID - 10.1111/jce.13828 [doi]
PST - ppublish
SO  - J Cardiovasc Electrophysiol. 2019 Mar;30(3):348-356. doi: 10.1111/jce.13828. Epub 
      2019 Jan 4.