Cochrane for Clinicians
Putting Evidence into Practice
Amiodarone for the Prevention of Sudden Cardiac Death
Am Fam Physician. 2016 Nov 1;94(9):692-693.
Author disclosure: No relevant financial affiliations.
Is amiodarone effective for the prevention of sudden cardiac death in patients at increased risk?
Although not a substitute for an implantable cardioverter-defibrillator (ICD), amiodarone is effective for the primary prevention of sudden cardiac death when compared with placebo (number needed to treat [NNT] = 47; 95% confidence interval [CI], 33 to 100), but it does not significantly lower all-cause mortality in those at high risk. Amiodarone increases the risk of all-cause mortality when used for secondary prevention (number needed to harm [NNH] = 15; 95% CI, 5 to 91) and should not be used in this setting. Adverse effects of therapy include thyroid and pulmonary toxicity.1 (Strength of Recommendation: A, based on consistent, good-quality patient-oriented evidence.)
Sudden cardiac death causes approximately 25% of worldwide cardiac-related deaths each year.2 ICDs are standard therapy for the prevention of sudden cardiac death in patients who have an expected survival of more than one to two years and have risk factors such as a history of cardiac arrest, sustained ventricular tachycardia with hemodynamic compromise, a familial cardiac condition with a high risk of sudden cardiac death, or heart failure with significant left ventricular dysfunction.2–5 Despite this, high up-front costs limit the use of ICDs in resource-constrained areas, and some patients may not wish to have an ICD placed. The authors of this review sought to determine whether amiodarone, a class III antiarrhythmic, would be helpful for the prevention of sudden cardiac death in these settings.1
This Cochrane review included 24 randomized trials and 9,997 patients.1 For primary prevention—that is, for patients at high risk of arrhythmia but no history of cardiac arrest or ventricular arrhythmia–associated syncope—amiodarone in a dosage of 200 to 400 mg daily (after a loading dose) decreased the risk of sudden cardiac death when compared with placebo
REFERENCESshow all references
1. Claro JC, Candia R, Rada G, Baraona F, Larrondo F, Letelier LM. Amiodarone versus other pharmacological interventions for prevention of sudden cardiac death. Cochrane Database Syst Rev. 2015;(12):CD008093....
2. Priori SG, Blomström-Lundqvist C, Mazzanti A, et al. 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: The Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC). Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC). Eur Heart J. 2015;36(41):2793–2867.
3. National Institute for Health and Care Excellence. Implantable cardioverter defibrillators and cardiac resynchronisation therapy for arrhythmias and heart failure. London: National Institute for Health and Care Excellence; 2014. http://www.nice.org.uk/guidance/ta314/resources/implantable-cardioverter-defibrillators-and-cardiac-resynchronisation-therapy-for-arrhythmias-and-heart-failure-review-of-ta95-and-ta120-82602426443461. Accessed March 5, 2016.
4. Epstein AE, DiMarco JP, Ellenbogen KA, et al. 2012 ACCF/AHA/HRS focused update incorporated into the ACCF/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2013;61(3):e6–e75.
5. Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;62(16):e147–e239.
These are summaries of reviews from the Cochrane Library.
This series is coordinated by Corey D. Fogleman, MD, Assistant Medical Editor.
A collection of Cochrane for Clinicians published in AFP is available at http://www.aafp.org/afp/cochrane.
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