Amiodarone Cuts Total Mortality Post-MI, CHF

Amiodarone has become the first antiarrhythmic drug to reduce theoverall death rate in patients who have had a myocardial infarction or have congestive heart failure, according to the results of the Amiodarone Trials Meta-Analysis (ATMA). The results of the analysis were presented at a press conference and symposium in Paris on June 6-7.

Ventricular arrhythmias are a major cause of death in MI and CHF patients, especially in those with left ventricular function. Previous attempts to suppress these events with various antiarrhythmic drugs have been disappointing. The CAST and CAST II trials of class I drugs (encainide, flecainide and moricizine) had to be stopped early because of excess mortality in the treatment group, while a pure class III agent, d-sotalol, was also found to be harmful in the SWORD study.

Apart from beta blockers, the only drug which has shown much promise in these patients is amiodarone, a class III agent which has sympatholytic properties and is marketed by Sanofi Winthrop and Wyeth-Ayerst as Cordarone. The large-scale CAMIAT and EMIAT studies, which included patients with frequent ectopic beats and left ventricular dysfunction respectively, were reported in The Lancet (March 8) and found that the drug was able to reduce the risk of arrhythmic death after an MI, but these studies were not powered to detect anything other than a very large effect on total mortality.