Arrhythmias: Amiodarone decreases death.

Clinical bottom line (level 1a)

  1. Patients with a risk of sudden cardiac death who are given amiodarone, are less likely to be dead at follow-up than those given a control.
Sim et al: Circulation 1997; 96 (9): 2823-2829
Expires October 2003

The study

Systematic review of randomised controlled trials of
  • Patients: risk of sudden cardiac death
  • Intervention: amiodarone compared with placebo (8 trials), propranolol (1), sotalol (1), usual care (4) or individualised control (1)
  • Outcome: total mortality, cardiac death and sudden cardiac death


    • Articles found in ? using MEDLINE and BIOSIS, January 1985 to March 1997 (search terms: not given ) and cross-references, relevant conference proceedings and professional contacts were checked to identify all relevant trials.

    Selection criteria: random allocation, mortality outcomes reported, treatment and follow-up lasted at least 3 months
    Appraisal criteria: Studies were abstracted by two independent reviewers and were checked by a third with differences resolved by consensus.
    Articles excluded if: amiodarone was given intravenously, treatment was for atrial arrhythmias or nonarrhythmic indications, underlying cardiac disease was hypertrophic cardiomyopathy, patients could be randomised to an implantable cardiac defibrillator

    15 trials of amiodarone
    • The patient population consisted of patients who were post myocardial infarction(8 trials), had left ventricular dysfunction (5) or were post cardiac arrest(2).
    The hierarchical Bayes linear model was used to determine heterogeneity, and there appeared to be no difference in results overall. However, it also suggested that the placebo-controlled trials showed less amiodarone efficacy than the 'usual care'-controlled trials.

    The evidence

    Outcome Time to outcome CER OR
    (95% CI)    		 NNT
    (95% CI)
    total mortality unknown 755/
    (25.8%)    		 0.81
    (0.69 to 0.94)     		26
    (16.0 to 86.0)
    cardiac mortality unknown 647/
    (22.1%)    		 0.77
    (0.66 to 0.89)     		24
    (16.0 to 52.0)
    sudden death unknown 384/
    (13.1%)    		 0.70
    (0.58 to 0.85)     		28
    (20.0 to 57.0)

    Citation

    1. Sim I, McDonald KM, Lavori PW, et al: Quantitative overview of randomised trials of amiodarone to prevent sudden cardiac death. Circulation 1997; 96 (9): 2823-2829
    Contributor: Clare Wotton and Musab Hayatli, October 1999
    Reviewer: William Rhoton

    Clinical Question.
    Patient risk of sudden cardiac death
    Intervention or Exposure amiodarone
    Comparison placebo
    Outcome mortality