Author + information
- Received March 23, 1989
- Revision received June 28, 1989
- Accepted July 6, 1989
- Published online December 1, 1989.
- Angas W.F. Hamer, MD, FACC∗,
- L. Barry Arkles, MD and
- Jennifer A. Johns, MD
- ↵∗Address for reprints: Angas W. F. Hamer, MD, Department of Cardiology, Repatriation General Hospital, Private Bag No. 1, West Heidelberg Victoria, 3081, Australia.
The effects of amiodarone in a low dosage (200 mg every 8 h for 2 weeks, then 200 mg/day) was assessed in a double-blind placebo-controlled trial in 34 patients with a history of severe congestive heart failure but no sustained ventricular arrhythmia. Left ventricular ejection fraction, treadmill exercise tolerance and 48 h electrocardiographic monitoring were assessed before and repeatedly after beginning amiodarone or placebo therapy over 6 months, and side effects were monitored.
In patients receiving amiodarone, the ejection fraction increased significantly from 19 ± 7 to 29 ± 15% at 6 months (p < 0.01 from baseline), but not significantly in 14 placebo-treated patients (18 ± 5 to 22 ± 9%). Exercise tolerance increased significantly in amiodarone-treated patients (median 433 s to 907 s, p < 0.05), but not significantly in placebo-treated patients (757 to 918 s). Nonsustained ventricular tachycardia was present in 88% of amiodaronetreated patients before, but in only 21% of patients after 6 months of treatment (p = 0.06); it was seen in 43% of placebo-treated patients at baseline and in 50% after 6 months. Fifty percent of amiodarone-treated patients had side effects (principally nausea) and the drug was withdrawn in 28% of cases; no life-threatening effects were seen.
Low dose amiodarone appears to have a multifaceted potential to produce benefits in arrhythmia control, exercise tolerance and ventricular function in patients with a history of severe congestive heart failure, but better control of side effects (principally nausea) appears essential. Effects on mortality could not be determined from this study; such assessment requires a larger cohort of patients.
- Received March 23, 1989.
- Revision received June 28, 1989.
- Accepted July 6, 1989.