The AHA Guidelines and Scientific Statements Handbook

Chapter 17 Ventricular Arrhythmias and Sudden Cardiac Death

6 Implantation is reasonable for treatment of recur-
rent ventricular tachycardia in patients post-MI
with normal or near normal ventricular function
who are receiving chronic optimal medical therapy
and who have reasonable expectation of survival
with a good functional status for more than 1 year.
(Level of Evidence: C)

Class IIb
1 Curative catheter ablation or amiodarone may be
considered in lieu of ICD therapy to improve symp-
toms in patients with LV dysfunction due to prior
MI and recurrent hemodynamically stable VT whose
LVEF is greater than 40%. (Level of Evidence: B) (Fig.
17.6) [33].
2 Amiodarone may be reasonable therapy for
patients with LV dysfunction due to prior MI with
an ICD indication, as defi ned above, in patients who
cannot or refuse to have an ICD implanted. (Level
of Evidence: C) (Fig. 17.6) [33].

Class III

1 Prophylactic antiarrhythmic drug therapy is not

indicated to reduce mortality in patients with

asymptomatic nonsustained ventricular arrhyth-

mias. (Level of Evidence: B)

2 Class IC antiarrhythmic drugs in patients with

a past history of MI should not be used. (Level of

Evidence: A)

Valvular heart disease

Recommendations

Class I

Patients with valvular heart disease and ventricular

arrhythmias should be evaluated and treated follow-

ing current recommendations for each disorder.

(Level of Evidence: C)

Class IIb

The effectiveness of mitral valve repair or replace-

ment to reduce the risk of SCD in patients with

mitral valve prolapse, severe mitral regurgitation,

Amiodarone Better

0.5 0.6 0.7 0.8 0.9 1 1.1 1.2 1.3

Odds Ratio

The ATMA Group, 1996

6518 pts

13 trials

Months of follow-up

0

0.10.1

0.20.2

0.30.3

0.40.4

00 66 1212 1818 2424 3030 3636 4242 4848 5454 6060

All cause mortality

HR 1.06 97.5% CI: 0.86 - 1.30

P = 0.529

Event-Free Probability

01224 Months

1

0.9

0.8

A+BB

BB

A

Placebo

ECMA Boutitie et al, 1999

Bardy et al, 2005

Amiodarone

Placebo

Fig. 17.6 Pictorial representation of the controversy related to the possible value of amiodarone for the prevention of sudden cardiac death
in patients with heart failure or recent myocardial infarction. The ATMA, Amiodarone Trial Meta Analysis, and ECMA, EMIAT, European
Myocardial Infarction Amiodarone Trial, and CAMIAT, Canadian Amiodarone Myocardial Infarction Arrhythmia Trial) Meta Analyses
demonstrated benefi t from amiodarone particularly when combined with beta-blockade. SCD-HeFT, Sudden Cardiac Death in Heart Failure
Trial, however, demonstrated no difference between amiodarone and placebo treatment for patients with NYHA Class II or III heart failure and
an ejection fraction ≤35%. A, amiodarone; BB, beta-blockade; AD, arrhythmic death; CAr, cardiac arrest; NAD, nonarrhythmic death; TCM,
total cardiac mortality; ACM, all cause mortality; pts, patients; HR, hazard ratio; CI, confi dence interval.