| Effect of amiodarone and sotalol on ventricular defibrillation threshold: the optimal pharmacological therapy in cardioverter defibrillator patients (OPTIC) trial. | |
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MedLine Citation:
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PMID: 16818810 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Many patients with implanted cardioverter defibrillators (ICDs) receive adjunctive antiarrhythmic drug therapy, most commonly amiodarone or sotalol. The effects of these drugs on defibrillation energy requirements have not been previously assessed in a randomized controlled trial. METHODS AND RESULTS: The Optimal Pharmacological Therapy in Cardioverter Defibrillator Patients (OPTIC) trial was a randomized clinical trial evaluating the efficacy of amiodarone plus beta-blocker and sotalol versus beta-blocker alone for reduction of ICD shocks. Within OPTIC, a prospectively designed substudy evaluated the effects of the 3 treatment arms on defibrillation energy requirements. Defibrillation thresholds (DFTs) were measured (binary step-down protocol) at baseline and again after 8 to 12 weeks of therapy in 94 patients, of whom 29 were randomized to receive beta-blocker therapy (control group), 35 to amiodarone plus beta-blocker, and 30 to sotalol. In the control group, the mean DFT decreased from 8.77+/-5.15 J at baseline to 7.13+/-3.43 J (P=0.027); in the amiodarone group, DFT increased from 8.53+/-4.29 to 9.82+/-5.84 J (P=0.091). In the sotalol group, DFT decreased from 8.09+/-4.81 to 7.20+/-5.30 J (P=0.21). DFT changes in the beta-blocker and the amiodarone group were significantly different (P=0.006). In all patients, adequate safety margins for defibrillation were maintained. No clinical variable predicted baseline DFT or changes in DFT on therapy. CONCLUSIONS: Although amiodarone increased DFT, the effect size with modern ICD systems is very small. Therefore, DFT reassessment after the institution of antiarrhythmic drug therapy with amiodarone or sotalol is not routinely required. |
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Authors:
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Stefan H Hohnloser; Paul Dorian; Robin Roberts; Michael Gent; Carsten W Israel; Eric Fain; Jean Champagne; Stuart J Connolly |
Publication Detail:
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Type: Comparative Study; Journal Article; Randomized Controlled Trial Date: 2006-07-03 |
Journal Detail:
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Title: Circulation Volume: 114 ISSN: 1524-4539 ISO Abbreviation: Circulation Publication Date: 2006 Jul |
Date Detail:
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Created Date: 2006-07-11 Completed Date: 2006-08-14 Revised Date: 2013-05-28 |
Medline Journal Info:
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Nlm Unique ID: 0147763 Medline TA: Circulation Country: United States |
Other Details:
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Languages: eng Pagination: 104-9 Citation Subset: AIM; IM |
Affiliation:
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Department of Medicine, Division of Cardiology, J.W. Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany. Hohnloser@em.uni-frankfurt.de |
| Data Bank Information | |
Bank Name/Acc. No.:
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ClinicalTrials.gov/NCT00257959 |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adrenergic beta-Antagonists
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therapeutic use Aged Amiodarone / therapeutic use* Anti-Arrhythmia Agents / therapeutic use* Atrial Fibrillation / physiopathology Bisoprolol / therapeutic use Carbazoles / therapeutic use Combined Modality Therapy Defibrillators, Implantable* Female Heart Arrest Humans Male Metoprolol / therapeutic use Middle Aged Myocardial Infarction / physiopathology Propanolamines / therapeutic use Sotalol / therapeutic use* Ventricular Fibrillation / drug therapy*, surgery* Ventricular Function, Left |
| Chemical | |
Reg. No./Substance:
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0/Adrenergic beta-Antagonists; 0/Anti-Arrhythmia Agents; 0/Carbazoles; 0/Propanolamines; 0K47UL67F2/carvedilol; 1951-25-3/Amiodarone; 37350-58-6/Metoprolol; 3930-20-9/Sotalol; 66722-44-9/Bisoprolol |
| Comments/Corrections | |
Comment In:
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Circulation. 2006 Jul 11;114(2):98-100
[PMID:
16831995
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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