After CAMIAT and EMIAT What is the Role for Amiodarone in the Prevention of Sudden Death

  • Y. G. Yap
  • A. J. Camm


Despite the tremendous strides in its diagnosis and management over the recent years, coronary heart disease remains the leading cause of death in the industrialised world. In the UK, about 459 people die of a heart attack everyday-over 170 000 people every year [1]. The majority of deaths following an acute myocardial infarction (AMI) occur in the first year, with a mortality rate ranging from between 5% to 15% [2, 3]. The major cause of death in the first year after acute myocardial infarction is sudden death, usually due to ventricular arrhythmias [4, 5]. While the definition of sudden death is still under much debate [6] it is recognised that the majority of these events, although not exclusively, begin as ventricular tachycardia which quickly degenerates into ventricular fibrillation, in the absence of either acute infarction or significant ischaemia [7, 8].


Acute Myocardial Infarction Ventricular Arrhythmia Acute Myocardial Infarction Arrhythmic Death Ventricular Premature Depolarisation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Boaz A, Rayner M (1995) Coronary Heart Disease Statistics, The Coronary Prevention Group/British Heart Foundation Statistics Database, 102, Gloucester Place, London, UKGoogle Scholar
  2. 2.
    Frishman WH, Furberg CD, Friedewald WT (1984) Beta-adrenergic blockade for survivors of acute myocardial infarction. New Engl J Med 310: 830–837PubMedCrossRefGoogle Scholar
  3. 3.
    The Multicenter Postinfarction Research Group (1983) Risk stratification and survival after myocardial infarction. New Engl J Med 309: 331–336CrossRefGoogle Scholar
  4. 4.
    Rosenthal ME, Oseran DS, Gang E, Peter T (1985) Sudden cardiac death following acute myocardial infarction. Am Heart J 109: 865–875PubMedCrossRefGoogle Scholar
  5. 5.
    Bigger JT Jr, Heller CA, Wenger TL et al (1978) Risk stratification after acute myocardial infarction. Am J Cardiol 42: 202–210PubMedCrossRefGoogle Scholar
  6. 6.
    Hinkle LE, Thaler HT (1982) Clinical classification of cardiac deaths. Circulation 65: 457–464PubMedCrossRefGoogle Scholar
  7. 7.
    Rapaport E (1988) Sudden cardiac death. Am i Cardiol 62: 31–61CrossRefGoogle Scholar
  8. 8.
    Kempf FC, Josephson ME (1984) Cardiac arrest recorded on ambulatory electrocar-diograms. Am J Cardiol 53: 1577–1582PubMedCrossRefGoogle Scholar
  9. 9.
    Beta-blocker Heart Attack Trial Research Group (1982) A randomised trial of propranolol in patients with acute myocardial infarction. JAMA 247: 1701–1714CrossRefGoogle Scholar
  10. 10.
    The Norwegian Multicentre Study Group (1979) Timolol-induced reduction in mortality and reinfarction in patients surviving acute myocardial infarction. Lancet 11: 865–872Google Scholar
  11. 11.
    Hjalmarson A, Elmfeldt D, Herlitz J et al (1981) Effect on mortality of metoprolol in acute myocardial infarction. A double-blind randomised trial. Lancet 1: 823–827CrossRefGoogle Scholar
  12. 12.
    Kober L, Torp-Pedersen C, Carlsen JE, Bagger H, Eliasen P, Lyngborg K, Videbaek J, Cole D, Auclert L, Pauly N, Aliot E, Persson S, Camm AJ for the TRAndolapril Cardiac Evaluation (TRACE) Study Group (1995) A clinical trial of the Angiotensin-converting-enzyme inhibitor trandolapril in patients with left-ventricular dysfunction after myocardial infarction. New Eng J Med 333: 1670–1676PubMedCrossRefGoogle Scholar
  13. 13.
    Echt DS, Liebson PR, Mitchell LB, Peters RW, Obias-Manno D, Barker AH et al (1991) Mortality and morbidity in patients receiving encanide, flecainide or placebo. The Cardiac Arrhythmia Suppression Trial. New Engl J Med 324: 781–787PubMedCrossRefGoogle Scholar
  14. 14.
    The Cardiac Arrhythmia Suppression Trial II Investigators (1992) Effect of the anti-arrhythmic agent moricizine on survival after myocardial infarction. New Engl J Med 327: 227–233CrossRefGoogle Scholar
  15. 15.
    Waldo AL, Camm AJ, deRuyter H, Friedman PL, MacNeil DJ, Pauls JF, Pitt B, Pratt CM, Schwartz PJ, Veitri EP for the SWORD investigators (1996) Effect of d-sotalol on mortality in patients with left ventricular dysfunction after recent and remote myocardial infarction. Lancet 348: 7–12Google Scholar
  16. 16.
    Podrid PJ (1995) Amiodarone: re-evaluation of an old drug. Ann Intern Med 122: 689–700PubMedCrossRefGoogle Scholar
  17. 17.
    Herre JM, Sauve MJ, Malone P et al (1989) Long-term results of amiodarone therapy in patients with recurrent sustained ventricular tachycardia or ventricular fibrillation. J Am Coll Cardiol 13: 442–449PubMedCrossRefGoogle Scholar
  18. 18.
    Cairns JA, Connolly SJ, Roberts R, Gent M for the Canadian Amiodarone Myocardial Infarction Arrhythmia Trial investigators (1997) Randomised trial of outcome after myocardial infarction in patients with frequent or repetitive ventricular premature depolarisations: CAMIAT. Lancet 349: 675–682Google Scholar
  19. 19.
    Julian D, Camm AJ, Frangin G, Janse MJ, Munoz A, Schwartz PJ, Simon P for the European Myocardial Infarct Amiodarone Trial Investigators (1997) Randomised trial of the effect of amiodarone on mortality in patients with left-ventricular dysfunction after recent myocardial infarction: EMIAT. Lancet 349: 667–674Google Scholar
  20. 20.
    Ruberman W, Weinblatt E, Goldberg JD, Frank CW, Chaudhary BS, Shapiro S (1981) Ventricular premature complexes and sudden death after myocardial infarction. Circulation 64: 297–305PubMedCrossRefGoogle Scholar
  21. 21.
    Maggioni AP, Zuanetti G, Franzosi MG et al (1993) Prevalence and prognostic significance of ventricular arrhythmias after acute myocardial infarction in the fibrinolytic era: GISSI-2 results. Circulation 87: 512–522CrossRefGoogle Scholar
  22. 22.
    Kuchar DL, Thorburn CW, Sammel NL (1987) Prediction of serious arrhythmic events after myocardial infarction: signal-averaged electrocardiogram, Holter monitoring and radionuclide ventriculography. J Am Coll Cardiol 9: 531–538PubMedCrossRefGoogle Scholar
  23. 23.
    Bigger JT Jr, Flaiss JL, Kleiger J et al (1984) The relationship among ventricular arrhythmias, left ventricular dysfunction, and mortality in two years after myocardial infarction. Circulation 69: 250–258PubMedCrossRefGoogle Scholar
  24. 24.
    Pitt B (1982) Sudden cardiac death: role of left ventricular dysfunction. Ann NY Acad Sci 382: 218–228PubMedCrossRefGoogle Scholar
  25. 25.
    Nattel S (1993) Comparative mechanisms of action of antiarrhythmic drugs. Am J Cardiol 72: 13F - 17FPubMedCrossRefGoogle Scholar
  26. 26.
    Gottlieb SS (1997) De ad is dead-artificial definitions are no substitute. Lancet 349: 662–663PubMedCrossRefGoogle Scholar
  27. 27.
    Pfisterer ME, Kiowski W, Brunner H, Burckhardt D, Burkart F (1993) Long-term benefit of 1-year amiodarone treatment for persistent complex ventricular arrhythmias after myocardial infarction. Circulation 87: 309–311PubMedCrossRefGoogle Scholar
  28. 28.
    Cairns JA, Connolly SJ, Roberts R, Gent M (1993) Amiodarone for patients with ventricular premature depolarisation after myocardial infarction: is it safe to stop treatment at one year?. Circulation 87: 637–639PubMedCrossRefGoogle Scholar
  29. 29.
    McKenna WJ, Adams KM, Poloniecki JD et al (1989) Long term survival with amiodarone in patients with hypertrophic cardiomyopathy and ventricular tachycardia. Circulation 80[suppl II1:II-7 (abstr)Google Scholar
  30. 30.
    Neri R, Mestroni L, Salvi A, Pandullo C, Camerini F (1987) Ventricular arrhythmias in dilated cardiomyopathy: efficacy of amiodarone. Am Heart J 113: 707–715PubMedCrossRefGoogle Scholar
  31. 31.
    Singh BN, Vaughan William EM (1970) A third class of anti-arrhythmic action: effects on atrial and ventricular intracellular potentials, and other pharmacological actions on cardiac muscle of MJ 1999 and AH 3474. Br J Pharmacol 39: 675–687PubMedCrossRefGoogle Scholar
  32. 32.
    Singh BN, Vaughan William EM (1972) A fourth class of anti-arrhythmic action? Effect of verapamil on ouabain toxicity, on atrial and ventricular intracellular potentials, and on other features of cardiac function. Cardiovasc Res 6: 109–119PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 1998

Authors and Affiliations

  • Y. G. Yap
    • 1
  • A. J. Camm
    • 1
  1. 1.Department of Cardiological SciencesSt. George’s Hospital Medical School, Cranmer TerraceLondonUK

Personalised recommendations