A Single-Center Experience with Japanese Patients with Severe Ischemic Heart Failure and Arrhythmia Receiving Amiodarone

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Background: Arrhythmias are common in patients with coronary artery disease and heart failure (HF), and confer substantial risks of mortality and morbidity. Amiodarone is an antiarrhythmic drug with potential benefits in HF. The aim of this study was to evaluate the prognosis and change in systolic function of Japanese patients with severe ischemic HF and arrhythmia prescribed amiodarone.

Methods: This single-center, single-arm, retrospective study included 68 patients with ischemic HF 〔New York Heart Association (NYHA) functional class III or IV〕 and left ventricular ejection fraction (LVEF) ≤ 35% who were prescribed amiodarone between 1995 and 2010. The median follow-up period was 25 months. The primary endpoint was death from any cause. The secondary endpoints were cardiovascular death, hospitalization due to worsening HF, and ventricular tachyarrhythmias. Echocardiographic parameters were evaluated during the first 2 years after initiation of therapy.

Results: The cumulative rate of death from any cause was 39% and 62% at 2 years and 5 years, respectively. The cumulative rates of cardiovascular death, hospitalization due to worsening HF and ventricular tachyarrhythmia was 44%, 58% and 29% at 5 years, respectively. Echocardiographic findings showed no changes in left ventricular dimension/volume or LVEF during 2 years of amiodarone therapy. Amiodarone therapy was discontinued in 10 patients (15%) because of its pulmonary toxicity or other adverse effects.

Conclusion: The prognosis of patients with severe ischemic HF and reduced LVEF who received amiodarone was limited and their systolic function was not improved.