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Hypertrophic cardiomyopathy: is there a role for amiodarone?
  1. K PRASAD,
  1. Department of Cardiology,
  2. University of Wales College of Medicine,
  3. Heath Park, Cardiff CF4 4XN, UK

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The usual mechanism of sudden death in various forms of heart disease is thought to be ventricular arrhythmia.1-3However, antiarrhythmic drugs have not been shown conclusively to prevent sudden death, except in the case of β blockers, which improve survival in patients with heart failure and after myocardial infarction (MI),4 although this may or may not relate to their antiarrhythmic properties. Indeed, class I antiarrhythmic agents and sotalol have been reported to increase mortality because of their proarrhythmic properties.5 ,6 Amiodarone is attractive because it is a potent antiarrhythmic that does not have significant negative inotropic properties,7 and has fewer proarrhythmic properties than class I agents.7 Studies in patients with heart failure have demonstrated conflicting results indicating that there may be a survival benefit with amiodarone in non-ischaemic but not ischaemic heart failure.8 ,9 In post-MI patients, reductions in arrhythmic death, but not total mortality, have been reported in the CAMIAT and EMIAT studies.10 ,11

Potential role for amiodarone in hypertrophic cardiomyopathy

Although the major incidence of sudden death occurs in older people, sudden death does occur in adolescents and young adults.2 ,12 Hypertrophic cardiomyopathy is a common cause of sudden death in these younger pateints13 and prevention of this complication is a major challenge.12 Risk factors for sudden death in patients with hypertrophic cardiomyopathy include family history of sudden death (especially if in more than one family member), recurrent syncope, abnormal exercise blood pressure response (hypotension or failure of blood pressure to rise), and episodes of non-sustained ventricular tachycardia on Holter monitoring.14 ,15 The last association, reported independently by two groups in the early 1980s,16 ,17 led to the hypothesis that amiodarone might reduce sudden death in high risk individuals with hypertrophic cardiomyopathy. In 1985 …

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