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Is amiodarone safe in heart failure?

BMJ 2006; 332 doi: (Published 09 February 2006) Cite this as: BMJ 2006;332:317
  1. Michele Coceani, cardiology specialty trainee (,
  2. Rita Mariotti, professor of cardiology
  1. Division of Cardiology, Cardiac and Thoracic Department, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy

    Recent trials do not provide a definite answer

    Heart failure is a complex clinical syndrome that may lead to sudden cardiac death. Several trials have studied whether the antiarrhythmic agent amiodarone reduces such mortality in heart failure,1 and two trials in particular have been at the centre of the debate: GESICA and CHF-STAT.

    In the GESICA trial, treatment with amiodarone was associated with reduced mortality, but the study was carried out in Argentina, with its genetically distinct population, where conditions other than a prior myocardial infarction—for example, Chagas disease—may be associated with heart failure. Therefore, caution should be used in extending the results to North American and European settings. Furthermore, GESICA was not blinded, and results, including an exceedingly optimistic 3% dropout rate, might have been affected by a treatment bias.1 The CHF-STAT trial was placebo controlled, and more than 70% of the participants had heart failure of ischaemic origin. Despite the beneficial effect of amiodarone on left ventricular systolic function in this trial, the drug had no …

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