LETTER
Amiodarone and Torsade de Pointes
Tsung O. Cheng
1 April 1995 | Volume 122 Issue 7 | Pages 553-554
TO THE EDITOR:
No sooner had I finished reading the convincing review by Hohnloser and associates [1], who argued against the importance of amiodarone-associated proarrhythmic effects, than I read an equally persuasive article expressing a diametrically opposed view in another journal published at the same time [2]. The former article [1] concluded that the "low arrhythmogenicity and the negligible negative inotropic effect. make amiodarone particularly useful in treating high-risk patients (with coronary artery disease) prone to sudden cardiac death (due to torsade de pointes tachycardia)," whereas the latter concluded that "amiodarone therapy should be withheld in patients with ventricular tachycardia until they have been assessed as candidates for possible surgical intervention" [2].
These differing views not only present clinicians with a dilemma but also have serious implications in the cost of health care delivery in patients with coronary artery disease. Ongoing placebo-controlled trials of amiodarone in patients with heart failure or patients who have survived myocardial infarction, as well as trials comparing implantable devices in patients with ventricular tachycardia or fibrillation [3], are likely to be crucial in establishing the effect of amiodarone on arrhythmia-related mortality, but what should we do in the meantime? I would like Hohnloser and colleagues to analyze the article by Mickleborough and colleagues [2] and explain the difference in the conclusions.
1. Hohnloser SH, Klingenheben T, Singh BN. Amiodarone-associated proarrhythmic effects. A review with special reference to torasade de pointes tachycardia. Ann Intern Med. 1994; 121:529-35.
2. Mickleborough LL, Maruyama H, Mohamed S, Rappaport DC, Downar E, Butany J, et al. Are patients receiving amiodarone at increased risk for cardiac operations? Ann Thorac Surg. 1994; 58:622-9.
3. Cheng TO. Acronyms of clinical trials in cardiology—1994. Am J Cardiol. 1994; 74:79-94.
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