Amiodarone Discontinuation or Dose Reduction Following Catheter Ablation for Ventricular Tachycardia in Structural Heart Disease

• Published in: JACC. Clinical electrophysiology 2017-05, Vol.3 (5), p.503-511
• Main Authors: Liang, Jackson J., DO, Yang, Wei, PhD, Santangeli, Pasquale, MD, Schaller, Robert D., DO, Supple, Gregory E., MD, Hutchinson, Mathew D., MD, Garcia, Fermin, MD, Lin, David, MD, Dixit, Sanjay, MD, Epstein, Andrew E., MD, Callans, David J., MD, Marchlinski, Francis E., MD, Frankel, David S., MD
• Format: Article
• Language: English
• Subjects: amiodarone; antiarrhythmic drug; cardiomyopathy; Cardiovascular; catheter ablation; ventricular tachycardia
• ISSN: 2405-500X; 2405-5018
• DOI: 10.1016/j.jacep.2016.11.005

Abstract Objectives This study sought to examine long-term outcomes in patients with structural heart disease in whom amiodarone was reduced/discontinued after ventricular tachycardia (VT) ablation. Background VT in patients with structural heart disease increases morbidity and mortality. Amiodarone can decrease VT burden, but long-term use may result in organ toxicities and possibly increased mortality. Catheter ablation can also decrease VT burden. Whether amiodarone can be safely reduced/discontinued following ablation remains unknown. Methods We studied consecutive patients undergoing VT ablation from 2008 to 2011, typically followed by noninvasive programmed stimulation several days later. Patients were divided into 3 groups by amiodarone use: group A—amiodarone reduced/discontinued following ablation; group B—amiodarone not reduced; group C—not on amiodarone at time of ablation. Baseline characteristics and outcomes were compared between groups. Results Overall, 231 patients (90% male; mean age: 63.4 ± 12.9 years; 53.7% ischemic cardiomyopathy) were included (group A: 99; group B: 29; group C: 103). Group B patients were older with more advanced heart failure. Group A patients less frequently had inducible VT at the end of ablation or noninvasive programmed stimulation. In follow-up, 1-year VT-free survival was similar between groups (p = 0.10). Mortality was highest in group B (p < 0.001). Higher amiodarone dose after ablation (hazard ratio: 1.23; 95% confidence interval: 1.03 to 1.47; p = 0.02) was independently associated with shorter time to death. Conclusions After successful VT ablation, as confirmed by noninducibility at the end of ablation and noninvasive programmed stimulation, amiodarone may be safely reduced/discontinued without an unacceptable increase in VT recurrence. Reduction/discontinuation of amiodarone should be considered an important goal of VT ablation.