Amiodarone or an Implantable Cardioverter–Defibrillator for Congestive Heart Failure

This placebo-controlled study compared the effect of amiodarone and an implantable cardioverter–defibrillator (ICD) on mortality in patients with New York Heart Association class II or III congestive heart failure (CHF). Amiodarone had no benefit overall and slightly increased mortality among patients with class III CHF. ICD therapy reduced mortality overall, but the benefit appeared to be restricted to patients with class II CHF. These important results will broaden the use of ICD therapy. This study compared the effect of amiodarone and an implantable cardioverter–defibrillator on mortality in patients with congestive heart failure. Patients with congestive heart failure (CHF) can die suddenly and unpredictably from arrhythmia despite the use of proven medical therapies, such as beta-blockade. Two approaches have been developed specifically to prevent sudden death among patients with CHF: therapy with amiodarone and therapy with an implantable cardioverter–defibrillator (ICD). Despite findings in earlier clinical trials, the ability of amiodarone to reduce the risk of death among patients with CHF remains uncertain. 1 , 2 The ability of an ICD to limit mortality in patients with CHF without prior cardiac arrest has been evaluated in small trials focused on patients with nonischemic cardiomyopathy 3 , 4 and . . .