Preliminary report: effect of encainide and flecainide on mortality in a randomized trial of arrhythmia suppression after myocardial infarction

Article Abstract:

Premature ventricular heartbeats indicate an increased risk of sudden death in survivors of myocardial infarction. (Ventricles are the main pumping chambers of the heart; myocardial infarction is a heart attack caused when part of the heart muscle dies due to loss of its blood supply.) It is unknown whether treatment to reduce this disturbance of heart rhythm reduces the risk of death. The effectiveness of the drugs encainide, flecainide, and moricizine were studied. All 2,300 patients had no or mild symptoms and six or more premature ventricular heartbeats per hour after myocardial infarction. One of the three study drugs suppressed the heartbeat irregularity of 75 percent of the patients. During an average of 10 months of follow-up, drug-treated patients had a higher rate of death from heartbeat irregularities. Encainide and flecainide accounted for the abnormally high rate of deaths from heartbeat disturbances and the abnormally high rate of non-fatal heart attacks. Out of the 730 patients taking encainide or flecainide, 33 died or had a non-fatal heart attack, compared with nine of a similar number of untreated patients. These two drugs also accounted for the higher overall death rate, which was eight percent for the treated patients versus three percent for the untreated ones. Because of these bad results, the part of the study involving encainide and flecainide was terminated. It was concluded that neither encainide nor flecainide should be used to treat patients with asymptomatic or minimally symptomatic irregularities of the ventricular heartbeat after myocardial infarction, even though these drugs may work for initially suppressing such irregularities. Whether these results apply to other patients who might be candidates for treatment to suppress heartbeat irregularities is unknown.

Research, Complications and side effects, Physiological aspects, Flecainide, Encainide hydrochloride, Encainide

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Amiodarone in patients with congestive heart failure and asymptomatic ventricular arrhythmia

Article Abstract:

Amiodarone may not prevent sudden death or prolong life in patients with heart failure and arrythmias. Amiodarone is a drug that causes dilation of blood vessels in the heart and prevents irregular heart beats, or arrythmias. Doctors assigned 336 patients to receive amiodarone and 338 to receive a placebo to determine the effect of the drug on longterm survival. Amiodarone did not have a significant effect on survival. During the study 274 patients died including 131 (39%) patients taking amiodarone and 143 (42%) taking a placebo. Among patients taking amiodarone, 64 (49%) suffered a sudden death compared to 75 (52%) of those patients taking a placebo. Amiodarone did have some beneficial effects. After two weeks of therapy, the patients taking amiodarone had a significantly lower heart rate averaging 70 beats/minute. In addition, the average frequency of irregular heart beats decreased from about 254 per hour to 66 per hour at two weeks to 44 per hour after three months.

Evaluation, Heart diseases, Congestive heart failure, Congestive heart failure agents

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Amiodarone in patients with heart failure

Article Abstract:

Some patients with heart failure may fail to respond to drug treatment with amiodarone, an antiarrhythmic agent. Amiodarone stabilizes irregular fast heart beats. Recent studies in the U.S. and Argentina had contradictory results with respect to mortality. The U.S. study showed no benefit after two years following amiodarone therapy. In contrast, lower risk and death rates were apparent in the data from Argentina. Patients differed with respect to age, sex, and disease severity. The U.S. patients were younger males with less advanced heart failure than the Argentinians. Amiodarone may be most effective among heart patients with advanced disease. Despite reducing arrhythmias, amiodarone had no effect on overall survival among Americans. Furthermore, therapeutic success with amiodarone may be dependent on the cause of heart failure. The U.S. trial established the safety of amiodarone without serious side effects.

Health aspects, Editorial, Heart failure

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