Management of Scar-Mediated Ventricular Tachycardia with Amiodarone

Role in Management of Scar-Mediated VT

For patients with scar-related heart disease presenting with VT, catheter ablation has evolved into an important treatment option and should be considered before long-term amiodarone therapy, as recommended by the European Society of Cardiology 1
Amiodarone is generally well tolerated hemodynamically in the setting of acute heart failure with ventricular arrhythmias and is preferred for longer-term administration when necessary, according to the American College of Cardiology 2

Amiodarone has been associated with overall neutral effects on survival when administered to patients with low ejection fraction and heart failure, as reported by the American Heart Association 3
The SCD-HeFT trial showed no survival benefit to patients with heart failure (NYHA functional class II and III) and LVEF ≤35% treated with amiodarone empirically, as published by the American College of Cardiology 4

ICDs are highly effective in preventing death due to ventricular tachyarrhythmias, but frequent shocks can lead to reduced quality of life, according to the American Heart Association 3
Beta-blocker therapy in combination with amiodarone reduces the number of ICD shocks, though side effects may result in drug discontinuation, as recommended by the European Society of Cardiology 1

The American College of Cardiology recommends ICD implantation as first-line therapy for patients with scar-related VT at high risk of sudden cardiac death 3, 4
The European Society of Cardiology suggests catheter ablation as second-line therapy for recurrent VT episodes 1
The American College of Cardiology recommends beta-blockers in combination with amiodarone as third-line therapy for patients with recurrent VT despite ICD and/or catheter ablation 1
The American Heart Association recommends amiodarone monotherapy as fourth-line therapy for patients who are not candidates for ICD or catheter ablation 3, 2