Conclusions
Amiodarone is currently the leading antiarrhythmic drug because of proven efficacy and safety. There is reasonable evidence of effectiveness against several clinical important arrhythmias. However, good randomized trials evaluating the efficacy of amiodarone are still needed, especially comparative studies against other drugs for control of AF and a placebo-controlled trial against VT. Amiodarone is particularly useful because its safety has been clearly demonstrated by a large body of evidence, including several randomized trials. Compared with many other antiarrhythmic drugs, amiodarone causes few cardiovascular adverse effects; however, its overall tolerance is limited by considerable noncardiac toxicity.
Although amiodarone will continue to give way to the ICD as primary therapy for many patients presenting with sustained VT or VF, it is likely that amiodarone use will continue in ICD patients to prevent ICD discharges. Evaluation of combined use of amiodarone and the ICD may provide the first opportunity to do a placebo-controlled trial of amiodarone efficacy against VT recurrence. Pharmacological therapy remains the major approach to management of AF, and use of amiodarone is likely to increase in future years.