ATHENS, GREECE — Suppression of frequent premature ventricular contractions (PVCs) in patients with systolic heart failure could help raise LV contractile function enough possibly to make a difference clinically, propose researchers based on small, randomized test of the idea using amiodarone .

The PVC reduction appeared to improve ventricular performance by allowing partial reversal of a cardiomyopathy that had been creating dyssynchrony, proposed Dr Vasileios Sousonis (University of Athens, Greece) when speaking with heartwire . None of the patients he and his colleagues studied had another indication for amiodarone, such as atrial fibrillation, he said; most had a nonischemic etiology to their heart failure.

There were no adverse effects from a year of amiodarone therapy, 200 mg/day, other than subclinical hypothyroidism, researchers said when presenting here at the Heart Failure Congress 2014 of the European Society of Cardiology Heart Failure Association.

They randomized 20 consecutive patients with heart failure with an LVEF <40% (mean 31%) who had been experiencing >7000 PVCs per 24 hours (cohort mean 15 444 per 24 h) to receive or not receive amiodarone daily on top of standard medical therapy; there was no loading dose. Nearly all were also on beta-blockers and either ACE inhibitors or angiotensin-receptor blockers; about half were on aldosterone inhibitors. Overall, their heart failure was not severe; the mean NYHA class was about 1.8 in both groups.

They underwent 24-hour Holter monitoring and echocardiography at baseline and at six months. Mean heart rate had been about 71 bpm, and it remained unchanged, as did LV end-systolic and LV end-diastolic diameters, in both groups.

Change in PVC/24 Hours and in LVEF From Baseline to Six Months in 20 Patients With HF and Frequent PVCs

End points Standard therapy alone (n=10) Standard therapy plus 200 mg/day amiodarone (n=10)
Baseline 6 mo p Baseline 6 mo p
PVC (per 24 h) 13 723 9723 NS 17 400 4973 0.002
LVEF (%) 33 33 NS 31 38 0.031

Amiodarone is approved for patients with heart failure, observed Sousonis, so it was reasonable to expect it to be safe enough in the current cohort. Still, he said, if the technique is adopted after further exploration in much larger trials, the best candidates might be those with heart failure and multifocal PVCs; unifocal PVCs may respond better to catheter ablation, obviating long-term amiodarone.

Neither Sousonis nor his coauthors had disclosures.


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