ICDs (Implantable cardioverter defibrillators) are very effective in preventing sudden cardiac death. However, are ICDs better than amiodarone (Cordarone) in improving survival in patients with life-threatening ventricular arrhythmias?
	Of 442 consecutive patients on amiodarone, we found 48 patients with symptomatic ventricular arrhythmias who met all of the following:
1) had inducible sustained ventricular tachycardia during EPS
2) had an oral amiodarone load of at least 10g over 10 to 14 days
3) remained inducible with an unstable ventricular arrhythmia at follow-up EPS
4) were advised to continue amiodarone therapy and have an ICD implantated
	The 28 patients who agreed to have an ICD implanted had an average EF of 29%. Those who refused implantation averaged 40%. ICD therapy was the strongest predictor of improved survival in patients with an EF of less than 40%. Thus, patients with depressed ejection fraction and continued inducibility of sustained ventricular tachycardia despite oral amiodarone loading have a poor prognosis. In such patients, ICDs are associated with a 58% reduction in total cardiac mortality.

Title: Mortality benefit of implantable cardioverter-defibrillator therapy in patients with persistent malignant ventricular arrhythmias despite amiodarone treatment
Authors: Barron HV, Khan HH, Viskin S, Heller K, Kalman JM, Scheinman MM, Lesh MD Department of Medicine and Cardiovascular Research Institute, University of California, San Francisco, USA
From: Am J Cardiol 1997 May 1;79(9):1180-4
PMID: 9164881, UI: 97307539