.European Journal of Heart Failure 2 2000 71]79 Combination therapy with carvedilol and amiodarone in patients with severe heart failure

Background: Carvedilol and at least in some studies, amiodarone have been shown to improve symptoms and prognosis of patients with heart failure. There are no reports on the outcome of combined treatment with both drugs on top of .angiotensin-converting enzyme inhibitors ACEI, diuretics and digitalis. Methods and Results: In 109 patients with severe wheart failure submitted for heart transplantation at one single center between the years 1996 and 1998 left ventricular . .ejection fraction LVEF 24.6"11%, 85 % males, 52 % idiopathic dilated cardiomyopathy DCM, mean observation time x . .1.9"0.4 years a therapy with low-dose amiodarone 1000 mgrweek plus titrated doses of carvedilol target 50 mgrday was .instituted. In addition, patients received a prophylactic dual chamber pacemaker PM in order to protect from bradycardia and for continuous holter monitoring. The devices were programed in back-up mode with a basal rate of 40 i.p.m. with a .hysteresis of 25%. Signi®cantly, more patients were in sinus rhythm after 1 year than at study entry 85 % vs. 63%, P-0.01. .In 47 patients, under therapy over at least 1 year, the resting heart rate fell from 90"19 to 59"5 b.p.m. P-0.001. .Ventricular premature contractions in 24-h holter ECGs were suppressed from 1.0"3 to 0.1"0.3%r24 h P-0.001 as did numbers of tachycardias)167 b.p.m. detected by the pacemaker 1.2"2.8 episodesrpatientr3 months vs. 0.3"0.8 . .episodesrpatientr3 months after 1 year P-0.01. The LVEF increased from 26"10 to 39"13 % P-0.001. NYHA class .improved from 3.17"0.3 to 1.8"0.6 P-0.001 as well as right heart catheterization data. From the total cohort, seve