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To the Editor: In their Clinical Review, Drs Vassallo and Trohman¹ examined the role of amiodarone in different clinical settings and, in particular, suggested that "amiodarone can be used safely in patients with left ventricular dysfunction and CHF [congestive heart failure]." However, the authors did not provide a complete analysis of the relevant clinical trials.

In the GESICA trial,² amiodarone reduced mortality, but that study was conducted in a single country, so its results may not be applicable to a broader spectrum of populations with a diverse natural history of CHF. In addition, GESICA had not been blinded. This shortcoming, along with the observation of an unexpectedly low drop-out rate (3%) despite amiodarone's well-known toxicity, suggest that the results should be viewed with caution.

The CHF-STAT study³ was placebo-controlled but had other limitations that could have affected the purported neutral effect on survival: small patient population, limited follow-up, and lack . . . [Full Text of this Article]

Michele Coceani, MD
michecoc@ifc.cnr.it
CNR Institute of Clinical Physiology
Pisa, Italy

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