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Beta-blockers are the only antiarrhythmic agents with proven benefit after myocardial infarction. In contrast, class IC drugs (such as flecainide) have been associated with increased mortality. This multicenter trial suggests that amiodarone is an effective antiarrhythmic drug.
Ten to 60 days after acute MI, 368 patients with ejection fractions of 20 to 45 percent and three or more asymptomatic ventricular premature complexes (VPCs) per hour were randomized to receive amiodarone (200 mg/day), metoprolol (100 to 200 mg/day), or no antiarrhythmic therapy. Patients were followed for a median of 2.8 years. Those treated with amiodarone had the lowest mortality, but the only statistically significant difference in mortality was between the amioda…