|
|
| (33 intermediate revisions by 4 users not shown) |
| Line 1: |
Line 1: |
| {{Ventricular tachycardia}}
| | #redirect[[Ventricular tachycardia secondary prevention]] |
| {{CMG}}; '''Associate Editor-in Chief''': [[User:Avirupguha|Avirup Guha, M.B.B.S.]][mailto:avirup.guha@gmail.com]
| |
| ==Landmark Clinical Trials==
| |
| ===Studies of secondary prevention of sudden cardiac death===
| |
| | |
| # ''AVID (The Antiarrhythmics versus Implantable Defibrillators)''
| |
| | |
| ##''Strategy'': ICD vs medication either amiodarone or sotalol
| |
| | |
| ##''Demographics'': Total: 1016 ICD: 507 Medications (predominantly amiodarone): 509 (80% with ischemic heart disease)
| |
| | |
| ##’’Mean EF’’: 32 (inclusion<40)
| |
| | |
| ##’’Result’’: Relative risk reduction: 1-year: 39% ; 2-year: 27% ; 3-year: 31% (p = 0.02)
| |
| | |
| #’’CIDS (Canadian Implantable Defibrillator Study)’’
| |
| | |
| ##’’Strategy’’: ICD vs amiodarone
| |
| | |
| ##’’Demographics’’: Total: 659 ICD: 328 Amiodarone: 331 (82% with ischemic heart disease)
| |
| | |
| ##’’Mean EF’’: <35
| |
| | |
| ##’’Result’’: Relative risk reduction: 20% (p = 0.142)
| |
| | |
| # ‘’CASH (Cardiac Arrest Study Hamburg)’’
| |
| | |
| ##’’Strategy’’: ICD vs amiodarone vs beta blocker
| |
| | |
| ##’’Demographics’’: Total: 288 (74% with ischemic heart disease) ICD: 99 Amiodarone: 92 Metoprolol: 97
| |
| | |
| ##’’Mean EF’’: 45
| |
| | |
| ##’’Result’’: Relative risk reduction at 5 years: 23% (p = 0.081)
| |
| | |
| === Trials of primary prevention of sudden cardiac death with implantable cardiac defibrillators.===
| |
| | |
| # ‘’MADIT I (Multicenter Automatic Defibrillator Implantation Trial)’’
| |
| | |
| ##’’Strategy’’: Conventional medical therapy vs ICD in patients with clinical NSVT and inducible VT during EPS that is not suppressible with procainamide
| |
| | |
| ##’’Demographics’’: Medical therapy: 101 ICD arm: 95
| |
| | |
| ##’’Mean EF’’: 35
| |
| | |
| ##’’Result’’: RR reduction in mortality in favor of ICD; 95% CI: 0.26-0.82; p = 0.009
| |
| | |
| # ‘’CABG-PATCH (Coronary Artery Bypass Graft (CABG) Patch Trial)’’
| |
| | |
| ##’’Strategy’’: CAD patients undergoing CABG with abnormal signal averaged ECG randomized to ICD or control group
| |
| | |
| ##’’Demographics’’: ICD epicardial: 446 Control arm: 45 Total: 900 30days and revascularization > 90 days) randomized 3:2 to ICD vs conventional medical therapy ICD: 42 Conventional medical therapy: 490
| |
| | |
| ##’’Mean EF’’: 30
| |
| | |
| ##’’Result’’: 31% RR reduction in favor of ICD; 95% CI: 0.51-0.93; p = 0.16
| |
| | |
| # ‘’AMIOVIRT (Amiodarone versus Implantable Defibrillator)’’
| |
| | |
| ##’’Strategy’’: Nonischemic dilated cardiomyopathy patients with nonsustained
| |
| VT, randomized to ICD vs amiodarone
| |
| | |
| ##’’Demographics’’: ICD: 51 Amiodarone: 52 Total: 103
| |
| | |
| ##’’Mean EF’’: 35
| |
| | |
| ##’’Result’’: No significant difference in survival
| |
| | |
| # ‘’DEFINITE (Defibrillators in Non-Ischemic Cardiomyopathy Treatment Evaluation)’’
| |
| | |
| ##’’Strategy’’: Nonischemic dilated cardiomyopathy patients with nonsustained VT, randomized to ICD vs standard medical therapy
| |
| | |
| ##’’Demographics’’: Singlechamber ICD: 229 Standard medical therapy: 229 Total: 458 120 ms) in both ischemic and nonischemic causes 1520 randomized in 1:2:2 ratio to receive optimum pharmacological therapy, biventricular pacemaker alone or biventricular pacemaker defibrillator
| |
| | |
| ##’’Mean EF’’: 35
| |
| | |
| ##’’Result’’: Combined end point of hospitalization and death reduced by the pacemaker alone 34% (p = 0.002) and pacemaker-ICD by 40% (p = 0.001). Secondary end point all-cause mortality reduced by defibrillator by RR-36% (p = 0.003) but not by pacemaker alone. RR: 24% (p = 0.059)
| |
| | |
| #’’DINAMIT (Defibrillator in Acute Myocardial Infarction Trial)’’
| |
| | |
| ##’’Strategy’’: Benefit of an ICD early after an MI within 6-40 days towards reduction of mortality when compared with medical therapy
| |
| | |
| ##’’Demographics’’: ICD: 332 Control: 342 Total: 674
| |
| | |
| ##’’Mean EF’’: 35
| |
| | |
| ##’’Result’’: 62 deaths in the ICD group and 58 in the control group (p = 0.66; CI: 0.76-1.55). Arrhythmic causes were less in the ICD group but nonarrhythmic causes were significantly higher and thus overall mortality was not significantly different
| |
| | |
| #’’SCD-HeFT (Sudden Cardiac Death in Heart Failure Trial)’’
| |
| | |
| ##’’Strategy’’: To assess prognostic effect of ICD vs amiodarone vs placebo in class II and III heart failure regardless of etiology.
| |
| | |
| ##’’Demographics’’: Conventional therapy and placebo: 847 Conventional therapy and amiodarone: 845 Conventional therapy and single lead, shock only ICD: 829 Total: 2521
| |
| | |
| ##’’Mean EF’’: 35 (ischemic etiology patients 52% and nonischemic etiology 48%)
| |
| | |
| ##’’Result’’: Amiodarone and placebo outcome were comparable. ICD arm absolute risk reduction: 7.2% after 5 years; RR: 23% (p = 0.007)
| |
| | |
| ==References==
| |
| {{reflist|2}}
| |
| | |
| [[Category: Electrophysiology]]
| |
| [[Category:Cardiology]]
| |
| | |
| {{WikiDoc Help Menu}}
| |
| {{WikiDoc Sources}}
| |