Subanalyses of secondary prevention implantable cardioverter-defibrillator trials: antiarrhythmics versus implantable defibrillators (AVID), Canadian Implantable Defibrillator Study (CIDS), and Cardiac Arrest Study Hamburg (CASH)
| Autor: | Oscar Oseroff, Andres Bochoeyer, Enrique Retyk |
|---|---|
| Rok vydání: | 2003 |
| Předmět: |
Secondary prevention
Heart Failure medicine.medical_specialty business.industry medicine.medical_treatment Implantable defibrillator Implantable cardioverter-defibrillator medicine.disease Implantable defibrillators Defibrillators Implantable Death Sudden Cardiac Evaluation Studies as Topic Heart failure medicine Humans Cardiology and Cardiovascular Medicine business Death sudden cardiac Intensive care medicine Anti-Arrhythmia Agents Randomized Controlled Trials as Topic |
| Zdroj: | Current opinion in cardiology. 19(1) |
| ISSN: | 0268-4705 |
| Popis: | Controlled trials for secondary prevention of sudden death--Antiarrhythmics Versus Implantable Defibrillators (AVID), Canadian Implantable Defibrillator Study (CIDS), and Cardiac Arrest Study Hamburg (CASH)--have been published and subanalyses of them provide useful clinical information on the outcome during the follow-up of this population.Results from a meta-analysis showed a significant risk reduction (RR) of 25 to 27% of total mortality (P0.001) and 50 to 52% of arrhythmic death (P0.001). Compared with amiodarone, patients treated with an implantable cardioverter-defibrillator (ICD) in AVID had a maximal benefit in survival when the ejection fraction (EF) was between 20 and 34%. In CIDS, the group of higher risk (older than 70 years, EF less than 3.5%, and New York Heart Association class III-IV) presented a 50% RR of mortality. It has been demonstrated that the imbalance in beta-blocker use cannot explain the better survival in the ICD patients. After 3 years the recurrence of arrhythmia was 64% in the ICD group of the AVID trial. Patients enrolled after an episode of ventricular tachycardia were more likely to have appropriate therapy during follow-up. Older age, lower blood pressure, history of atrial fibrillation, diabetes, congestive heart failure, and prior pacemaker were parameters used for high-risk stratification. Conversely, inducibility of ventricular tachyarrhythmias on electrophysiology did not predict death.Patients with ICD after ventricular tachyarrhythmias have a 28% RR in total mortality. Individuals with EF between 20 to 34% received the highest benefit with ICD therapy. |
| Databáze: | OpenAIRE |
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