A COMPARISON OF ANTIARRHYTHMIC-DRUG THERAPY WITH IMPLANTABLE DEFIBRILLATORS IN PATIENTS RESUSCITATED FROM NEAR-FATAL VENTRICULAR ARRHYTHMIAS

Authors
MCANULTY J HALPERIN B KRON J LARSEN G RAITT M SWENSON R FLOREK R MARCHANT C HAMLIN M HEYWOOD G FRIEDMAN P STEVENSON W SWAT M GANZ L SWEENEY M SHEA J STEINBERG J EHLERT F ZELENKOFSKE S MENCHAVEZTAN E DESTEFANO M BROWN G ANDERSON J KARAGOUNIS L CRANDALL B OSBORN J RAWLING D SUMMERS K JACOBSEN M HERRE J BERNSTEIN R KLEVAN L CANNON D BHANDARI A LERMAN R FIRTH B KLEIN R FREEDMAN R MARKS M DELAHUNTY M SPRATT C MARINCHAK R RIALS S KOWEY P FILART R HERNANDEZ M SCHER D ZUKERMAN L FARRELL S KOLK D CRINER H TAIT B WILKOFF B PINSKI S CROSS J SHEWCHIK J EPSTEIN A COOPER R DAILEY S KAY G PLUMB V BUBIEN R KNOTTSDOLSON S MCKENNA P TIDWELL C KIM S FISHER J FERRICK K GROSS J BENZUR U DURKIN J FERRICK A BECKMAN K MCCLELLAND J GONZALEZ M WIDMAN L LANE R DEATON T FOSTER J STRAUGHN G WADE L BRODSKY M ALLEN B EHRLICH S WOLFF L MACARIHINSON M COROMILAS J BIGGER T LIVELLI F REIFFEL J HICKEY K AKIYAMA T DAUBERT J KIM C SWITZER D PANDE P FLYNN D KELLER M OCAMPO C WAHL K VOGT J KUTALEK S HESSEN S MOVSOWITZ C SAMUELS F WILBER S BAESSLER C SOTO D SCHUSTER M SCOTT G COVELASKYROBINSON R FLETCHER S SIEGL K FINN L SAARI C ALMQUIST A BALDWIN P HAUSER R MILSTEIN S PRITZKER M SCHREIBER V TORRES V PAI S PLATT M TIMOTHY P BISHOP V ZIPES D ENGELSTEIN E MILES W FOREMAN L LOVE J CUTLER J BOSWORTHFARRELL S RIZOPATRON C BELCO K PAYNE J ARNOLD D ZHU W PRATT C MARTINS J LEE H HOPSON J HOPSON R TULLO N IRMIERE C HENRY A WATHEN M ECHT D RODEN D LEE J MURRAY K ROTTMAN J CRAWFORD D CONNORS N BERNS E LIPPMAN N BARRY M DALAMAGAS H COOK J KABELL G KIRCHHOFFER J WARWICK D BURKOTT B TOMASZEWSKI D BUXTON A HSIA H MILLER J ROTHMAN S ADELIZZI N GASTINEAU M THOME L WHITLEY D GREER G SANTORO I SWAIM J WHITTLE S ROME M KRESGE K TREGONING C HOWARD C CARLSON M ROSENBAUM D LEWIS W BIBLO L MACKALL J WALDO A KANDRAC J FOSTER P CREVEY B GENOVELY H SCHUTZMAN J VIATER K COYLE C PACIFICO A NASIR N TRAINOR K SUNG R LIEM B YOUNG C LAUER M PETERSON J OTTOBONI L GOOLD P CURTIS A CONTI J NELSON C MOUNSEY P NATH S HAINES D ACKERMAN S BOWMAN L NORA M OTOOLE M COLLURA R ENGER E RUSSO A WAXMAN H MORRISSEY J RASPA D JADONATH R GOLDNER B MERKATZ K CHEPURKO L SAKSENA S KROL R MUNSIF A LEWIS C LUCERI R ZILO P WEISS D JONAS A VARDEMAN L STAMATO N WHITING D CHILSON D LESSMEIER T POCHIS W BAXTER J NADEMANEE K WEINBERGER J BAILEY W REITER M BLANKENSHIP M PAGE R JESSEN M CANBY R HORTON R WELCH P KESSLER D JOGLAR J HAMDAN M NELSON L ERWIN G CHIEN W STEVENOT R MERILLAT J MCPHERSON M GOLD M SHOROFSKY S PETERS R KAVESH N FROMAN D SCOTT H SHIH HT DOUGHERTY A JALAL S NACCARRELLI G WOLBRETTE D WILSON D ROTH J GADHOKE A MAUERMANN S SCHWARTZ K ASBELL C SCHEINMAN M EISENBERG S EPSTEIN L FITZPATRICK A GRIFFIN G LEE R LESH M WONG M ZEBEDE J SAMET P TOLENTINO A RUBIN S PODRID P FUCHS T MAZUR M WYSE G DUFF H GILLIS A MITCHELL B ROTHSCHILD J SHELDON R CASSIDY P KARAIAN C DORIAN P NEWMAN D MITCHELL J GREENE M ROY D DUBUC M TALAJIC M THIBAULT B MORRISSETTE D JENKINS L CONNOLLY S HALLSTROM A GREENE L SCHOLZ M POWELL J RENFROE E LEDINGHAM R MORRIS M LANCASTER S MOORE R OLARTE A YAO Q BROOKS MM HOFER B SULLIVAN S SCHRON E DOMANSKI M FOLLMANN D ROSENBERG Y JENNINGS C RICHARDSON D COBB L FURMAN S DIMARCO J KNATTERUD G LEVINE R STRAUSS H WOOSLEY R SINGH B MASON J GRIFFIN J RUSKIN J YUSUF S
Citation
J. Mcanulty et al., A COMPARISON OF ANTIARRHYTHMIC-DRUG THERAPY WITH IMPLANTABLE DEFIBRILLATORS IN PATIENTS RESUSCITATED FROM NEAR-FATAL VENTRICULAR ARRHYTHMIAS, The New England journal of medicine, 337(22), 1997, pp. 1576-1583
Citations number
34
Categorie Soggetti
Medicine, General & Internal
Journal title
The New England journal of medicine → ACNP
ISSN journal
00284793
Volume
337
Issue
22
Year of publication
1997
Pages
1576 - 1583
Database
ISI
SICI code
0028-4793(1997)337:22<1576:ACOATW>2.0.ZU;2-8
Abstract
Background Patients who survive life-threatening ventricular arrhythmi as are at risk for recurrent arrhythmias. They can be treated with eit her an implantable cardioverter-defibrillator or antiarrhythmic drugs, but the relative efficacy of these two treatment strategies is unknow n. Methods To address this issue, we conducted a randomized comparison of these two treatment strategies in patients who had been resuscitat ed from near-fatal ventricular fibrillation or who had undergone cardi oversion from sustained ventricular tachycardia, Patients with ventric ular tachycardia also had either syncope or other serious cardiac symp toms, along with a left ventricular ejection fraction of 0.40 or less. One group of patients was treated with implantation of a cardioverter -defibrillator; the other received class III antiarrhythmic drugs, pri marily amiodarone at empirically determined doses. Fifty-six clinical centers screened all patients who presented with ventricular tachycard ia or ventricular fibrillation during a period of nearly four years. O f 1016 patients (45 percent of whom had ventricular fibrillation, and 55 percent ventricular tachycardia), 507 were randomly assigned to tre atment with implantable cardioverter-defibrillators and 509 to antiarr hythmic-drug therapy. The primary end point was overall mortality. Res ults Follow-up was complete for 1013 patients (99.7 percent). Overall survival was greater with the implantable defibrillator, with unadjust ed estimates of 89.3 percent, as compared with 82.3 percent in the ant iarrhythmic-drug group at one year, 81.6 percent versus 74.7 percent a t two years, and 75.4 percent versus 64.1 percent at three years (P<0. 02). The corresponding reductions in mortality (with 95 percent confid ence limits) with the implantable defibrillator were 39+/-20 percent, 27+/-21 percent, and 31+/-21 percent. Conclusions Among survivors of v entricular fibrillation or sustained ventricular tachycardia causing s evere symptoms, the implantable cardioverter-defibrillator is superior to antiarrhythmic drugs for increasing overall survival. (C) 1997, Ma ssachusetts Medical Society.