Multicenter prospective nonrandomized study of long-term antiarrhythmic drug therapy in patients with tachyarrhythmias - Japanese Antiarrhythmics Long-Term study-2 (JALT-2 study)

Based on the results of the Cardiac Arrhythmia Suppression Trial (CAST), st rategies for the treatment of tachy arrhythmias have changed rapidly. The J apanese Antiarrhythmics Long-Term (JALT) study was planned to investigate t he present methods for choosing antiarrhythmic drugs, and the effects on lo ng-term prognosis in patients with tachyarrhythmias in Japan. Following a 6 -month preliminary study (JALT-1), there was a multicenter nonrandomized pr ospective study (JALT-2), with a 2-year follow-up, of patients with paroxys mal atrial fibrillation (PAF), sustained ventricular tachycardia (SVT) and nonsustained VT (NSVT). Four hundred fifty-five patients were registered, a nd 361 of them (79%,) Were analyzed. Cerebral infarction occurred in 10 of 193 patients (5.2%) With PAF. Transition to chronic AF was observed in 21 p atients (10.9%, but in none of the patients receiving Ca antagonist therapy . Twenty-five patients died: 5 deaths were arrhythmic, 10 were because of p ump failure, and 9 were noncardiac. The most significant difference in drug selection between JALT-1 and JALT-2 was the increase in the use of slow ki netic Na channel blockers for PAF and the decrease in the use of the same a gents fur VT in the JALT-2, study. A marked change of therapeutic strategy occurred in JALT-2 compared with JALT-1. Most patients with a poor prognosi s had underlying heart diseases and heart failure, but the per annum rate o f death by arrhythmia and pump failure in JALT-2 was less than that in JALT -1.