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| {{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]
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| ==Landmark Clinical Trials==
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| ===Studies of secondary prevention of sudden cardiac death===
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| 1. '''AVID (The Antiarrhythmics versus Implantable Defibrillators)'''
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| * '''Strategy''': ICD vs medication either amiodarone or sotalol
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| * '''Demographics''': Total: 1016 ICD: 507 Medications (predominantly amiodarone): 509 (80% with ischemic heart disease)
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| * '''Mean EF''': 32 (inclusion<40)
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| * '''Result''': Relative risk reduction: 1-year: 39% ; 2-year: 27% ; 3-year: 31% (p = 0.02)
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| 2. '''CIDS (Canadian Implantable Defibrillator Study)'''
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| * '''Strategy''': ICD vs amiodarone
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| * '''Demographics''': Total: 659 ICD: 328 Amiodarone: 331 (82% with ischemic heart disease)
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| * '''Mean EF''': <35
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| * '''Result''': Relative risk reduction: 20% (p = 0.142)
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| 3. '''CASH (Cardiac Arrest Study Hamburg)'''
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| * '''Strategy''': ICD vs amiodarone vs beta blocker
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| * '''Demographics''': Total: 288 (74% with ischemic heart disease) ICD: 99 Amiodarone: 92 Metoprolol: 97
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| * '''Mean EF''': 45
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| * '''Result''': Relative risk reduction at 5 years: 23% (p = 0.081)
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| 4. '''CASCADE(The Cardiac Arrest in Seatle Conventional Versus Amiodarone Drug Evaluation study) '''
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| * '''Strategy''': Amiodarone vs conventional therapy in patients with/without AICD
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| * '''Demographics''': Total: 228 Amiodarone: 113 conventional antiarrhythmic drugs: 115(quinidine (n=33), procainamide (n = 26), combination therapy (n = 17), flecainide (n = 12). AICD: 105 (Amiodarone: 53, Conventional therapy: 52)
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| * '''Mean EF''': 35
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| * '''Result''': 13% more survival in patient population at the primary end point (total cardiac mortality, resuscitated cardiac arrest due to ventricular fibrillation, and syncopal Implanted defibrillator shocks) at the end of 6 years. (p=0.007). With AICD 16% survival more at the primary end point( shocks preceded by complete syncope)(p=0.032) conclusively showing superiority of Amidarone over convetional therapy in secondary prevention.
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| 5. ''' ESVEM (Electrophysiologic Study Versus Electrocardiographic Monitoring for Selection of Antiarrhythmic Therapy of Ventricular Tachyarrhythmias) '''
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| * '''Strategy''': EP testing and Holter monitor of 7 antiarrhythmics (imipramine, mexiletine, procainamide, quinidine, sotalol, pirmenol, propafenone)
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| * '''Demographics''': 486 patients were randomized and 296 patients were eventually followed up.
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| * '''Mean EF''': 33% in all 296 and 34% in Sotalol group
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| * '''Result''': No difference between Holter- and EP-guided groups. Sotalol group had lowest recurrence rate of VT (risk ratio, 0.43; 95 percent confidence interval, 0.29 to 0.62; p<0.001), arrhythmic death (risk ratio, 0.50; 95 percent confidence interval, 0.26 to 0.96; P = 0.04), total death (risk ratio, 0.50; 95 percent confidence interval, 0.30 to 0.80; P = 0.004).
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| === Trials of primary prevention of sudden cardiac death with implantable cardiac defibrillators.===
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| 1. '''MADIT I (Multicenter Automatic Defibrillator Implantation Trial)'''
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| * '''Strategy''': Conventional medical therapy vs ICD in patients with clinical NSVT and inducible VT during EPS that is not suppressible with procainamide
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| * '''Demographics''': Medical therapy: 101 ICD arm: 95
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| * '''Mean EF''': 35
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| * '''Result''': RR reduction in mortality in favor of ICD; 95% CI: 0.26-0.82; p = 0.009
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| 2. '''CABG-PATCH (Coronary Artery Bypass Graft (CABG) Patch Trial)'''
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| * '''Strategy''': CAD patients undergoing CABG with abnormal signal averaged ECG randomized to ICD or control group
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| * '''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
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| * '''Mean EF''': 30
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| * '''Result''': 31% RR reduction in favor of ICD; 95% CI: 0.51-0.93; p = 0.16
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| 3. '''AMIOVIRT (Amiodarone versus Implantable Defibrillator)'''
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| * '''Strategy''': Nonischemic dilated cardiomyopathy patients with nonsustained VT, randomized to ICD vs amiodarone
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| * '''Demographics''': ICD: 51 Amiodarone: 52 Total: 103
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| * '''Mean EF''': 35
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| * '''Result''': No significant difference in survival
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| 4. '''DEFINITE (Defibrillators in Non-Ischemic Cardiomyopathy Treatment Evaluation)'''
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| * '''Strategy''': Nonischemic dilated cardiomyopathy patients with nonsustained VT, randomized to ICD vs standard medical therapy
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| * '''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
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| *'''Mean EF''': 35
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| * '''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)
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| 5. '''DINAMIT (Defibrillator in Acute Myocardial Infarction Trial)'''
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| * '''Strategy''': Benefit of an ICD early after an MI within 6-40 days towards reduction of mortality when compared with medical therapy
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| * '''Demographics''': ICD: 332 Control: 342 Total: 674
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| * '''Mean EF''': 35
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| * '''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
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| 6. '''SCD-HeFT (Sudden Cardiac Death in Heart Failure Trial)'''
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| * '''Strategy''': To assess prognostic effect of ICD vs amiodarone vs placebo in class II and III heart failure regardless of etiology.
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| * '''Demographics''': Conventional therapy and placebo: 847 Conventional therapy and amiodarone: 845 Conventional therapy and single lead, shock only ICD: 829 Total: 2521
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| * '''Mean EF''': 35 (ischemic etiology patients 52% and nonischemic etiology 48%)
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| * '''Result''': Amiodarone and placebo outcome were comparable. ICD arm absolute risk reduction: 7.2% after 5 years; RR: 23% (p = 0.007)
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| ==References==
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| {{reflist|2}}
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| [[Category: Electrophysiology]]
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| [[Category:Cardiology]]
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