Large Clinical Trials in the Management of Ventricular Arrhythmias

Strobel, John; Epstein, Andrew E.

doi:10.1016/s0733-8651(05)70145-4

Cited by 7 publications

(8 citation statements)

References 49 publications

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“…[3][4][5][6][7][8][9][10] Although these trials provide invaluable data on the effects of therapies, clinical trial populations are highly selected because of careful and restricted eligibility criteria 11,12 and may not accurately reflect mortality or morbidity outcomes in the population that may be eligible for such therapies. 13,14 Evidence from clinical trials may not be generalizable in the real world because of several factors: access to resources, physician factors, patient factors, or overall resource allocation.…”

Section: Editorial See P 624 Clinical Perspective On P 713mentioning

confidence: 99%

Use of Primary Prevention Implantable Cardioverter-Defibrillators in a Population-Based Cohort Is Associated With a Significant Survival Benefit

Parkash

Sapp

Basta

et al. 2012

Circ: Arrhythmia and Electrophysiology

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Background— Underuse of implantable defibrillators has been previously noted in patients at risk for sudden cardiac death, as well as for survivors of sudden cardiac death. We sought to determine the utilization rates in a primary prevention implantable cardioverter-defibrillator (ICD)–eligible population and mortality in this group compared with a group that had undergone implantation of this therapy. Methods and Results— A retrospective cohort of patients from April 1, 2006, to December 31, 2009, was used to define a primary prevention ICD-eligible population. Two groups were compared on the basis of ICD implantation (no-ICD versus ICD). The primary outcome measure was mortality. Of the 717 patients found to be potentially eligible for a primary prevention ICD, 116 (16%) were referred. The remaining cohort of 601 patients were compared with an existing cohort of primary prevention ICD patients (n=290). A significant survival benefit was associated with primary prevention ICD implantation (hazard ratio, 0.46; 95% CI [0.33–0.64]; P <0.0001). When adjusted for prespecified variables known to be associated with overall mortality and propensity score, a similar survival benefit was seen (hazard ratio, 0.59; 95% CI [0.40–0.87]; P =0.01). Appropriate ICD therapy occurred in 26% of those in the ICD group, during a mean follow-up of 2.7 years. Conclusions— A significant mortality benefit was observed for patients who underwent primary prevention ICD implantation compared with those who did not. Vigilance is required to ensure that patients eligible for primary prevention ICDs are appropriately referred and assessed to allow such patients to benefit from this life-saving therapy.

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Section: Editorial See P 624 Clinical Perspective On P 713mentioning

confidence: 99%

Use of Primary Prevention Implantable Cardioverter-Defibrillators in a Population-Based Cohort Is Associated With a Significant Survival Benefit

Parkash

Sapp

Basta

et al. 2012

Circ: Arrhythmia and Electrophysiology

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“…Several studies [63,64] are under way to clarify the benefit of ICD therapy for primary prevention of SCD in a certain subset of patients such as those with heart failure due to either left ventricular systolic dysfunction of all causes or solely to nonischemic cardiomyopathy and those who have recently suffered acute MI.…”

Section: Ongoing Trials With Use Of Icdmentioning

confidence: 99%

“…Sudden Cardiac Death Heart Failure Trial (SCD-HeFT). In this study [63,64], patients with LVEF < 0.35, ischemic and nonischemic cardiomyopathy, and class II-III New York Heart Association (NYHA) heart failure are randomized among 3 groups, all of which also receive optimal medical treatment for heart failure: placebo, amiodarone, or ICD placement. This trial is important for 2 reasons.…”

Section: Ongoing Trials With Use Of Icdmentioning

confidence: 99%

Sudden Cardiac Death

Antezano

Hong²

2003

J Intensive Care Med

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Sudden cardiac death (SCD) due to ventricular tachyarrhythmias is a leading cause of death in the United States. This phenomenon is associated with coronary artery disease, valvular heart disease, nonischemic cardiomyopathies, congenital heart disease, primary electrical abnormalities, autonomic nervous system abnormalities, and other less common disorders. Evaluation and management of patients at risk for SCD (primary prevention) and of patients who have survived at least 1 episode of SCD (secondary prevention) have evolved in recent years because clinical trials have shown consistent benefit from implantation of cardioverter-defibrillators in appropriately selected patients. An evidence-based approach to primary and secondary prevention of SCD is presented.

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“…Studies such as MADIT‐II, DINAMIT, and others currently address the question of whether the presence of diminished LV function after myocardial infarction is an indication for defibrillator implant to prevent arrhythmic death in these patients 12 . Studies such as SCD‐HeFT 12 and DEFINITE 13 will find an answer to the question: “Is a diminished LV function regardless of etiology and presence of spontaneous ventricular arrhythmias an indication for a defibrillator implant rather than amiodarone or beta blocker therapy?”…”

Section: The Defibrillatormentioning

confidence: 99%

Future of Device Therapy for Arrhythmias

Wellens

2002

Cardiovasc electrophysiol

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Future of Device Therapy. During the last three decades, implantable devices have been developed that are able to treat complex arrhythmias on an individualized basis, with emphasis on rapid restoration of normal cardiac rhythm or creation of the best physiologic alternative. Currently, new areas for device therapy include atrial fibrillation, life‐threatening ventricular arrhythmias (with or without heart failure), and out‐of‐hospital sudden death. To improve resuscitation from circulatory arrest, the development and widespread use of dependable devices continuously registering cardiac rhythm and able to localize the victim are needed to shorten the time interval to successful defibrillation.

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Large Clinical Trials in the Management of Ventricular Arrhythmias

Cited by 7 publications

References 49 publications

Use of Primary Prevention Implantable Cardioverter-Defibrillators in a Population-Based Cohort Is Associated With a Significant Survival Benefit

Use of Primary Prevention Implantable Cardioverter-Defibrillators in a Population-Based Cohort Is Associated With a Significant Survival Benefit

Sudden Cardiac Death

Future of Device Therapy for Arrhythmias

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