"Electrophysiologically Guided Antiarrhythmic Therapy in Coronary Artery Disease Patients". The New England Journal of Medicine.
Links to original sources: Wiki Journal Post Full Journal Article
Contents 1 Clinical Question 2 Bottom Line 3 Major Points 4 Guidelines 5 Design 6 Population 6.1 Inclusion Criteria 6.2 Exclusion Criteria 6.3 Baseline Characteristics 7 Interventions 8 Outcomes 8.1 Primary Outcome 8.2 Secondary Outcomes 9 Funding 10 Further Reading
Does electrophysiologically guided antiarrhythmic therapy reduce the risk of sudden death among patients with coronary artery disease, a left ventricular ejection fraction of 40 percent or less, and asymptomatic unsustained ventricular tachycardia?
Electrophysiologically guided antiarrhythmic therapy with implantable defibrillators, but not with antiarrhythmic drugs, reduces the risk of sudden death in high-risk patients with coronary disease.
Patients with coronary artery disease, left ventricular dysfunction, and spontaneous unsustained ventricular tachycardia have a significant risk of sudden death. This study aimed to evaluate if an electrophysiologically guided therapy approach could reduce this risk.
Research findings suggested implanting defibrillators (but not the use of antiarrhythmic-drug therapy based on electrophysiologic testing) in patients like those within the trial criteria to provide beneficial outcomes.
Randomized, controlled trial with an enrollment period from 1990 to 1996.
A total of 704 patients with coronary artery disease, left ventricular ejection fraction of ≤40%, and spontaneous unsustained ventricular tachycardia.
Inclusion Criteria Patients with coronary artery disease, a left ventricular ejection fraction ≤40%, asymptomatic unsustained ventricular tachycardia, and sustained tachyarrhythmia induced by programmed stimulation.
Exclusion Criteria History of syncope or sustained ventricular tachycardia or fibrillation occurring more than 48 hours after myocardial infarction.
Baseline Characteristics Similar across both treatment and placebo groups. Patients had a median ejection fraction of around 29-30%.
Patients were randomized to receive electrophysiologically guided antiarrhythmic therapy or no therapy. Antiarrhythmic therapy included drugs and/or implantable defibrillators as indicated by electrophysiologic testing.
Primary Outcome Cardiac arrest or death from arrhythmia.
Overall mortality, death from cardiac causes, and the incidence of spontaneous, sustained ventricular tachycardia.
National Heart, Lung, and Blood Institute and multiple pharmaceutical and medical device companies.
The full text of this study provides detailed insights into the methodology, results, and implications of the study findings.
Appendix: List of participating investigators and institutions included in the study.