"Electrophysiologically Guided Antiarrhythmic Therapy in Coronary Artery Disease Patients". The New England Journal of Medicine.

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

Clinical Question

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?

Bottom Line

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.

Major Points

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.

Guidelines

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.

Design

Randomized, controlled trial with an enrollment period from 1990 to 1996.

Population

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%.

Interventions

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.

Outcomes

Primary Outcome
Cardiac arrest or death from arrhythmia.

Secondary Outcomes
Overall mortality, death from cardiac causes, and the incidence of spontaneous, sustained ventricular tachycardia.

Funding

National Heart, Lung, and Blood Institute and multiple pharmaceutical and medical device companies.

Further Reading

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.