Skip to main content
SpringerLink
Log in

Is primary antiarrhythmic drug therapy for ventricular arrhythmias obsolete?

  • Published:
Current Cardiology Reports Aims and scope Submit manuscript

Abstract

Sudden cardiac death (SCD) remains a major public health threat. Patients with aborted SCD have a high incidence of recurrent life-threatening ventricular arrhythmias. Antiarrhythmic drug approaches dominated early attempts to prevent SCD; however, several trials with sotalol and amiodarone revealed an unacceptably high rate of recurrent arrhythmic events. With the advent of the implantable cardioverter defibrillator (ICD), the primary role of antiarrhythmic drug therapy for the secondary prevention of SCD has been called into question. Two recently completed trials, the Antiarrhythmics Versus Implantable Defibrillators (AVID) trial and the Canadian Implantable Defibrillator Study (CIDS), confirm the superiority of the ICD over the best medical therapy for saving lives.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Myerbur RJ, Castellanos A: Cardiac arrest and sudden cardiac death. In In Heart Disease: A Testbook of Cardiovascular Medicine. Edited by Braunwald E, Philadelphia: WB Saunders; 1992:4th edn. 756–789.

    Google Scholar 

  2. Englestein ED, Zipes DP: Sudden cardiac death. In In The Heart, Arteries and Veins. Edited by Alexander RW, Schlant RC, Fuster V. New York: McGraw-Hill; 1998:1081–1112.

    Google Scholar 

  3. Gillum RF: Sudden coronary death in the United States: 1980–1985. Circulation 1989, 79:756–765.

    PubMed  CAS  Google Scholar 

  4. Manolio TA, Furberg CD: Epidemiology of sudden cardiac death. In In Sudden Cardiac Death: Prevalence, Mechanisms and Approaches to Diagnosis and Management. Edited by Akhtar M, Myerburg RJ, Ruskin JN, Philadelphia: Williams and Wilkins; 1994:3–20.

    Google Scholar 

  5. Kannel WB, Cupples LA, D'Agostino RB: Sudden death risk in overt coronary heart disease: The Framingham Study. Am Heart J 1987, 113:799–804.

    Article  PubMed  CAS  Google Scholar 

  6. Perper JA, Kuller LH, Cooper M: Arteriosclerosis of coronary arteries in sudden unexpected deaths. Circulation 1975, 52 (6 Suppl): III 27–33.

    Google Scholar 

  7. Bayes de Luna A, Coumel P, Leclercq JF: Ambulatory sudden cardiac death: mechanisms of production of fatal arrhythmia on the basis of data from 157 cases. Am Heart J 1989, 117:151–159.

    Article  PubMed  CAS  Google Scholar 

  8. Myerbur RJ, Kessler KM, Castellanos A: Sudden cardiac death Structure, function and time-dependence of risk. Circulation 1992, 85 (Suppl I): I 2–10.

    Google Scholar 

  9. Kapoor WN, Karpf M, Wieand S, et al.: A prospective evaluation and follow-up of patients with syncope. N Engl J Med 1983, 309:197–204.

    Article  PubMed  CAS  Google Scholar 

  10. Sra JS, Anderson AJ, Sheikh SH, et al.: Unexplained syncope evaluated by electrophysiologic studies and head-tilt testing. Ann Intern Med 1991, 114:1013–1019.

    PubMed  CAS  Google Scholar 

  11. Deshpande S: Sudden cardiac death. In In Cardiac Intensive Care. Edited by Brown DL. Philadelphia: WB Saunders; 1998:391–404.

    Google Scholar 

  12. Mirowski M, Reid PR, Mower MM, et al.: Termination of malignant ventricular arrhythmias with an implanted automatic defibrillator in human beings. N Engl J Med 1980: 303:322–324.

    Article  PubMed  CAS  Google Scholar 

  13. Echt DS, Armstrong K, Schmidt P et al.: Clinical experience, complications, and survival in 70 patients with the automatic implantable cardioverter-defibrillator. Circulation 1985, 71:289–296.

    PubMed  CAS  Google Scholar 

  14. Kelly PA, Cannom DS, Mirabal G, et al.: The automatic implantable cardioverter-defibrillator: efficacy, complications and survival in patients with malignant ventribular arrhythmias J Am Coll Cardiol 1988, 11:1278–1286.

    Article  PubMed  CAS  Google Scholar 

  15. Lehmann MH, Steinman RH, Schuger CD, Jackson K: The automatic implantable defibrillator as antiarrhythmic treatment modality of choice for survivors of cardiac arrest unrelated to acute myocardial infarction. Am J Cardiol 1988, 62:803–805.

    Article  PubMed  CAS  Google Scholar 

  16. Winkle RA, Mead RH, Ruder JA, et al.: Long-term outcome with the automatic implantable cardioverter-defibrillator. J Am Coll Cardiol 1989, 13:1353–1361.

    Article  PubMed  CAS  Google Scholar 

  17. Fogoros RN, Elson JT, Bonnet CA: Actuarial incidence and pattern of occurrence of shocks following implantation of the automatic implantable cardioverter defibrillator. PACE 1989, 12 1465–1473.

    PubMed  CAS  Google Scholar 

  18. Levine JH, Mellits ED, Baumgardner RA, et al.: Predictors of first discharge and subsequent survival in patients with automatic implantable cardioverter-defibrillator. Circulation 1991, 84:558 566.

    PubMed  Google Scholar 

  19. The Antiarrhythmics Versus Implantable Defibrillators (AVID) investigators: A comparison of antiarrhythmic drug-therapy with implantable defibrillators in patients resuscitated from near-fatal ventricular arrhythmias N Engl J Med 1997, 337:1576–1583. This study was a large, randomized, secondary prevention trial comparing treatment with implantable defibrillators versus antiarrhythmic drugs. The ICD was associated with a 31% reduction in mortality at 3 years compared with antiarrhythmic drugs (mostly amiodarone).

    Article  Google Scholar 

  20. Connolly SJ, Gent M, Roberts RS, et al.: Canadian implantable defibrillator study (CIDS): Study design and organization. Am J Cardiol 1993, 72:103F-108F.

    Article  PubMed  CAS  Google Scholar 

  21. Herre JM, Sauve MJ, Malone P, et al.: Long-term results of amiodarone therapy in patients with recurrent sustained ventribular tachycardia or ventricular fibrillation. J Am Coll Cardiol 1989, 13:442 449.

    Article  PubMed  Google Scholar 

  22. Powell AC, Fuchs T, Finkelstein DM, et al.: Influence of implantable cardioverter-defibrillators on the long-term prognosis of survivors of out-of-hospital cardiac arrest. Circulation 1993, 88:1083–1092.

    PubMed  CAS  Google Scholar 

  23. Sra JS, Natale A, Axtell K, et al.: Experience with two different nonthoracotomy systems for implantable defibrillator in 170 patients. PACE 1994, 17 (Pt I):1741–1750.

    PubMed  CAS  Google Scholar 

  24. Mason JW, The ESVEM investigators: A comparison of electrophysiologic testing with Holter monitoring to predict antiarrhythmic-drug efficacy for ventricular tachyarrhythmias. N Engl J Med 1993, 329:445–451.

    Article  PubMed  CAS  Google Scholar 

  25. The CASCADE investigators: Randomized antiarrhythmic drug therapy in survivors of cardiac arrest (the CASCADE study). Am J Cardiol 1993, 72 280–287.

    Article  Google Scholar 

  26. Echt DS, Liebson PR, Mitchell LB, et al.: Mortality and morbidity in patients receiving encainide, flecainide, or placebo: The Cardiac Arrhythmia Suppression Trial. N Engl J Med 1991, 324:781–788.

    Article  PubMed  CAS  Google Scholar 

  27. Pratt MP, Greene HL, Anderson JL, et al.: Causes of death in the antiarrhythmics versus implantable defibrillabors (AVID) trial. Circulation 1998, 48(suppl):I-494 495.

    Google Scholar 

  28. Exner D, Epstein A, Reiter MJ, et al.: Beta blocker use and mortality in the antiarrhythmics versus implantable defibrillators (AVID) cohort. Circulation 1998, 48(suppl):I-494.

    Google Scholar 

  29. Levine JH, Mellits ED, Baumgardner RA, et al.: Predictors of first discharge and subsequent survival in patients with automatic implantable cardioverter-defibrillators. Circulation 1991, 84:558–566.

    PubMed  CAS  Google Scholar 

  30. Seidl K, Hauer B, Schwick NG, et al.: Comparison of Metoprolol and Sotalol in preventing ventricular tachyarrhythmias after the implantation of a cardioverter/defibrillator. Am J Cardiol 1998, 82:744–748.

    Article  PubMed  CAS  Google Scholar 

  31. Anderson JL, Hallstrom AP, Epstein AE, et al.: Design and Results of the Antiarrhythmics vs Implantable Defibrillators (AVID) Registry. Circulation 1999, 99:1692–1699. An AVID Registry study that reported poor survival in patients with seemingly low-risk ventricular arrhythmias.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Milwaukee Heart Institute, 960 North 12th Street, 53233, Milwaukee, Wisconsin, USA

    Ryan Cooley MD, Masood Akhtar MD & Jasbir Sra MD

Authors
  1. Ryan Cooley MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Masood Akhtar MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jasbir Sra MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Cooley, R., Akhtar, M. & Sra, J. Is primary antiarrhythmic drug therapy for ventricular arrhythmias obsolete?. Curr Cardiol Rep 1, 268–273 (1999). https://doi.org/10.1007/s11886-999-0049-1

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11886-999-0049-1

Keywords

Search

Navigation