A comparison of antiarrhythmic-drug therapy with implantable defibrillators in patients resuscitated from near-fatal ventricular arrhythmias

J. McAnulty, B. Halperin, J. Kron, G. Larsen, M. Rait, R. Swenson, R. Floreck, C. Marchant, M. Hamlin, G. Heywood, P. Friedman, W. Stevenson, M. Swat, L. Ganz, M. Sweeney, J. Shea, J. Steinberg, F. Ehlert, S. Zelenkofstke, E. Menchavez-Tan & 79 others M. De Stefano, G. Brown, L. Karagounis, B. Crandall, J. Osborn, D. Rawling, K. Summers, M. Jacobsen, J. Herre, R. Bernsteim, L. Klevan, D. Cannom, A. Bhandari, R. Lerman, B. Firth, R. Klein, R. Freedman, M. Marks, M. Delahunty, C. Spratt, R. Marinchak, S. Rials, P. Kowey, R. Fillart, M. Hernandez, D. Scher, L. Zukerman, S. Farrell, J. Cross, J. Shewchjik, A. Epstein, R. Cooper, R. Dailey, S. Dailey, G. Kay, V. Plumb, R. Bubien, S. Knotts-Dolson, P. McKenna, C. Tidwell, Soo G. Kim, John Devens Fisher, Kevin J. Ferrick, Jay N. Gross, U. Ben-Zur, J. Durkin, A. Ferrick, K. Beckman, J. McClelland, M. Gonzalez, L. Widman, R. Lane, T. Deaton, J. Foster, G. Straughan, L. Wade, M. Brodsky, B. Allen, S. Ehrlich, L. Wolff, M. Macari-Hinson, J. Coromilas, Jr Bigger T., Jr Livelli F., J. Reiffel, K. Hickey, T. Akiyama, J. Daubert, C. Kim, D. Switzer, P. Pande, D. Flynn, M. Keller, C. Ocampo, K. Wahl, J. Vogt, S. Kutalek, S. Hessen, C. Movsowitz

Research output: Contribution to journalArticle

2667 Citations (Scopus)

Abstract

Background: Patients who survive life-threatening ventricular arrhythmias are at risk for recurrent arrhythmias. They can be treated with either an implantable cardioverter-defibrillator or antiarrhythmic drugs, but the relative efficacy of these two treatment strategies is unknown. Methods: To address this issue, we conducted a randomized comparison of these two treatment strategies in patients who had been resuscitated from near-fatal ventricular fibrillation or who had undergone cardioversion from sustained ventricular tachycardia. Patients with ventricular tachycardia also had either syncope or other serious cardiac symptoms, along with a left ventricular ejection fraction of 0.40 or less. One group of patients was treated with implantation of a cardioverter-defibrillator; the other received class III antiarrhythmic drugs, primarily amiodarone at empirically determined doses. Fifty-six clinical centers screened all patients who presented with ventricular tachycardia or ventricular fibrillation during a period of nearly four years. Of 1016 patients (45 percent of whom had ventricular fibrillation, and 55 percent ventricular tachycardia), 507 were randomly assigned to treatment with implantable cardioverter-defibrillators and 509 to antiarrhythmic-drug therapy. The primary end point was overall mortality. Results: Follow-up was complete for 1013 patients (99.7 percent). Overall survival was greater with the implantable defibrillator, with unadjusted estimates of 89.3 percent, as compared with 82.3 percent in the antiarrhythmic-drug group at one year, 81.6 perCent versus 74.7 percent at two years, and 75.4 percent versus 64.1 percent at three years (P<0.02). The corresponding reductions in mortality (with 95 percent confidence limits) with the implantable defibrillator were 39±20 percent, 27±21 percent, and 31±21 percent. Conclusions: Among survivors of ventricular fibrillation or sustained ventricular tachycardia causing severe symptoms, the implantable cardioverter-defibrillator is superior to antiarrhythmic drugs for increasing overall survival.

Original languageEnglish (US)
Pages (from-to)1576-1583
Number of pages8
JournalNew England Journal of Medicine
Volume337
Issue number22
DOIs
StatePublished - Nov 27 1997
Externally publishedYes

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Implantable Defibrillators
Anti-Arrhythmia Agents
Cardiac Arrhythmias
Ventricular Tachycardia
Drug Therapy
Ventricular Fibrillation
Electric Countershock
Defibrillators
Survival
Amiodarone
Mortality
Syncope
Stroke Volume
Survivors
Therapeutics

ASJC Scopus subject areas

  • Medicine(all)

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A comparison of antiarrhythmic-drug therapy with implantable defibrillators in patients resuscitated from near-fatal ventricular arrhythmias. / McAnulty, J.; Halperin, B.; Kron, J.; Larsen, G.; Rait, M.; Swenson, R.; Floreck, R.; Marchant, C.; Hamlin, M.; Heywood, G.; Friedman, P.; Stevenson, W.; Swat, M.; Ganz, L.; Sweeney, M.; Shea, J.; Steinberg, J.; Ehlert, F.; Zelenkofstke, S.; Menchavez-Tan, E.; De Stefano, M.; Brown, G.; Karagounis, L.; Crandall, B.; Osborn, J.; Rawling, D.; Summers, K.; Jacobsen, M.; Herre, J.; Bernsteim, R.; Klevan, L.; Cannom, D.; Bhandari, A.; Lerman, R.; Firth, B.; Klein, R.; Freedman, R.; Marks, M.; Delahunty, M.; Spratt, C.; Marinchak, R.; Rials, S.; Kowey, P.; Fillart, R.; Hernandez, M.; Scher, D.; Zukerman, L.; Farrell, S.; Cross, J.; Shewchjik, J.; Epstein, A.; Cooper, R.; Dailey, R.; Dailey, S.; Kay, G.; Plumb, V.; Bubien, R.; Knotts-Dolson, S.; McKenna, P.; Tidwell, C.; Kim, Soo G.; Fisher, John Devens; Ferrick, Kevin J.; Gross, Jay N.; Ben-Zur, U.; Durkin, J.; Ferrick, A.; Beckman, K.; McClelland, J.; Gonzalez, M.; Widman, L.; Lane, R.; Deaton, T.; Foster, J.; Straughan, G.; Wade, L.; Brodsky, M.; Allen, B.; Ehrlich, S.; Wolff, L.; Macari-Hinson, M.; Coromilas, J.; Bigger T., Jr; Livelli F., Jr; Reiffel, J.; Hickey, K.; Akiyama, T.; Daubert, J.; Kim, C.; Switzer, D.; Pande, P.; Flynn, D.; Keller, M.; Ocampo, C.; Wahl, K.; Vogt, J.; Kutalek, S.; Hessen, S.; Movsowitz, C.

In: New England Journal of Medicine, Vol. 337, No. 22, 27.11.1997, p. 1576-1583.

Research output: Contribution to journalArticle

McAnulty, J, Halperin, B, Kron, J, Larsen, G, Rait, M, Swenson, R, Floreck, R, Marchant, C, Hamlin, M, Heywood, G, Friedman, P, Stevenson, W, Swat, M, Ganz, L, Sweeney, M, Shea, J, Steinberg, J, Ehlert, F, Zelenkofstke, S, Menchavez-Tan, E, De Stefano, M, Brown, G, Karagounis, L, Crandall, B, Osborn, J, Rawling, D, Summers, K, Jacobsen, M, Herre, J, Bernsteim, R, Klevan, L, Cannom, D, Bhandari, A, Lerman, R, Firth, B, Klein, R, Freedman, R, Marks, M, Delahunty, M, Spratt, C, Marinchak, R, Rials, S, Kowey, P, Fillart, R, Hernandez, M, Scher, D, Zukerman, L, Farrell, S, Cross, J, Shewchjik, J, Epstein, A, Cooper, R, Dailey, R, Dailey, S, Kay, G, Plumb, V, Bubien, R, Knotts-Dolson, S, McKenna, P, Tidwell, C, Kim, SG, Fisher, JD, Ferrick, KJ, Gross, JN, Ben-Zur, U, Durkin, J, Ferrick, A, Beckman, K, McClelland, J, Gonzalez, M, Widman, L, Lane, R, Deaton, T, Foster, J, Straughan, G, Wade, L, Brodsky, M, Allen, B, Ehrlich, S, Wolff, L, Macari-Hinson, M, Coromilas, J, Bigger T., J, Livelli F., J, Reiffel, J, Hickey, K, Akiyama, T, Daubert, J, Kim, C, Switzer, D, Pande, P, Flynn, D, Keller, M, Ocampo, C, Wahl, K, Vogt, J, Kutalek, S, Hessen, S & Movsowitz, C 1997, 'A comparison of antiarrhythmic-drug therapy with implantable defibrillators in patients resuscitated from near-fatal ventricular arrhythmias', New England Journal of Medicine, vol. 337, no. 22, pp. 1576-1583. https://doi.org/10.1056/NEJM199711273372202
McAnulty, J. ; Halperin, B. ; Kron, J. ; Larsen, G. ; Rait, M. ; Swenson, R. ; Floreck, R. ; Marchant, C. ; Hamlin, M. ; Heywood, G. ; Friedman, P. ; Stevenson, W. ; Swat, M. ; Ganz, L. ; Sweeney, M. ; Shea, J. ; Steinberg, J. ; Ehlert, F. ; Zelenkofstke, S. ; Menchavez-Tan, E. ; De Stefano, M. ; Brown, G. ; Karagounis, L. ; Crandall, B. ; Osborn, J. ; Rawling, D. ; Summers, K. ; Jacobsen, M. ; Herre, J. ; Bernsteim, R. ; Klevan, L. ; Cannom, D. ; Bhandari, A. ; Lerman, R. ; Firth, B. ; Klein, R. ; Freedman, R. ; Marks, M. ; Delahunty, M. ; Spratt, C. ; Marinchak, R. ; Rials, S. ; Kowey, P. ; Fillart, R. ; Hernandez, M. ; Scher, D. ; Zukerman, L. ; Farrell, S. ; Cross, J. ; Shewchjik, J. ; Epstein, A. ; Cooper, R. ; Dailey, R. ; Dailey, S. ; Kay, G. ; Plumb, V. ; Bubien, R. ; Knotts-Dolson, S. ; McKenna, P. ; Tidwell, C. ; Kim, Soo G. ; Fisher, John Devens ; Ferrick, Kevin J. ; Gross, Jay N. ; Ben-Zur, U. ; Durkin, J. ; Ferrick, A. ; Beckman, K. ; McClelland, J. ; Gonzalez, M. ; Widman, L. ; Lane, R. ; Deaton, T. ; Foster, J. ; Straughan, G. ; Wade, L. ; Brodsky, M. ; Allen, B. ; Ehrlich, S. ; Wolff, L. ; Macari-Hinson, M. ; Coromilas, J. ; Bigger T., Jr ; Livelli F., Jr ; Reiffel, J. ; Hickey, K. ; Akiyama, T. ; Daubert, J. ; Kim, C. ; Switzer, D. ; Pande, P. ; Flynn, D. ; Keller, M. ; Ocampo, C. ; Wahl, K. ; Vogt, J. ; Kutalek, S. ; Hessen, S. ; Movsowitz, C. / A comparison of antiarrhythmic-drug therapy with implantable defibrillators in patients resuscitated from near-fatal ventricular arrhythmias. In: New England Journal of Medicine. 1997 ; Vol. 337, No. 22. pp. 1576-1583.
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title = "A comparison of antiarrhythmic-drug therapy with implantable defibrillators in patients resuscitated from near-fatal ventricular arrhythmias",
abstract = "Background: Patients who survive life-threatening ventricular arrhythmias are at risk for recurrent arrhythmias. They can be treated with either an implantable cardioverter-defibrillator or antiarrhythmic drugs, but the relative efficacy of these two treatment strategies is unknown. Methods: To address this issue, we conducted a randomized comparison of these two treatment strategies in patients who had been resuscitated from near-fatal ventricular fibrillation or who had undergone cardioversion from sustained ventricular tachycardia. Patients with ventricular tachycardia also had either syncope or other serious cardiac symptoms, along with a left ventricular ejection fraction of 0.40 or less. One group of patients was treated with implantation of a cardioverter-defibrillator; the other received class III antiarrhythmic drugs, primarily amiodarone at empirically determined doses. Fifty-six clinical centers screened all patients who presented with ventricular tachycardia or ventricular fibrillation during a period of nearly four years. Of 1016 patients (45 percent of whom had ventricular fibrillation, and 55 percent ventricular tachycardia), 507 were randomly assigned to treatment with implantable cardioverter-defibrillators and 509 to antiarrhythmic-drug therapy. The primary end point was overall mortality. Results: Follow-up was complete for 1013 patients (99.7 percent). Overall survival was greater with the implantable defibrillator, with unadjusted estimates of 89.3 percent, as compared with 82.3 percent in the antiarrhythmic-drug group at one year, 81.6 perCent versus 74.7 percent at two years, and 75.4 percent versus 64.1 percent at three years (P<0.02). The corresponding reductions in mortality (with 95 percent confidence limits) with the implantable defibrillator were 39±20 percent, 27±21 percent, and 31±21 percent. Conclusions: Among survivors of ventricular fibrillation or sustained ventricular tachycardia causing severe symptoms, the implantable cardioverter-defibrillator is superior to antiarrhythmic drugs for increasing overall survival.",
author = "J. McAnulty and B. Halperin and J. Kron and G. Larsen and M. Rait and R. Swenson and R. Floreck and C. Marchant and M. Hamlin and G. Heywood and P. Friedman and W. Stevenson and M. Swat and L. Ganz and M. Sweeney and J. Shea and J. Steinberg and F. Ehlert and S. Zelenkofstke and E. Menchavez-Tan and {De Stefano}, M. and G. Brown and L. Karagounis and B. Crandall and J. Osborn and D. Rawling and K. Summers and M. Jacobsen and J. Herre and R. Bernsteim and L. Klevan and D. Cannom and A. Bhandari and R. Lerman and B. Firth and R. Klein and R. Freedman and M. Marks and M. Delahunty and C. Spratt and R. Marinchak and S. Rials and P. Kowey and R. Fillart and M. Hernandez and D. Scher and L. Zukerman and S. Farrell and J. Cross and J. Shewchjik and A. Epstein and R. Cooper and R. Dailey and S. Dailey and G. Kay and V. Plumb and R. Bubien and S. Knotts-Dolson and P. McKenna and C. Tidwell and Kim, {Soo G.} and Fisher, {John Devens} and Ferrick, {Kevin J.} and Gross, {Jay N.} and U. Ben-Zur and J. Durkin and A. Ferrick and K. Beckman and J. McClelland and M. Gonzalez and L. Widman and R. Lane and T. Deaton and J. Foster and G. Straughan and L. Wade and M. Brodsky and B. Allen and S. Ehrlich and L. Wolff and M. Macari-Hinson and J. Coromilas and {Bigger T.}, Jr and {Livelli F.}, Jr and J. Reiffel and K. Hickey and T. Akiyama and J. Daubert and C. Kim and D. Switzer and P. Pande and D. Flynn and M. Keller and C. Ocampo and K. Wahl and J. Vogt and S. Kutalek and S. Hessen and C. Movsowitz",
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language = "English (US)",
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TY - JOUR

T1 - A comparison of antiarrhythmic-drug therapy with implantable defibrillators in patients resuscitated from near-fatal ventricular arrhythmias

AU - McAnulty, J.

AU - Halperin, B.

AU - Kron, J.

AU - Larsen, G.

AU - Rait, M.

AU - Swenson, R.

AU - Floreck, R.

AU - Marchant, C.

AU - Hamlin, M.

AU - Heywood, G.

AU - Friedman, P.

AU - Stevenson, W.

AU - Swat, M.

AU - Ganz, L.

AU - Sweeney, M.

AU - Shea, J.

AU - Steinberg, J.

AU - Ehlert, F.

AU - Zelenkofstke, S.

AU - Menchavez-Tan, E.

AU - De Stefano, M.

AU - Brown, G.

AU - Karagounis, L.

AU - Crandall, B.

AU - Osborn, J.

AU - Rawling, D.

AU - Summers, K.

AU - Jacobsen, M.

AU - Herre, J.

AU - Bernsteim, R.

AU - Klevan, L.

AU - Cannom, D.

AU - Bhandari, A.

AU - Lerman, R.

AU - Firth, B.

AU - Klein, R.

AU - Freedman, R.

AU - Marks, M.

AU - Delahunty, M.

AU - Spratt, C.

AU - Marinchak, R.

AU - Rials, S.

AU - Kowey, P.

AU - Fillart, R.

AU - Hernandez, M.

AU - Scher, D.

AU - Zukerman, L.

AU - Farrell, S.

AU - Cross, J.

AU - Shewchjik, J.

AU - Epstein, A.

AU - Cooper, R.

AU - Dailey, R.

AU - Dailey, S.

AU - Kay, G.

AU - Plumb, V.

AU - Bubien, R.

AU - Knotts-Dolson, S.

AU - McKenna, P.

AU - Tidwell, C.

AU - Kim, Soo G.

AU - Fisher, John Devens

AU - Ferrick, Kevin J.

AU - Gross, Jay N.

AU - Ben-Zur, U.

AU - Durkin, J.

AU - Ferrick, A.

AU - Beckman, K.

AU - McClelland, J.

AU - Gonzalez, M.

AU - Widman, L.

AU - Lane, R.

AU - Deaton, T.

AU - Foster, J.

AU - Straughan, G.

AU - Wade, L.

AU - Brodsky, M.

AU - Allen, B.

AU - Ehrlich, S.

AU - Wolff, L.

AU - Macari-Hinson, M.

AU - Coromilas, J.

AU - Bigger T., Jr

AU - Livelli F., Jr

AU - Reiffel, J.

AU - Hickey, K.

AU - Akiyama, T.

AU - Daubert, J.

AU - Kim, C.

AU - Switzer, D.

AU - Pande, P.

AU - Flynn, D.

AU - Keller, M.

AU - Ocampo, C.

AU - Wahl, K.

AU - Vogt, J.

AU - Kutalek, S.

AU - Hessen, S.

AU - Movsowitz, C.

PY - 1997/11/27

Y1 - 1997/11/27

N2 - Background: Patients who survive life-threatening ventricular arrhythmias are at risk for recurrent arrhythmias. They can be treated with either an implantable cardioverter-defibrillator or antiarrhythmic drugs, but the relative efficacy of these two treatment strategies is unknown. Methods: To address this issue, we conducted a randomized comparison of these two treatment strategies in patients who had been resuscitated from near-fatal ventricular fibrillation or who had undergone cardioversion from sustained ventricular tachycardia. Patients with ventricular tachycardia also had either syncope or other serious cardiac symptoms, along with a left ventricular ejection fraction of 0.40 or less. One group of patients was treated with implantation of a cardioverter-defibrillator; the other received class III antiarrhythmic drugs, primarily amiodarone at empirically determined doses. Fifty-six clinical centers screened all patients who presented with ventricular tachycardia or ventricular fibrillation during a period of nearly four years. Of 1016 patients (45 percent of whom had ventricular fibrillation, and 55 percent ventricular tachycardia), 507 were randomly assigned to treatment with implantable cardioverter-defibrillators and 509 to antiarrhythmic-drug therapy. The primary end point was overall mortality. Results: Follow-up was complete for 1013 patients (99.7 percent). Overall survival was greater with the implantable defibrillator, with unadjusted estimates of 89.3 percent, as compared with 82.3 percent in the antiarrhythmic-drug group at one year, 81.6 perCent versus 74.7 percent at two years, and 75.4 percent versus 64.1 percent at three years (P<0.02). The corresponding reductions in mortality (with 95 percent confidence limits) with the implantable defibrillator were 39±20 percent, 27±21 percent, and 31±21 percent. Conclusions: Among survivors of ventricular fibrillation or sustained ventricular tachycardia causing severe symptoms, the implantable cardioverter-defibrillator is superior to antiarrhythmic drugs for increasing overall survival.

AB - Background: Patients who survive life-threatening ventricular arrhythmias are at risk for recurrent arrhythmias. They can be treated with either an implantable cardioverter-defibrillator or antiarrhythmic drugs, but the relative efficacy of these two treatment strategies is unknown. Methods: To address this issue, we conducted a randomized comparison of these two treatment strategies in patients who had been resuscitated from near-fatal ventricular fibrillation or who had undergone cardioversion from sustained ventricular tachycardia. Patients with ventricular tachycardia also had either syncope or other serious cardiac symptoms, along with a left ventricular ejection fraction of 0.40 or less. One group of patients was treated with implantation of a cardioverter-defibrillator; the other received class III antiarrhythmic drugs, primarily amiodarone at empirically determined doses. Fifty-six clinical centers screened all patients who presented with ventricular tachycardia or ventricular fibrillation during a period of nearly four years. Of 1016 patients (45 percent of whom had ventricular fibrillation, and 55 percent ventricular tachycardia), 507 were randomly assigned to treatment with implantable cardioverter-defibrillators and 509 to antiarrhythmic-drug therapy. The primary end point was overall mortality. Results: Follow-up was complete for 1013 patients (99.7 percent). Overall survival was greater with the implantable defibrillator, with unadjusted estimates of 89.3 percent, as compared with 82.3 percent in the antiarrhythmic-drug group at one year, 81.6 perCent versus 74.7 percent at two years, and 75.4 percent versus 64.1 percent at three years (P<0.02). The corresponding reductions in mortality (with 95 percent confidence limits) with the implantable defibrillator were 39±20 percent, 27±21 percent, and 31±21 percent. Conclusions: Among survivors of ventricular fibrillation or sustained ventricular tachycardia causing severe symptoms, the implantable cardioverter-defibrillator is superior to antiarrhythmic drugs for increasing overall survival.

UR - http://www.scopus.com/inward/record.url?scp=9844224486&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=9844224486&partnerID=8YFLogxK

U2 - 10.1056/NEJM199711273372202

DO - 10.1056/NEJM199711273372202

M3 - Article

VL - 337

SP - 1576

EP - 1583

JO - New England Journal of Medicine

JF - New England Journal of Medicine

SN - 0028-4793

IS - 22

ER -