Improved survival with an implanted defibrillator in patients with coronary disease at high risk for ventricular arrhythmia

Arthur J. Moss, W. Jackson Hall, David S. Cannom, James P. Daubert, Steven L. Higgins, Helmut Klein, Joseph H. Levine, Sanjeev Saksena, Albert L. Waldo, David Wilber, Mary W. Brown, Moonseong Heo

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Abstract

Background: Unsustained ventricular tachycardia in patients with previous myocardial infarction and left ventricular dysfunction is associated with a two-year mortality rate of about 30 percent. We studied, whether prophylactic therapy with an implanted cardioverter-defibrillator, as compared with conventional medical therapy, would improve survival in this high-risk group of patients. Methods: Over the course of five years, 196 patients in New York Heart Association functional class I, II, or III with prior myocardial infarction; a left ventricular ejection fraction ≤0.35; a documented episode of asymptomatic unsustained ventricular tachycardia; and inducible, nonsuppressible ventricular tachyarrhythmia on electrophysiologic study were randomly assigned to receive an implanted defibrillator (n=95) or conventional medical therapy (n= 101). We used a two-sided sequential design with death from any cause as the end point. Results: The base-line characteristics of the two treatment groups were similar. During an average follow-up of 27 months, there were 15 deaths in the defibrillator group (11 from cardiac causes) and 39 deaths in the conventional-therapy group (27 from cardiac causes) (hazard ratio for overall mortality, 0.46; 95 percent confidence interval, 0.26 to 0.82; P=0.009). There was no evidence that amiodarone, beta-blockers, or any other antiarrhythmic therapy had a significant influence on the observed hazard ratio. Conclusions: In patients with a prior myocardial infarction who are at high risk for ventricular tachyarrhythmia, prophylactic therapy with an implanted defibrillator leads to improved survival as compared with conventional medical therapy.

Original languageEnglish (US)
Pages (from-to)1933-1940
Number of pages8
JournalNew England Journal of Medicine
Volume335
Issue number26
DOIs
StatePublished - Dec 26 1996

ASJC Scopus subject areas

  • Medicine(all)

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    Moss, A. J., Jackson Hall, W., Cannom, D. S., Daubert, J. P., Higgins, S. L., Klein, H., Levine, J. H., Saksena, S., Waldo, A. L., Wilber, D., Brown, M. W., & Heo, M. (1996). Improved survival with an implanted defibrillator in patients with coronary disease at high risk for ventricular arrhythmia. New England Journal of Medicine, 335(26), 1933-1940. https://doi.org/10.1056/NEJM199612263352601