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 language | English (US) |
|---|---|
| Pages (from-to) | 1933-1940 |
| Number of pages | 8 |
| Journal | New England Journal of Medicine |
| Volume | 335 |
| Issue number | 26 |
| DOIs | |
| State | Published - Dec 26 1996 |
| Externally published | Yes |
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Cite this
Improved survival with an implanted defibrillator in patients with coronary disease at high risk for ventricular arrhythmia. / Moss, Arthur J.; Jackson Hall, W.; Cannom, David S.; Daubert, James P.; Higgins, Steven L.; Klein, Helmut; Levine, Joseph H.; Saksena, Sanjeev; Waldo, Albert L.; Wilber, David; Brown, Mary W.; Heo, Moonseong.
In: New England Journal of Medicine, Vol. 335, No. 26, 26.12.1996, p. 1933-1940.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Improved survival with an implanted defibrillator in patients with coronary disease at high risk for ventricular arrhythmia
AU - Moss, Arthur J.
AU - Jackson Hall, W.
AU - Cannom, David S.
AU - Daubert, James P.
AU - Higgins, Steven L.
AU - Klein, Helmut
AU - Levine, Joseph H.
AU - Saksena, Sanjeev
AU - Waldo, Albert L.
AU - Wilber, David
AU - Brown, Mary W.
AU - Heo, Moonseong
PY - 1996/12/26
Y1 - 1996/12/26
N2 - 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.
AB - 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.
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U2 - 10.1056/NEJM199612263352601
DO - 10.1056/NEJM199612263352601
M3 - Article
C2 - 8960472
AN - SCOPUS:0006918490
VL - 335
SP - 1933
EP - 1940
JO - New England Journal of Medicine
JF - New England Journal of Medicine
SN - 0028-4793
IS - 26
ER -