91064
document
A comparison of antiarrhythmic-drug therapy with implantable defibrillators in patients resuscitated from near-fatal ventricular arrhythmias . The Antiarrhythmics versus Implantable Defibrillators ( AVID ) Investigators . 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 .
91065
Intervention_Pharmacological
antiarrhythmic-drug therapy
91066
Intervention_Physical
implantable defibrillators
91067
Intervention_Pharmacological
Antiarrhythmics
91068
Intervention_Physical
Implantable Defibrillators
91069
Intervention_Physical
implantable cardioverter-defibrillator
91070
Intervention_Pharmacological
antiarrhythmic drugs
91071
Intervention_Physical
implantation of a cardioverter-defibrillator ;
91072
Intervention_Pharmacological
class III antiarrhythmic drugs
91073
Intervention_Pharmacological
amiodarone
91074
Intervention_Physical
implantable cardioverter-defibrillators
91075
Intervention_Pharmacological
antiarrhythmic-drug therapy .
91076
Intervention_Physical
implantable defibrillator
91077
Intervention_Pharmacological
antiarrhythmic-drug
91078
Intervention_Physical
implantable defibrillator
91079
Intervention_Physical
implantable cardioverter-defibrillator
91080
Intervention_Pharmacological
antiarrhythmic drugs
91081
Outcome_Mortality
overall mortality .
91082
Outcome_Mortality
survival
91083
Outcome_Mortality
mortality