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Volume 335:1933-1940 December 26, 1996 Number 26 Next

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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.

Source Information

From the Cardiology Unit, Department of Medicine (A.J.M., J.P.D.), the Department of Biostatistics (W.J.H., M.H.), and the Department of Community and Preventive Medicine (M.W.B.), University of Rochester School of Medicine and Dentistry, Rochester, N.Y.; Good Samaritan Hospital, Los Angeles (D.S.C.); Scripps Memorial Hospital, La Jolla, Calif. (S.L.H.); University Hospital, Magdeburg, Germany (H.K.); St. Francis Hospital–Heart Center, Roslyn, N.Y. (J.H.L.); Eastern Heart Institute, Passaic, N.J. (S.S.); the Department of Medicine, Case Western Reserve University, and University Hospitals of Cleveland, Cleveland (A.L.W.); and the Cardiology Unit, University of Chicago, Chicago (D.W.).

Address reprint requests to Dr. Moss at the Heart Research Follow-up Program, Box 653, University of Rochester Medical Center, Rochester, NY 14642.

Full Text of this Article

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