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Original Article
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Volume 337:1576-1584 November 27, 1997 Number 22
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A Comparison of Antiarrhythmic-Drug Therapy with Implantable Defibrillators in Patients Resuscitated from Near-Fatal Ventricular Arrhythmias
The Antiarrhythmics versus Implantable Defibrillators (AVID) Investigators

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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.


Source Information

From the AVID Clinical Trial Center, University of Washington, Seattle. The manuscript was prepared by members of the AVID Executive Committee, who accept responsibility for its scientific content: Douglas P. Zipes, M.D. (chairman), Indiana University, Indianapolis; D. George Wyse, M.D., Ph.D., University of Calgary, Calgary, Alta., Canada; Peter L. Friedman, M.D., Ph.D., Brigham and Women's Hospital, Boston; Andrew E. Epstein, M.D., University of Alabama, Birmingham; Alfred P. Hallstrom, Ph.D., and H. Leon Greene, M.D., University of Washington, Seattle; and Eleanor B. Schron, M.S., R.N., and Michael Domanski, M.D., National Heart, Lung, and Blood Institute, Bethesda, Md.

Address reprint requests to the AVID Clinical Trial Center, 1107 N.E. 45th St., Rm. 505, Seattle, WA 98105.

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