title: Randomized controlled trial of prophylactic antiarrhythmic therapy in patients with inducible ventricular tachyarrhythmias after recent myocardial infarction.
abstract: Survivors of acute myocardial infarction who had inducible sustained ventricular tachyarrhythmias at programmed stimulation 1-4 weeks after infarction were recruited to a randomized pilot trial of Class I antiarrhythmic drugs, in an attempt to determine whether their mortality and risk of spontaneous ventricular tachycardia and fibrillation could be reduced by treatment. Of 136 eligible patients, 96 (71%) joined the trial and 47 were randomized to 'no treatment' and 49 were randomized to 'treatment' (quinidine, disopyramide or mexiletine given to attain 'therapeutic' serum levels). During follow-up, the two groups fared similarly. For the 'treatment' and 'no treatment' groups, the respective 3-year probabilities of remaining incident-free were:cardiac death, 0.91 vs 0.89; instantaneous death + non-fatal ventricular tachyarrhythmias, 0.87 vs 0.87; cardiac death + non-fatal ventricular tachyarrhythmias, 0.83 vs 0.85. The highest risk patients with inducible ventricular tachycardia fared similarly in the 'treatment' and 'no treatment' groups. The respective probabilities of remaining incident-free were: cardiac death, 0.89 vs 0.88; instantaneous death + non-fatal ventricular tachyarrhythmias, 0.79 vs 0.84; cardiac death + non-fatal ventricular tachyarrhythmias, 0.76 vs 0.77. We conclude that prophylactic Class I antiarrhythmic drug therapy with quinidine, disopyramide or mexiletine given to achieve a 'therapeutic' serum level does not appear to alter the prognosis of patients with inducible ventricular tachyarrhythmias after myocardial infarction.
authors.affiliation: Department of Medicine, University of Sydney, Westmead Hospital, Australia.
authors.forename: A R
authors.initials: AR
authors.lastname: Denniss
authors.forename: D L
authors.initials: DL
authors.lastname: Ross
authors.forename: D V
authors.initials: DV
authors.lastname: Cody
authors.forename: P A
authors.initials: PA
authors.lastname: Russell
authors.forename: A A
authors.initials: AA
authors.lastname: Young
authors.forename: D A
authors.initials: DA
authors.lastname: Richards
authors.forename: J B
authors.initials: JB
authors.lastname: Uther
mesh_terms: D000206:Actuarial Analysis; D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000097:blood / Q000627:therapeutic use*; D001145:Arrhythmias, Cardiac / Q000209:etiology / Q000517:prevention & control*; D004206:Disopyramide / Q000097:blood / Q000627:therapeutic use; D004558:Electric Stimulation; D004562:Electrocardiography; D006352:Heart Ventricles / Q000503:physiopathology; D006801:Humans; D008801:Mexiletine / Q000097:blood / Q000627:therapeutic use; D009203:Myocardial Infarction / Q000150:complications* / Q000401:mortality; D011379:Prognosis; D011802:Quinidine / Q000097:blood / Q000627:therapeutic use; D011897:Random Allocation
chemical_list: D000889:Anti-Arrhythmia Agents; D008801:Mexiletine; D004206:Disopyramide; D011802:Quinidine