title: The Cardiac Arrhythmia Suppression Trial: Implications for nursing practice.
abstract: BACKGROUND
  Care of patients with ventricular arrhythmia after myocardial infarction requires careful nursing management, including assisting with arrhythmia monitoring and testing. Because ventricular premature depolarization is a known risk factor for sudden cardiac death, it was hypothesized that the suppression of asymptomatic or mildly symptomatic ventricular premature depolarization would improve survival in these patients.
  
  
  OBJECTIVE
  To review the Cardiac Arrhythmia Suppression Trial findings and provide implications for nursing practice for patients after myocardial infarction.
  
  
  METHODS
  The Cardiac Arrhythmia Suppression Trial was a multicenter, randomized, placebo-controlled trial designed to determine whether the suppression of ventricular premature depolarizations in postmyocardial infarction patients would improve survival. Three class I antiarrhythmic drugs were used: encainide, flecainide, or moricizine. Patients for whom the drug suppressed their arrhythmia 80% or more were randomly assigned to that drug and dose or its matching placebo and were followed every 4 months (main study). Patients with 1% to 79% suppression were randomly assigned to the drug or its placebo that best treated their arrhythmia and followed every 4 months.
  
  
  RESULTS
  Suppression of asymptomatic or mildly symptomatic ventricular premature depolarization in patients using encainide, flecainide, or moricizine failed to improve patient survival and was even harmful in some cases.
  
  
  CONCLUSIONS
  Our results showed that in the absence of effective antiarrhythmic drug therapy, supportive nursing care and arrhythmia monitoring is important until appropriate therapy for the management of these arrhythmias in patients who have had a myocardial infarction can be found. Clinical trials are essential to provide an evaluation of therapies and direction for further studies, as well as a basis for practicing clinicians.
authors.affiliation: University of Calgary, Alberta.
authors.forename: J C
authors.initials: JC
authors.lastname: Kellen
authors.forename: A
authors.initials: A
authors.lastname: Ettinger
authors.forename: L
authors.initials: L
authors.lastname: Todd
authors.forename: M L
authors.initials: ML
authors.lastname: Brezsnyak
authors.forename: J
authors.initials: J
authors.lastname: Campion
authors.forename: R
authors.initials: R
authors.lastname: McBride
authors.forename: S
authors.initials: S
authors.lastname: Thomas
authors.forename: J
authors.initials: J
authors.lastname: Corum
authors.forename: E
authors.initials: E
authors.lastname: Schron
mesh_terms: D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D003422:Critical Care; D016757:Death, Sudden, Cardiac / Q000517:prevention & control; D016700:Encainide / Q000627:therapeutic use; D005260:Female; D005424:Flecainide / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D016293:Moricizine / Q000627:therapeutic use; D009203:Myocardial Infarction / Q000451:nursing* / Q000503:physiopathology; D009730:Nursing Assessment; D015996:Survival Rate; D018879:Ventricular Premature Complexes / Q000188:drug therapy* / Q000451:nursing
chemical_list: D000889:Anti-Arrhythmia Agents; D016293:Moricizine; D005424:Flecainide; D016700:Encainide