Multicenter prospective nonrandomized study of long-term antiarrhythmic drug therapy in patients with tachyarrhythmias: Japanese Antiarrhythmics Long-Term Study-2 (JALT-2 Study).
Based on the results of the Cardiac Arrhythmia Suppression Trial (CAST), strategies for the treatment of tachyarrhythmias have changed rapidly. The Japanese Antiarrhythmics Long-Term (JALT) study was planned to investigate the present methods for choosing antiarrhythmic drugs, and the effects on long-term prognosis in patients with tachyarrhythmias in Japan. Following a 6-month preliminary study (JALT-1), there was a multicenter nonrandomized prospective study (JALT-2), with a 2-year follow-up, of patients with paroxysmal atrial fibrillation (PAF), sustained ventricular tachycardia (SVT) and nonsustained VT (NSVT). Four hundred fifty-five patients were registered, and 361 of them (79%) were analyzed. Cerebral infarction occurred in 10 of 193 patients (5.2%) with PAF. Transition to chronic AF was observed in 21 patients (10.9%), but in none of the patients receiving Ca antagonist therapy. Twenty-five patients died: 5 deaths were arrhythmic, 10 were because of pump failure, and 9 were noncardiac. The most significant difference in drug selection between JALT-1 and JALT-2 was the increase in the use of slow kinetic Na channel blockers for PAF and the decrease in the use of the same agents for VT in the JALT-2 study. A marked change of therapeutic strategy occurred in JALT-2 compared with JALT-1. Most patients with a poor prognosis had underlying heart diseases and heart failure, but the per annum rate of death by arrhythmia and pump failure in JALT-2 was less than that in JALT-1.
Katoh
T
T
First Department of Internal Medicine, Nippon Medical School, Tokyo, Japan.
Iinuma
H
H
Inoue
H
H
Ohe
T
T
Ogawa
S
S
Kasanuki
H
H
Tanabe
T
T
Hayakawa
H
H
D000328:Adult; D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000145:classification / Q000627:therapeutic use*; D001145:Arrhythmias, Cardiac / Q000401:mortality; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000453:epidemiology; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D002423:Cause of Death; D002544:Cerebral Infarction / Q000453:epidemiology / Q000209:etiology; D018450:Disease Progression; D004363:Drug Utilization / Q000706:statistics & numerical data / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000401:mortality; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D013610:Tachycardia / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D017180:Tachycardia, Ventricular / Q000188:drug therapy / Q000453:epidemiology; D016896:Treatment Outcome
D000889:Anti-Arrhythmia Agents; D002121:Calcium Channel Blockers