title: The effect of spironolactone on ventricular tachyarrhythmias in patients with implantable cardioverter-defibrillators.
abstract: BACKGROUND
  Previous studies have suggested that aldosterone blockade can reduce the incidence of ventricular tachycardia (VT) or ventricular fibrillation (VF) in patients with heart failure. The SPIronolactone to Reduce ICD Therapy (SPIRIT) trial was designed to test the hypothesis that spironolactone reduces the incidence of VT/VF in patients with implantable cardioverter-defibrillators (ICDs) who are at moderately high risk for recurrent VT/VF.
  
  
  RESULTS
  Ninety patients who had ICDs who were at moderately high risk for recurrent VT/VF and who were not candidates for spironolactone by current heart failure guidelines were randomized to receive spironolactone 25 mg daily or placebo in a double-blind fashion. All patients had previously received ICD therapy (shock or antitachycardia pacing) for VT/VF within 2 years of randomization or an ICD for secondary prevention of VT/VF within 6 months of randomization. The primary end point was time to first recurrence of VT/VF requiring ICD therapy. After a median follow-up of 35 months, the Kaplan-Meier probability estimates for VT/VF requiring ICD therapy were 68.7% in the placebo group and 84.7% in the spironolactone group. Compared with placebo, spironolactone was associated with a similar risk of VT/VF (hazard ratio, 1.01; 95% CI, 0.64-1.83; P=0.71). There was no significant difference between the median times to first VT/VF recurrence requiring ICD therapy in the 2 groups.
  
  
  CONCLUSIONS
  In patients with ICDs who were at moderately high risk for recurrent VT/VF on account of a recent VT/VF event that was either sustained or treated by the ICD and who were not candidates for spironolactone by current heart failure guidelines, spironolactone did not delay the first recurrence of VT/VF or reduce the risk of recurrent VT/VF.
authors: Division of Cardiology, Portland Veterans Affairs Medical Center and Oregon Health and Science University, Portland, OR 97239, USA. Ignatius.Zarraga@va.gov
authors: Ignatius Gerardo E
authors: IG
authors: Zarraga
authors: Cynthia M
authors: CM
authors: Dougherty
authors: Karen S
authors: KS
authors: MacMurdy
authors: Merritt H
authors: MH
authors: Raitt
mesh_terms: D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000009:adverse effects / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D017147:Defibrillators, Implantable / Q000009:adverse effects; D018572:Disease-Free Survival; D004311:Double-Blind Method; D004554:Electric Countershock / Q000009:adverse effects / Q000295:instrumentation*; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D015999:Multivariate Analysis; D017410:Practice Guidelines as Topic; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D055502:Secondary Prevention; D013148:Spironolactone / Q000009:adverse effects / Q000627:therapeutic use*; D017180:Tachycardia, Ventricular / Q000453:epidemiology / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D014493:United States Department of Veterans Affairs; D014693:Ventricular Fibrillation / Q000453:epidemiology / Q000517:prevention & control*
chemical_list: D000889:Anti-Arrhythmia Agents; D000451:Mineralocorticoid Receptor Antagonists; D013148:Spironolactone