Document Detail


Follow-up of patients with unexplained syncope and inducible ventricular tachyarrhythmias: analysis of the AVID registry and an AVID substudy. Antiarrhythmics Versus Implantable Defibrillators.
MedLine Citation:
PMID:  11573709     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
INTRODUCTION: A prospective registry and substudy were conducted in the Antiarrhythmics Versus Implantable Defibrillators (AVID) Study to clarify the prognosis and recurrent event rate, risk factors, and impact of implantable cardioverter defibrillator (ICD) therapy in patients with unexplained syncope, structural heart disease, and inducible ventricular tachyarrhythmias. METHODS AND RESULTS: Included in the AVID registry were patients from all participating sites who had "out of hospital syncope with structural heart disease and EP-inducible VT/VF with symptoms." In addition, 13 collaborating sites provided more in-depth clinical and electrophysiologic data as part of a formal prospective substudy. Patients in the substudy were followed by local investigators for recurrent arrhythmic events and mortality. Registry patients were tracked for fatal outcomes by the National Death Index. A total of 429 patients with syncope were entered in the AVID registry, of whom 80 participated in the substudy. Of the substudy patients, 21 patients (26%) had inducible polymorphic ventricular tachycardia/ventricular fibrillation (VT/VF), 11 patients (14%) had sustained monomorphic VT <200 beats/min, and 48 patients (60%) had sustained monomorphic VT > or = 200 beats/min. The ICD was used as sole therapy in 75% of the syncope substudy patients (and with antiarrhythmic drug in an additional 9%) and in 59% of the syncope registry patients. Survival rates at 1 and 3 years were 93% and 74% for the substudy patients and 90% and 74% for the registry patients, respectively. Survival of the syncope substudy patients (predominantly treated by ICD) was similar to the VT patients treated by ICD and superior to the VT patients treated by an antiarrhythmic drug (P = 0.05) in the randomized main trial. Mortality events in the substudy were marginally predicted by ejection fraction (P = 0.06) but not by electrophysiologic study-induced arrhythmia. The significant predictor of increased mortality in the registry was age (P = 0.003) and of reduced mortality was treatment with ICD (P = 0.006). CONCLUSION: The results of these analyses support the role of the ICD as primary antiarrhythmic therapy in patients with unexplained syncope, structural heart disease, and inducible VT/VF at electrophysiologic study.
Authors:
J S Steinberg; K Beckman; H L Greene; R Marinchak; R C Klein; S G Greer; F Ehlert; P Foster; E Menchavez; M Raitt; M S Wathen; M Morris; A Hallstrom
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Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Journal of cardiovascular electrophysiology     Volume:  12     ISSN:  1045-3873     ISO Abbreviation:  J. Cardiovasc. Electrophysiol.     Publication Date:  2001 Sep 
Date Detail:
Created Date:  2001-09-27     Completed Date:  2002-02-19     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  9010756     Medline TA:  J Cardiovasc Electrophysiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  996-1001     Citation Subset:  IM    
Affiliation:
St. Luke's-Roosevelt Hospital Center and Columbia University College of Physicians and Surgeons, New York, New York 10025, USA. jss7@columbia.edu
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MeSH Terms
Descriptor/Qualifier:
Anti-Arrhythmia Agents / therapeutic use*
Defibrillators, Implantable*
Female
Humans
Male
Middle Aged
Multivariate Analysis
Prognosis
Proportional Hazards Models
Prospective Studies
Randomized Controlled Trials as Topic
Recurrence
Registries
Survival Rate
Syncope / mortality,  therapy*
Tachycardia, Ventricular / mortality,  therapy*
Ventricular Fibrillation / mortality,  therapy*
Grant Support
ID/Acronym/Agency:
N01-HC-25117/HC/NHLBI NIH HHS
Chemical
Reg. No./Substance:
0/Anti-Arrhythmia Agents
Comments/Corrections
Comment In:
J Cardiovasc Electrophysiol. 2001 Sep;12(9):1002-3   [PMID:  11573687 ]

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