| Follow-up of patients with unexplained syncope and inducible ventricular tachyarrhythmias: analysis of the AVID registry and an AVID substudy. Antiarrhythmics Versus Implantable Defibrillators. | |
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MedLine Citation:
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PMID: 11573709 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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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:
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Type: Journal Article; Multicenter Study; Research Support, U.S. Gov't, P.H.S. |
Journal Detail:
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Title: Journal of cardiovascular electrophysiology Volume: 12 ISSN: 1045-3873 ISO Abbreviation: J. Cardiovasc. Electrophysiol. Publication Date: 2001 Sep |
Date Detail:
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Created Date: 2001-09-27 Completed Date: 2002-02-19 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 9010756 Medline TA: J Cardiovasc Electrophysiol Country: United States |
Other Details:
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Languages: eng Pagination: 996-1001 Citation Subset: IM |
Affiliation:
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St. Luke's-Roosevelt Hospital Center and Columbia University College of Physicians and Surgeons, New York, New York 10025, USA. jss7@columbia.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Anti-Arrhythmia Agents
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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:
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N01-HC-25117/HC/NHLBI NIH HHS |
| Chemical | |
Reg. No./Substance:
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0/Anti-Arrhythmia Agents |
| Comments/Corrections | |
Comment In:
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J Cardiovasc Electrophysiol. 2001 Sep;12(9):1002-3
[PMID:
11573687
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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