Electrical storm presages nonsudden death: the antiarrhythmics versus implantable defibrillators (AVID) trial.
نویسندگان
چکیده
BACKGROUND Electrical storm, multiple temporally related episodes of ventricular tachycardia (VT) or ventricular fibrillation (VF), is a frequent problem among recipients of implantable cardioverter defibrillators (ICDs). However, insufficient data exist regarding its prognostic significance. METHODS AND RESULTS This analysis includes 457 patients who received an ICD in the Antiarrhythmics Versus Implantable Defibrillators (AVID) trial and who were followed for 31 +/- 13 months. Electrical storm was defined as > or = 3 separate episodes of VT/VF within 24 hours. Characteristics and survival of patients surviving electrical storm (n = 90), those with VT/VF unrelated to electrical storm (n = 184), and the remaining patients (n = 183) were compared. The 3 groups differed in terms of ejection fraction, index arrhythmia, revascularization status, and baseline medication use. Survival was evaluated using time-dependent Cox modeling. Electrical storm occurred 9.2 +/- 11.5 months after ICD implantation, and most episodes (86%) were due to VT. Electrical storm was a significant risk factor for subsequent death, independent of ejection fraction and other prognostic variables (relative risk [RR], 2.4; 95% confidence interval [CI], 1.3 to 4.2; P = 0.003), but VT/VF unrelated to electrical storm was not (RR, 1.0; 95% CI, 0.6 to 1.7; P = 0.9). The risk of death was greatest 3 months after electrical storm (RR, 5.4; 95% Cl, 2.4 to 12.3; P = 0.0001) and diminished beyond this time (RR, 1.9; 95% CI, 1.0 to 3.6; P=0.04). CONCLUSIONS Electrical storm is an important, independent marker for subsequent death among ICD recipients, particularly in the first 3 months after its occurrence. However, the development of VT/VF unrelated to electrical storm does not seem to be associated with an increased risk of subsequent death.
منابع مشابه
Design and results of the antiarrhythmics vs implantable defibrillators (AVID) registry. The AVID Investigators.
BACKGROUND The Antiarrhythmics Versus Implantable Defibrillators (AVID) Study compared treatment with implantable cardioverter-defibrillators versus antiarrhythmic drugs in patients with life-threatening ventricular arrhythmias (VAs). AVID maintained a Registry on all patients, randomized or not, with any VA or unexplained syncope who could be considered for either of the treatment strategies. ...
متن کامل"Stable" ventricular tachycardia is not a benign rhythm : insights from the antiarrhythmics versus implantable defibrillators (AVID) registry.
BACKGROUND Sustained ventricular tachycardia (VT) can be unstable, can be associated with serious symptoms, or can be stable and relatively free of symptoms. Patients with unstable VT are at high risk for sudden death and are best treated with an implantable defibrillator. The prognosis of patients with stable VT is controversial, and it is unknown whether implantable cardioverter-defibrillator...
متن کاملDesign and Results of the Antiarrhythmics vs Implantable Defibrillators (AVID) Registry
Background—The Antiarrhythmics Versus Implantable Defibrillators (AVID) Study compared treatment with implantable cardioverter-defibrillators versus antiarrhythmic drugs in patients with life-threatening ventricular arrhythmias (VAs). AVID maintained a Registry on all patients, randomized or not, with any VA or unexplained syncope who could be considered for either of the treatment strategies. ...
متن کاملAnalysis of implantable cardioverter defibrillator therapy in the Antiarrhythmics Versus Implantable Defibrillators (AVID) Trial.
INTRODUCTION The implantable cardioverter defibrillator (ICD) is commonly used to treat patients with documented sustained ventricular tachycardia (VT) or ventricular fibrillation (VF). Arrhythmia recurrence rates in these patients are high, but which patients will receive a therapy and the forms of arrhythmia recurrence (VT or VF) are poorly understood. METHODS AND RESULTS The therapy delive...
متن کاملCLINICAL STUDIES Arrhythmias Beta-Blocker Use and Survival in Patients With Ventricular Fibrillation or Symptomatic Ventricular Tachycardia: The Antiarrhythmics Versus Implantable Defibrillators (AVID) Trial
Derek V. Exner, MD, MPH,* James A. Reiffel, MD, FACC,‡ Andrew E. Epstein, MD, FACC,‡ Robert Ledingham, MS,† Michael J. Reiter, MD, PHD, FACC,‡ Qing Yao, PHD,† Henry J. Duff, MD,‡ Dean Follmann, PHD,* Eleanor Schron, RN,* H. Leon Greene, MD, FACC,† Mark D. Carlson, MD, FACC,‡ Michael A. Brodsky, MD, FACC,‡ Toshio Akiyama, MD, FACC,‡ Christina Baessler, MSN,‡ Jeffrey L. Anderson, MD, FACC,‡ and t...
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ورودعنوان ژورنال:
- Circulation
دوره 103 16 شماره
صفحات -
تاریخ انتشار 2001