Comparison of β-Blockers, Amiodarone Plus β-Blockers, or Sotalol for Prevention of Shocks From Implantable Cardioverter Defibrillators&lt;SUBTITLE&gt;The OPTIC Study: A Randomized Trial&lt;/SUBTITLE&gt;

Connolly, Stuart J.; Dorian, Paul; Roberts, Robin S.; Gent, Michael; Bailin, Steven J.; Fain, Eric; Thorpe, Kevin E.; Champagne, Jean; Talajic, Mario; Coutu, Benoit; Grönefeld, Gerian; Hohnloser, Stefan H.

doi:10.1001/jama.295.2.165

Cited by 704 publications

(445 citation statements)

References 13 publications

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“…However, the OPTIC study demonstrated the additional benefit of amiodarone in combination with beta‐blockers for preventing future ICD interventions in those with inducible or spontaneous ventricular tachyarrhythmias 32. Nonetheless, previous reports were frequently confounded by a nonuniform patient population 33, 34.…”

Section: Management Of Vt In Nicmmentioning

confidence: 99%

Ventricular arrhythmias in nonischemic cardiomyopathy

Chung

Lin

et al. 2018

Journal of Arrhythmia

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Nonischemic cardiomyopathies (NICMs) are composed of variable disease entities, including primary and secondary cardiomyopathies. Determining the etiology of NICM provides pivotal roles of not only the understanding of the individual pathogenesis, but also the clinical management, such as risk stratification, pharmacological treatment, and intervention therapies. Despite the diverse causes of NICM, these cases mostly require clinical attention owing to progressive myocardial injury, resulting in ventricular dysfunction and heart failure. The interaction between the diseased ventricular substrates and systemic/neurophysiological factors contributes to the cornerstones responsible for ventricular arrhythmogenesis and sudden cardiac death (SCD). Prevention of SCD and diminishing ventricular tachyarrhythmias are the important mainstays for the management of NICM patients. Given the understanding of the abnormal ventricular substrates and advancement of navigation systems, radiofrequency catheter ablation (RFCA) has become an adjunctive or alternative strategy for NICM patients who experience drug‐refractory ventricular tachycardias (VTs). Successful ablation can frequently be achieved at the expense of an epicardial intervention. A recent study has proven the survival benefits for NICM patients who are free from recurrent VTs after a successful RFCA, regardless of the New York Heart Association (NYHA) functional class status or left ventricular ejection fraction. Additionally, recent evidence has highlighted the better delineation of a diseased myocardium through the incorporation of cardiovascular magnetic resonance imaging (CMRI) and 3D mapping systems, which can facilitate the identification of critical ventricular arrhythmogenic substrates in NICM patients.

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Section: Management Of Vt In Nicmmentioning

confidence: 99%

Ventricular arrhythmias in nonischemic cardiomyopathy

Chung

Lin

et al. 2018

Journal of Arrhythmia

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“…Antiarrhythmic drugs are the usual long-term treatment strategy, and in most patients amiodarone is chosen in the first line. Although amiodarone or sotalol may reduce ventricular tachyarrhythmias, they are often ineffective or may not be tolerated [4,5].…”

Section: Discussionmentioning

confidence: 99%

Efficacy and tolerability of mexiletine treatment in patients with recurrent ventricular tachyarrhythmias and implantable cardioverter-defibrillator shocks

Sobiech¹,

Lewandowski²,

Zając³

et al. 2017

Kardiol Pol

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A b s t r a c tBackground: Antiarrhythmic treatment of patients with recurrent ventricular tachyarrhythmia, in whom catheter ablation and amiodarone treatment were ineffective or contraindicated, is an unsolved clinical problem. Aim:The study aims to evaluate the efficacy and tolerability of mexiletine in patients with recurrent ventricular tachyarrhythmias and/or electrical storm events, in whom standard treatment strategies failed to prevent ventricular tachyarrhythmia. Methods:We performed a retrospective cohort analysis of all patients treated with mexiletine for recurrent ventricular tachycardia and/or ventricular fibrillation in our institution between January 2011 and September 2015. The primary endpoints were total number of electrical storm events and ventricular tachycardia/ventricular fibrillation (VT/VF) episodes after the beginning of mexiletine therapy. Secondary endpoints were total number of implantable cardioverter-defibrillator (ICD) therapies and discontinuation of the therapy. Events were compared with a matched duration period before initiating mexiletine. Patients served as self-controls.Results: Seventeen patients were included in the study; 11 patients were males. Mean age was 64.2 ± 15.4 years. The median time of mexiletine treatment was eight months (interquartile range [IR]: 1-22 months). The mexiletine dose was 600 mg/day in 13 patients and 400 mg/day in four patients. In four patients the dose was modified during treatment in a range from 400 to 600 mg/day depending on clinical decision. Treatment with mexiletine significantly reduced the number of electrical storm events (14 episodes Conclusions:Mexiletine was a sufficiently tolerated antiarrhythmic drug in short-term treatment of ventricular tachyarrhythmias in the studied population. Mexiletine may be effective in the treatment of recurring ventricular tachyarrhythmias or electrical storm events.

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“…Decreasing the number of shocks triggered by the defi brillator is an important treatment goal for a variety of reasons. A high burden of shocks can contribute to mortality by causing myocardial necrosis and promoting or exacerbating ventricular dysfunction (40), (41) .…”

Section: Antiarrhythmic Drugsmentioning

confidence: 99%

“…ICDs treat VTs by delivering shocks or by providing antitachycardia pacing, effectively preventing arrhythmic sudden death. Nevertheless, the ICD-delivered shocks are painful and can substantially decrease the quality of life (40), (61) , a characteristic that calls attention to the importance of therapies that prevent VT recurrence. Because of the toxicity of antiarrhythmic drugs and their failure in preventing recurrences, ablation (surgical or catheter-based) is, for many patients, the only option to treat recurrent VT.…”

Section: Ablation Therapymentioning

confidence: 99%

Ventricular arrhythmias in Chagas disease

Barbosa

Carmo

Rocha

et al. 2015

Rev. Soc. Bras. Med. Trop.

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Sudden death is one of the most characteristic phenomena of Chagas disease, and approximately one-third of infected patients develop life-threatening heart disease, including malignant ventricular arrhythmias. Fibrotic lesions secondary to chronic cardiomyopathy produce arrhythmogenic substrates that lead to the appearance and maintenance of ventricular arrhythmias. The objective of this study is to discuss the main clinical and epidemiological aspects of ventricular arrhythmias in Chagas disease, the specifi c workups and treatments for these abnormalities, and the breakthroughs needed to determine a more effective approach to these arrhythmias. A literature review was performed via a search of the PubMed database from 1965 to May 31, 2014 for studies of patients with Chagas disease. Clinical management of patients with chronic Chagas disease begins with proper clinical stratifi cation and the identifi cation of individuals at a higher risk of sudden cardiac death. Once a patient develops malignant ventricular arrhythmia, the therapeutic approach aims to prevent the recurrence of arrhythmias and sudden cardiac death by the use of implantable cardioverter defi brillators, antiarrhythmic drugs, or both. In select cases, invasive ablation of the reentrant circuit causing tachycardia may be useful. Ventricular arrhythmias are important manifestations of Chagas cardiomyopathy. This review highlights the absence of high-quality evidence regarding the treatment of ventricular arrhythmias in Chagas disease. Recognizing high-risk patients who require specifi c therapies, especially invasive procedures such as the implantation of cardioverter defi brillators and ablative approaches, is a major challenge in clinical practice.

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Comparison of β-Blockers, Amiodarone Plus β-Blockers, or Sotalol for Prevention of Shocks From Implantable Cardioverter Defibrillators<SUBTITLE>The OPTIC Study: A Randomized Trial</SUBTITLE>

Cited by 704 publications

References 13 publications

Ventricular arrhythmias in nonischemic cardiomyopathy

Ventricular arrhythmias in nonischemic cardiomyopathy

Efficacy and tolerability of mexiletine treatment in patients with recurrent ventricular tachyarrhythmias and implantable cardioverter-defibrillator shocks

Ventricular arrhythmias in Chagas disease

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