Effect of antiarrhythmic therapy on mortality in survivors of myocardial infarction with asymptomatic complex ventricular arrhythmias: Basel antiarrhythmic study of infarct survival (BASIS)

Abstract

In view of the high risk of sudden cardiac death and the prognostic importance of complex ventricular ectopic activity, the effects of prophylactic antiarrhythmic treatment were investigated prospectively in patients with persisting asymptomatic complex arrhythmias after myocardial infarction. End points were total mortality and arrhythmic events (sudden death, sustained ventricular tachycardia and ventricular fibrillation). Of 1,220 consecutively screened survivors of myocardial infarction, 312 had Lown class 3 or 4b arrhythmia on 24 h electrocardiographic recordings before hospital discharge and consented to the study. They were randomized to individualized antiarrhythmic treatment (Group 1, n = 100), treatment with low dose amiodarone, 200 mg/day (Group 2, n = 98) or no antiarrhythmic therapy (Group 3 [control group], n = 114). During the 1 year follow-up period, 10 patients in Group 1 died, as did 5 in Group 2 and 15 in Group 3. On the basis of an intention to treat analysis, the probability of survival of patients given amiodarone was significantly greater than that of control patients (p less than 0.05). In addition, arrhythmic events were significantly reduced by amiodarone (p less than 0.01). These effects were less marked and not significant for individually treated patients (Group 1). These findings suggest that low dose amiodarone decreases mortality in the 1st year after myocardial infarction in patients at high risk of sudden death.

Diretrizes

“…Diretrizes fármaco com efeito promissor, e em determinadas situações, é a amiodarona 572,573 . Por exemplo, em pacientes com disfunção ventricular esquerda associada a arritmias ventriculares frequentes e repetitivas, o fármaco pode promover a redução do risco de morte súbita elétrica 574,575 .…”

Indications for an Implantable Cardioverter Defibrillator (ICD)

“…Among antiarrhythmic drugs, amiodarone showed a benefit in patients at high risk of SCD, especially for patients with cardiac dysfunction with or without frequent asymptomatic ventricular arrhythmias (39)(40)(41)(42)(43)(44).…”

Implantable cardioverter defibrillators: Uses, abuses, gains and complications

“…Amiodarone has been extensively tested in various populations and has not been convincingly associated with improved long-term outcome yet. (30)(31)(32) Icds treAt vf, reduce scd, IMprove survIvAl…”