Advertisement

Secondary prevention of sudden death: the Dutch study, the antiarrhythmics versus implantable defibrillator trial, the cardiac arrest study Hamburg, and the Canadian implantable defibrillator study

  • Riccardo Cappato
    Correspondence
    Address for reprints: Riccardo Cappato, MD, Second Department of Internal Medicine, AK St. Georg, Lohmühlenstrasse 5, 20099 Hamburg, Germany
    Affiliations
    Second Department of Internal Medicine, St. Georg Hospital, Hamburg, Germany
    Search for articles by this author

      Abstract

      Although indisputably effective in the prevention of sudden death, use of implantable cardioverter defibrillator (ICD) therapy may not necessarily affect all-cause mortality, as most patients at risk also present with severely depressed left ventricular dysfunction. Correction of the sudden death risk in these patients creates a new clinical condition in need of a careful assessment. Should all-cause mortality be affected by the expected reduction in sudden death rate associated with ICD therapy, issues of critical importance, such as the time extent of life prolongation and the associated quality of life, still remain to established. To investigate the potential benefit of ICD therapy compared with antiarrhythmic drug treatment, 4 prospective studies—the Dutch trial, the Antiarrhythmics Versus Implantable Defibrillators (AVID) study, the Cardiac Arrest Study Hamburg (CASH), and the Canadian Implantable Defibrillator Study (CIDS)—have been conducted in which patients with documented sustained ventricular arrhythmia were randomized to 1 of these 2 treatment strategies. The enrollment criteria differed in these 4 studies: (1) in the Dutch trial, they included cardiac arrest secondary to a ventricular arrhythmia, old (>4 weeks) myocardial infarction, and inducible ventricular arrhythmia; (2) in AVID and CIDS, ventricular fibrillation or poorly tolerated ventricular tachycardia; and (3) in CASH, cardiac arrest secondary to a ventricular arrhythmia regardless of the underlying disease. With regard to the antiarrhythmic drugs, the Dutch trial tested class I and III agents, whereas AVID and CIDS compared ICD therapy with class III agents (mostly amiodarone). In CASH, 3 drug subgroups were investigated: propafenone, amiodarone, and metoprolol. All trials used all-cause mortality as the primary endpoint. Data from these trials provide support for ICD as a therapy superior to antiarrhythmic drugs in prolonging survival in patients meeting the entry criteria. This review briefly summarizes the methods, results, limitations, and clinical implications of these 4 studies.
      To read this article in full you will need to make a payment

      References

        • Myerburg R.J
        • Interian Jr, A
        • Mitrani R.M
        • Kessler K.M
        • Castellanos A
        Frequency of sudden death and profiles of risk.
        Am J Cardiol. 1997; 80: 10F-19F
        • Liberthson R.R
        • Nagel E.L
        • Hirschman J.C
        • Nussenfeld S.R
        Prehospital ventricular defibrillation. Prognosis and follow-up course.
        N Engl J Med. 1974; 291: 317-321
        • Baum R.S
        • Alvarez H
        • Cobb L.A
        Survival after resuscitation from out-of-hospital ventricular fibrillation.
        Circulation. 1974; 50: 1231-1235
        • Shaffer W.A
        • Cobb L.A
        Recurrent ventricular fibrillation and mode of death in survivors of out-of-hospital ventricular fibrillation.
        N Engl J Med. 1975; 293: 259-262
        • Tresch D.D
        • Keelan Jr, M.H
        • Siegel R
        • Troup P.J
        • Boncheck L.I
        • Olinger G.N
        • Brooks H.L
        Long-term survival after prehospital sudden cardiac death.
        Am Heart J. 1984; 108: 1-5
        • Myerburg R.J
        • Kessler K.M
        • Estes D
        • Conde C.A
        • Luceri R.M
        • Zaman L
        • Koslovskis P.L
        • Castellanos A
        Long-term survival after prehospital cardiac arrest.
        Circulation. 1984; 70: 538-546
        • Wilber D.J
        • Garan H
        • Finkelstein D
        • Kelly E
        • Newell J
        • McGovern B
        • Ruskin J.N
        Out-of-hospital cardiac arrest.
        N Engl J Med. 1988; 318: 19-24
        • Furukawa T
        • Rozanski J.J
        • Nogami A
        • Moroe K
        • Gosselin A.J
        • Lister J.W
        Time-dependent risk of and predictors for cardiac arrest recurrence in survivors of out-of-hospital cardiac arrest with chronic coronary artery disease.
        Circulation. 1989; 80: 599-608
        • Ruskin J.N
        • DiMarco J.P
        • Garan H
        Out-of-hospital cardiac arrest.
        N Engl J Med. 1980; 303: 607-613
        • Weaver W.D
        • Lorch G.S
        • Alvarez H.A
        • Cobb L.A
        Angiographic findings and prognostic indicators in patients resuscitated from sudden cardiac death.
        Circulation. 1976; 54: 895-900
        • Morady F
        • Scheinmann M.M
        • Hess D.S
        • Sung R.J
        • Shen E
        • Shapiro W
        Electrophysiologic testing in the management of survivors of out-of-hospital cardiac arrest.
        Am J Cardiol. 1983; 51: 85-89
        • Benditt D.G
        • Benson Jr, D.W
        • Klein G.J
        • Pritzker M.R
        • Kriett J.M
        • Anderson R.W
        Prevention of recurrent sudden cardiac arrest.
        J Am Coll Cardiol. 1983; 2: 418-425
        • Roy D
        • Waxman H.L
        • Kienzle M.G
        • Buxton A.E
        • Marchlinski F.E
        • Josephson M.E
        Clinical characteristics and long-term follow-up in 119 survivors of cardiac arrest.
        Am J Cardiol. 1983; 53: 969-974
        • Skale B.T
        • Miles W.M
        • Heger J.J
        • Zipes D.P
        • Prystowsky E.N
        Survivors of cardiac arrest.
        Am J Cardiol. 1986; 57: 113-119
        • Eldar M
        • Sauve M.J
        • Scheinmann M.M
        Electrophysiologic testing and follow-up in patients with aborted sudden death.
        J Am Coll Cardiol. 1987; 10: 291-298
        • Freedman R.A
        • Swerdlow C.D
        • Soderholm-Difatte V
        • Mason J.W
        Prognostic significance of arrhythmic inducibility or noninducibility at initial electrophysiologic study in survivors of cardiac arrest.
        Am J Cardiol. 1988; 61: 578-582
        • Mirowski M
        • Reid P.R
        • Mower M.M
        • Watkins L
        • Gott V.L
        • Schauble J.F
        • Langer A
        • Heilman M.S
        • Kolenik S.A
        • Fischell R.E
        • Weisfeldt M.L
        Termination of malignant ventricular arrhythmias with an implanted automatic defibrillator in human beings.
        N Engl J Med. 1980; 303: 322-324
        • Winkle R.A
        • Mead R.H
        • Ruder M.A
        • Gaudiani V.A
        • Smith N.A
        • Buch W.S
        • Schmidt P
        • Shipman T
        Long-term outcome with the automatic implantable cardioverter-defibrillator.
        J Am Coll Cardiol. 1989; 13: 1353-1361
        • Fogoros R.N
        • Elson J.J
        • Bonnet C.A
        • Fiedler S.B
        • Burkholder J.A
        Efficacy of the automatic implantable cardioverter-defibrillator in prolonging survival in patients with severe heart disease.
        J Am Coll Cardiol. 1990; 16: 381-386
        • Newman D
        • Sauve M.J
        • Herre J
        • Langberg J.J
        • Lee M.A
        • Titus C
        • Franklin J
        • Scheinman M.M
        • Griffin J.C
        Survival after implantation of the cardioverter defibrillator.
        Am J Cardiol. 1992; 69: 899-903
        • Tchou P.J
        • Kadri N
        • Anderson J
        • Caceres J.A
        • Jazayeri M
        • Akhtar M
        Automatic implantable cardioverter defibrillators and survival of patients with left ventricular dysfunction and malignant ventricular arrhythmias.
        Ann Intern Med. 1988; 109: 529-534
        • Levine J.H
        • Mellits E.D
        • Baumgardner R.A
        • Veltri E.P
        • Mower M
        • Grunwald L
        • Guarnieri T
        • Aarons D
        • Griffith L.S
        Predictors of first discharge and subsequent survivals in patients with automatic implantable cardioverter defibrillators.
        Circulation. 1991; 84: 558-566
        • de Marchena E
        • Chakko S
        • Fernandez P
        • Villa A
        • Cooper D
        • Wozniak P
        • Cruz J
        • Thurer R.J
        • Kessler K.M
        • Myerburg R.J
        Usefulness of the automatic implantable cardioverter defibrillator in improving survival of patients with severely depressed left ventricular function associated with coronary artery disease.
        Am J Cardiol. 1991; 67: 812-816
        • Myerburg R.J
        • Luceri R.M
        • Thurer R
        • Cooper D.K
        • Zaman L
        • Interian A
        • Fernandez P
        • Cox M
        • Glicksman F
        • Castellanos A
        Time to first shock and clinical outcome in patients receiving an automatic implantable cardioverter defibrillator.
        J Am Coll Cardiol. 1989; 14: 508-514
        • Fogoros R.N
        • Elson J.J
        • Bonnet C.A
        Actuarial incidence and pattern of occurrence of shocks following implantation of the automatic implantable cardioverter defibrillator.
        PACE Pacing Clin Electrophysiol. 1989; 12: 1465-1473
        • Mason J.W
        A comparison of seven antiarrhythmic drugs in patients with ventricular tachyarrhythmias.
        N Engl J Med. 1993; 329: 452-458
        • The CASCADE investigators
        Randomized antiarrhythmic drug therapy in survivors of cardiac arrest (The CASCADE study).
        Am J Cardiol. 1993; 72: 280-287
        • The Cardiac Arrhythmia Suppression Trial (CAST) Investigators
        Preliminary report.
        N Engl J Med. 1989; 321: 406-412
        • The Cardiac Arrhythmia Suppression Trial II Investigators
        Effect of the antiarrhythmic agent moricizine on survival after myocardial infarction.
        N Engl J Med. 1992; 327: 227-233
        • Kim S.G
        Implantable defibrillator therapy: does it really prolong life? How can we prove it?.
        Am J Cardiol. 1992; 71: 1213-1216
        • Kuck K.H
        • Cappato R
        • Siebels J
        ICD therapy.
        in: Camm A.J Clinical Approaches to Tachyarrhythmias. Futura Publishing Company, Armonk, NY1996
        • Epstein A.E
        AVID necessity.
        PACE Pacing Clin Electrophysiol. 1993; 16: 1773-1775
        • Kim S.G
        • Fogoros R.N
        • Furman S
        • Connolly S.J
        • Kuck K.H
        • Moss A.J
        Standardized reporting of ICD patient outcome.
        PACE Pacing Clin Electrophysiol. 1993; 16: 1358-1363
        • Wever E.F.D
        • Hauer R.N.W
        • van Capelle F.J.I
        • Tijssen J.G.P
        • Crijns H.J.G.M
        • Algra A
        • Wiesfeld A.C.P
        • Bakker P.F.A
        • Robles de Medina E.O
        Randomized study of implantable defibrillator as first-choice therapy versus conventional strategy in postinfarct sudden death survivors.
        Circulation. 1995; 91: 2195-2203
        • The Antiarrhythmic versus Implantable Defibrillators (AVID) Investigators
        A comparison of antiarrhythmic drug therapy with implantable defibrillators in patients resuscitated from near-fatal ventricular arrhythmias.
        N Engl J Med. 1997; 337: 1576-1583
        • Siebels J
        • Cappato R
        • Rüppel R
        • Schneider M.A.E
        • Kuck K.H
        • CASH Investigators
        ICD versus drugs in cardiac arrest survivors.
        PACE Pacing Clin Electrophysiol. 1993; 16: 552-558
        • Connolly S.J
        • Gent M
        • Roberts R.S
        • Dorian P
        • Green M.S
        • Klein G.J
        • Mitchell L.B
        • Sheldon R.S
        • Roy D
        • CIDS Co-investigators
        Canadian Implantable Defibrillator Study (CIDS).
        Am J Cardiol. 1993; 72: 103F-108F
      1. Kuck KH, on behalf of the CASH investigators. The CASH study: final results. Oral presentation at the Annual Session of the American College of Cardiology, Atlanta, March 29–April 1, 1998.

      2. Connolly S, on behalf of the CIDS Investigators. The CIDS study: final results. Oral presentation at the Annual Session of the American College of Cardiology meeting, Atlanta, March 29 - April 1, 1998.

      3. ACC/AHA Guidelines for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices. A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (committee on pacemakers implantation).
        J Am Coll Cardiol. 1998; 31: 1175-1209
        • Redfield M.M
        • Gersh B.J
        • Bailey K.R
        • Ballard D.J
        • Rodeheffer R.J
        Natural hystory of dilated cardiomyopathy.
        J Am Coll Cardiol. 1993; 22: 1921-1926
        • Task Force of the Working Group on Arrhythmia of the European Society of Cardiology
        The early termination of clinical trials.
        Circulation. 1994; 89: 2892-2907
        • Echt D.S
        • Armstrong K
        • Schmidt R.N
        • Oyer P.E
        • Stinson E.B
        • Winkle R.A
        Clinical experience, complications and survival in 70 patients with the automatic implantable cardioverter/defibrillator.
        Circulation. 1985; 2: 289-296
        • Marchlinski F.E
        • Flores B.T
        • Buxton A.E
        • Hargrove III, W.C
        • Addonizio V.P
        • Stephenson L.W
        • Harken A.H
        • Doherty J.U
        • Grogan Jr, E.W
        • Josephson M.E
        The automatic implantable cardioverter-defibrillator.
        Ann Intern Med. 1986; 104: 481-488
        • Fogoros R.N
        • Fiedler S.B
        • Elson J.J
        The automatic implantable cardioverter-defibrillator in drug-refractory ventricular tachyarrhythmias.
        Ann Intern Med. 1987; 107: 635-641