Treatment of Ventricular Tachycardia

Pharmacological vs. Automatic Implantable Cardioverter-Defibrillator in Treatment of Ventricular Tachycardia and/or Ventricular Fibrillation.

Patients continue to die each year from ventricular arrhythmia, accounting for less than 1 percent of all those in western countries dying suddenly. Following the primary event, patients continue to present a high risk for tachyarrhythmia to follow (Cappato, 1999). Pinski, Yao, Epstein, Greene, Pacifico, Cook, Jadonath, Marinchak, and the AVID Investigators (AVID) (2000) reported that while research has attempted to establish outcomes of sustained ventricular tachyarrhythmias, with regard to treatment, findings remain inconclusive.

Treatments thus far have included the use of antiarrhythmic drugs and implantable cardioverter defibrillators (ICDs) in addition to treating the underlying disease. Drug treatments are limited by the potential harm associated and more recent studies have shown that class I antiarrhythmic drugs are less effective than class III drugs for those patients with ventricular arrhythmia. Other reports have shown that ICDs have resulted in decreases in sudden cardiac death for those patients with sustained ventricular arrhythmia. However, researchers continue to debate whether this evidence translates into a reduction in total mortality. The major randomized studies researching the differences between outcomes of antiarrhythmics versus implantable defibrillators, include the Antiarrhythmic

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more current state of affairs. Review and Categorization of Principal Findings Cappato (1999) provided an overview of the findings from the four studies reviewed: that ICD was superior to antiarrhythmic drugs for prolonging the survival of patient who met the entry criteria. The inclusion criteria for the four studies were as follows: for the AVID and CIDS study, VF or poorly tolerated VT; for CASH, cardiac arrest secondary to ventricular arrhythmia, regardless of underlying disease; and for the Dutch trial, cardiac arrest secondary to a ventricular arrhythmia, old (.4 weeks) myocardial infarction, and inducible ventricular arrhythmia. Hohnloser (1999) also reviewed the top studies and provided additional information. The CASH study was initiated in 1987, included survivors of cardiac arrest and compared ICD with propafenone, metoprolol, and amiodarone. AVID is considered the largest prospective trial. The AVID study enrolled only not cardiac arrest survivors, but also utilized those with VT. ICD was compared with amiodarone or sotalol regarding primary endpoint of total mortality. CIDS used patients which were similar to those found in AVID. Most patients however, used drug therapy along with ICD. These 3 studies enr

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