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      Overview of Completed Sudden Death Trials: US Experience

      Cardiology

      S. Karger AG

      Clinical trials, Sudden death, Beta blockers, Antiarrhythmics

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          Abstract

          Ventricular arrhythmias are the major cause of death in patients with coronary heart disease. By suppressing the arrhythmias, antiarrhythmic agents have the theoretical potential of preventing sudden arrhythmic deaths. A large number of randomized, controlled clinical trials of these agents have been conducted during the early hospital phase after an acute myocardial infarction as well as after discharge. Included in this review are approximately 20 mortality trials of antiarrhythmic drugs, including beta blockers, which have been conducted in the United States and Australia. Results of the trials of antiarrhythmics reported to date have not demonstrated an effect on patient survival or risk of sudden death. Three possible explanations exist. First, these agents do not improve prognosis, which is contrary to massive evidence from animal, clinical, and epidemiologic studies. Second, drug treatment prolongs life, but benefit has not been observed in the trials. This explanation is plausible, since the completed trials have methodologic limitations. Third, control of ventricular arrhythmias helps some patients but harms others. Larger, properly designed trials are needed to resolve the uncertainty about the value of antiarrhythmics in the prevention of sudden death. The short- and long-term trials of beta blockers have documented an effect on survival. The benefit seems to be explained primarily through a reduction in sudden or instantaneous death. Whether this effect is mediated through a reduction in ventricular ectopies or an elevation of the fibrillation threshold is debated, as is the effect, if any, of beta-2 blockade on the incidence of ventricular fibrillation.

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          Author and article information

          Journal
          CRD
          Cardiology
          10.1159/issn.0008-6312
          Cardiology
          S. Karger AG
          978-3-8055-4629-4
          978-3-318-01764-9
          0008-6312
          1421-9751
          1987
          1987
          11 November 2008
          : 74
          : Suppl 2
          : 24-31
          Affiliations
          Center for Prevention Research and Biometry, Bowman Gray School of Medicine, Winston-Salem, N.C., USA
          Article
          174284 Cardiology 1987;74:24–31
          10.1159/000174284
          2887288
          © 1987 S. Karger AG, Basel

          Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

          Page count
          Pages: 8
          Categories
          Paper

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