DX/RX: Arrhythmias, 1st Edition: Rosenthal, Lawrence S

This document is created with trial version of CHM2PDF Pilot 2.16.100.
Authors: Rosenthal, Lawrence S.

Title: DX/RX: Arrhythmias, 1st Edition
Copyright ©2008 Jones and Bartlett Publishers
2008
Jones and Bartlett Publishers

Sudbury, MA 01776
978-0-7637-2354-5
0-7637-2354-1
World Headquarters
Jones and Bartlett Publishers
40 Tall Pine Drive, Sudbury, MA 01776, 978-443-5000, info@jbpub.com , www.jbpub.com
Jones and Bartlett Publishers Canada
6339 Ormindale Way, Mississauga, Ontario L5V 1J2, Canada
Jones and Bartlett Publishers International
Barb House, Barb Mews, London W6 7PA, United Kingdom
Jones and Bartlett's books and products are available through most bookstores and online
booksellers. To contact Jones and Bartlett Publishers directly, call 800-832-0034, fax 978-443-
8000, or visit our website, www.jbpub.com .
Substantial discounts on bulk quantities of Jones and Bartlett's publications are available to
corporations, professional associations, and other qualified organizations. For details and
specific discount information, contact the special sales department at Jones and Bartlett via
the above contact information or send an email to specialsales@jbpub.com .
Copyright © 2008 by Jones and Bartlett Publishers, Inc.
ISBN-13: 978-0-7637-2354-5
ISBN-10: 0-7637-2354-1
All rights reserved. No part of the material protected by this copyright notice may be
reproduced or utilized in any form, electronic or mechanical, including photocopying,
recording, or any information storage or retrieval system, without written permission from
the copyright owner.
The authors, editor, and publisher have made every effort to provide accurate information.
However, they are not responsible for errors, omissions, or for any outcomes related to the
use of the contents of this book and take no responsibility for the use of the products
described. Treatments and side effects described in this book may not be applicable to all
patients; likewise, some patients may require a dose or experience a side effect that is not
Page 1 of 102
described herein. The reader should confer with his or her own physician regarding specific
treatments and side effects. Drugs and medical devices are discussed that may have limited
availability controlled by the Food and Drug Administration (FDA) for use only in a research
study or clinical trial. The drug information presented has been derived from reference
sources, recently published data, and pharmaceutical research data. Research, clinical
practice, and government regulations often change the accepted standard in this field. When
consideration is being given to use of any drug in the clinical setting, the health care provider
or reader is responsible for determining FDA status of the drug, reading the package insert,
reviewing prescribing information for the most up-to-date recommendations on dose,
precautions, and contraindications, and determining the appropriate usage for the product.
This is especially important in the case of drugs that are new or seldom used.
Library of Congress Cataloging-in-Publication Data
Rosenthal, Lawrence S.
Dx/Rx. Arrhythmias / Lawrence S. Rosenthal.
p. ; cm. — (Jones and Bartlett publishers Dx/Rx cardiology series)
Includes bibliographical references and index.
ISBN-13: 978-0-7637-2354-5 (pbk. : alk. paper)
ISBN-10: 0-7637-2354-1 (pbk. : alk. paper)
1. Arrhythmia—Handbooks, manuals, etc. I. Title. II. Title:Arrhythmias. III. Series.
[DNLM: 1. Tachycardia—diagnosis—Handbooks. 2. Anti-Arrhythmia Agents— Handbooks. 3.

Arrhythmia—Handbooks. 4. Tachycardia—therapy—Handbooks.
WG 39 R815d 2008]
RC685.A65R55 2008
616.1′8—dc22
2007028853
Production Credits
Executive Publisher: Christopher Davis
Acquisitions Editor: Janice Hackenberg
Associate Editor: Kathy Richardson
Production Director: Amy Rose
Production Editor: Carolyn F. Rogers
Senior Marketing Manager: Katrina Gosek
Associate Marketing Manager: Rebecca Wasley
Manufacturing Buyer: Therese Connell
Page 2 of 102
Cover Design: Anne Spencer
Composition: ATLIS Graphics
Printing and Binding: Malloy, Inc.
Cover Printing: Malloy, Inc.
Printed in the United States of America
11 10 09 08 07 10 9 8 7 6 5 4 3 2 1
Page 3 of 102
> Front of Book > Authors
Author
Lawrence S. Rosenthal MD, PhD, FACC
Associate Professor of Medicine
Director, Section Cardiac Pacing and Electrophysiology
Division of Cardiology
UMass Memorial Medical Center
Worcester, Massachusetts
Series Editor:
Dennis A. Tighe MD, FACC, FACP
Page 4 of 102
> Front of Book > Editor's Preface
Editor's Preface
Cardiac arrhythmias are commonly encountered in both inpatient and outpatient settings.
They are seen in a variety of patients and may reflect a severe underlying cardiac disorder or
represent a cardiac response to a non-cardiac disorder. To the nonspecialist, the diagnosis and
management of cardiac arrhythmias can sometimes present diagnostic and/or therapeutic
dilemmas. In this monograph, Dr. Lawrence Rosenthal shares his experience and presents a
concise and practical approach to the diagnosis and treatment of cardiac arrhythmias. The
text is well supplemented with tables and illustrations of the various cardiac arrhythmias. I am
most grateful to Larry for his excellent contribution to this series. Any healthcare professional
who deals with cardiac patients will find this book to be most informative and helpful.
Dennis A. Tighe
Worcester, MA
Page 5 of 102
Page 6 of 102
Page 7 of 102
Page 8 of 102
Page 9 of 102
Page 10 of 102
Page 11 of 102
Page 12 of 102
Page 13 of 102
Page 14 of 102
Page 15 of 102
Page 16 of 102
Page 17 of 102
Page 18 of 102
Page 19 of 102
Page 20 of 102
Page 21 of 102
Page 22 of 102
Page 23 of 102
Page 24 of 102
Page 25 of 102
Page 26 of 102
Page 27 of 102
Page 28 of 102
Page 29 of 102
Page 30 of 102
Page 31 of 102
Page 32 of 102
Page 33 of 102
Page 34 of 102
Page 35 of 102
Page 36 of 102
Page 37 of 102
Page 38 of 102
Page 39 of 102
Page 40 of 102
Page 41 of 102
Page 42 of 102
Page 43 of 102
Page 44 of 102
Page 45 of 102
Page 46 of 102
Page 47 of 102
Page 48 of 102
Page 49 of 102
Page 50 of 102
Page 51 of 102
Page 52 of 102
Page 53 of 102
Page 54 of 102
Page 55 of 102
Page 56 of 102
Page 57 of 102
Page 58 of 102
Page 59 of 102
Page 60 of 102
Page 61 of 102
Page 62 of 102
Page 63 of 102
Page 64 of 102
Page 65 of 102
Page 66 of 102
Page 67 of 102
Page 68 of 102
Page 69 of 102
Page 70 of 102
Page 71 of 102
Page 72 of 102
Page 73 of 102
Page 74 of 102
Page 75 of 102
Page 76 of 102
Page 77 of 102
Page 78 of 102
Page 79 of 102
Page 80 of 102
Page 81 of 102
Page 82 of 102
Page 83 of 102
Page 84 of 102
Page 85 of 102
Page 86 of 102
Page 87 of 102
Page 88 of 102
Page 89 of 102
Page 90 of 102
Page 91 of 102
Page 92 of 102
Page 93 of 102
> Back of Book > Appendix I - Drug Trials and Device Therapy in Patients with Ventricular Arrhythmias
Appendix I
Drug Trials and Device Therapy in Patients with
Ventricular Arrhythmias
n Several clinical trials have helped to clarify the indications for drug therapy in various
subgroups of patients with ventricular arrhythmias.
▪ Ventricular Ectopic Activity and Sudden Cardiac Death:

Post-MI
n Following MI there is no indication to treat isolated premature ventricular beats.
BHAT (Beta-Blocker Heart Attack Trial)

n The BHAT trial examined the usefulness of beta-blockers in the prevention of sudden
cardiac death (SCD).
n This randomized, double-blind, placebo-controlled study tested whether the administration

of propranolol in patients with a history of at least one myocardial infarction could reduce
subsequent mortality.
n A total of 3,837 patients were randomized to receive propranolol (180 or 200 mg/d) or a
placebo.
n The trial was stopped nine months before the planned termination date because of the
significant improvement in total mortality in the beta-blocker treatment group.
n Total mortality at 25.1 months was 7.2% in the propranolol-treated patients and 9.8% in the
placebo group.
n SCD was significantly less frequent in the propranolol-treated patients (3.3% in the
propranolol-treated group versus 4.6% in the placebo group).
n Patients with a history of congestive heart failure experienced a 47% reduction in SCD
(5.5% in the propanolol treated group versus 10.4% in the placebo group).
P.108
References
Beta-Blocker Heart Attack Trial Research Group. A randomized trial of propranolol in
Page 94 of 102
This document is created
patients with myocardial
with acute trial version infarction,
of CHM2PDFI: Pilot 2.16.100.
mortality results. JAMA. 1982;247:1707-1714.
Chadda K, Goldstein S, Byington R, Curb JD. Effect of propranolol after acute myocardial
infarction in patients with congestive heart failure. Circulation. 1986;73:503-510.
CAST I and II (Cardiac Arrhythmia Suppression Trial)

n In patients with coronary artery disease and LV function of less than 40%, the suppression of
ventricular ectopic beats with flecainide, encainide, and moricizine was associated with
an increased risk of mortality.
References
Echt DS, Liebson PR, Mitchell LB, et al. Mortality and morbidity in patients receiving
encainide, flecainide, or placebo: the Cardiac Arrhythmia Suppression Trial. N Engl J
Med. 1991; 324:781-788.
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.
BASIS (Basel Antiarrhythmic Study of Infarct Survival)

n This is the only study supporting the suppression of ventricular ectopy with antiarrhythmic
drugs post-MI.
n Amiodarone therapy was associated with an improved survival even after the drug was
discontinued.
n Most experts, however, do not recommend amiodarone for the treatment of isolated
ventricular ectopy.
Reference
Burkart F, Pfisterer M, Kiowski W, Follath F, Burckhardt D. Effect of antiarrhythmic
therapy on mortality in survivors of myocardial infarction with asymptomatic complex
ventricular arrhythmias: Basel Antiarrhythmic Study of Infarct Survival (BASIS). J Am Coll
Cardiol. 1990;16:1711-1718.
P.109
CAMIAT (Canadian Amiodarone Myocardial
Infarction Arrhythmia Trial)
n The use of amiodarone in post-MI patients with ventricular ectopic activity was associated
with a decrease in sudden death. However, this study did not include enough patients and
Page 95 of 102
did not follow them long enough to show an improvement in survival.
Reference
Cairns JA, Connolly SJ, Roberts R, Gent M. Randomised trial of outcome after myocardial
infarction in patients with frequent or repetitive ventricular premature depolarisations:
CAMIAT. Lancet. 349(9053):675-682.
EMIAT (European Myocardial Infarction Amiodarone

Trial)
n The European Myocardial Infarct Amiodarone Trial (EMIAT) was designed to study the
efficacy of amiodarone in reducing mortality in patients with decreased left ventricular
function after myocardial infarction.
n This trial enrolled 1,486 patients.
n Patients were enrolled 5 to 21 days after myocardial infarction if their left ventricular
ejection fraction (LVEF) was less than or equal to 40%.
n Patients were randomized to receive treatment with amiodarone or placebo.
n There was no difference in all-cause mortality (the primary end point of the study) or in
cardiac mortality.
n Arrhythmic death was reduced from 7.0% in the placebo group to 4.0% in the amiodarone
group (P = .05).
n Retrospective analysis of the data demonstrated a significant reduction in cardiac deaths in

amiodarone-treated patients who were also treated with beta-blockers; this suggests that
beta-blockers confer an additional benefit beyond that provided by amiodarone alone.
n The failure of an improvement in arrhythmic death to translate into an improvement in

cardiac or all-cause mortality may be related to the limited power of the study.
P.110
Reference
Julian DG, Camm AJ, Frangin G, et al. Randomised trial of effect of amiodarone on
mortality in patients with left-ventricular dysfunction after recent myocardial infarction:
EMIAT: European Myocardial Infarct Amiodarone Trial Investigators. Lancet. 1997;349: 667-
674.
SWORD (Survival With Oral D-Sotalol)

n The SWORD trial was designed to test the hypothesis that d-sotalol would reduce mortality
in high-risk survivors of a myocardial infarction.
Page 96 of 102
n This study enrolled patients with an LVEF of less than or equal to 40% and a history of
myocardial infarction with heart failure.
n The study was designed to enroll 6400 patients but was stopped after the enrollment of
3400 patients because excess mortality in the d-sotalol group was observed.
l The mortality rate was 4.6% in the sotalol group and 2.7% in the placebo group (P
= .005).
Reference
Waldo AL, Camm AJ, deRuyter H, et al. Effect of d-sotalol on mortality in patients with
left ventricular dysfunction after recent and remote myocardial infarction: the SWORD
Investigators: Survival With Oral d-Sotalol. Lancet. 1996;348:7-12.
▪ Congestive Heart Failure

CHF-STAT (Survival Trial of Antiarrhythmic Therapy in
Congestive Heart Failure)
n This study enrolled 674 patients with the following conditions: symptoms of congestive
heart failure, cardiac enlargement, 10 or more PVCs/min, and an LVEF of less than or equal
to 40%.
n Patients were randomly assigned to receive amiodarone or a placebo.
n The primary end point of this study was total mortality, and the median follow-up was 45
months.
n Treatment with amiodarone was effective in suppressing ventricular ectopy but did not
result in a substantial reduction
in the combined endpoint of cardiac death or hospitalizations for heart failure. P.111
Reference
Singh S, Fletcher R, Fisher S, Singh B. Amiodarone in patients with congestive heart
failure and asymptomatic ventricular arrhythmia: Survival Trial of Amiodarone in Patients
with Congestive Heart Failure. N Engl J Med. 1995;333:77-82.
GESICA (Grupo de Estudio de la Sobrevida en la

Insuficiecia Cardiaca en Argentina)
n This trial examined the prophylactic use of amiodarone in SCD prevention in patients at
risk because of heart failure.
n This study randomized 516 patients with advanced heart failure to treatment with
Page 97 of 102
amiodarone and standard heart failure therapy or to standard heart failure therapy alone.
n At an average follow-up of 13 months, mortality was 41.4% in the control group and 33.5%
in the amiodaronetreated patients (P = .02).
n Treatment with amiodarone resulted in a 28% risk reduction for mortality attributable both
to arrhythmic death and to progressive heart failure.
l These results are divergent from those of CHF-STAT; no consensus exists in the United
States to treat CHF patients with PVCs.
Reference
Doval HC, Nul DL, Grancelli HO, et al. Randomized trial of low-dose amiodarone in severe
congestive heart failure. Lancet. 1994;344:493-498.
▪ Nonsustained Ventricular Tachycardia: Primary

Prevention of SCD
n Nonsustained ventricular tachycardia is considered an independent predictor of mortality
after a myocardial infarction.
n In certain groups, treatment may improve survival.
P.112
MADIT (Multicenter Automatic Defibrillator
Implantation Trial)
n Among post-MI patients with an LVEF of less than 35%, nonsustained ventricular tachycardia,
and inducible but not suppressible sustained VTach at EPS, a 50% reduction in mortality was
observed with ICD therapy as compared to therapy with antiarrhythmic drugs (primarily
amiodarone).
Reference
Moss AJ, Hall WJ, Cannom DS, et al. Improved survival with an implanted defibrillator in
patients with coronary disease at high risk for ventricular arrhythmia: Multicenter
Automatic Defibrillator Implantation Trial Investigators. N Engl J Med. 1996;335:1933-
1940.
MUSTT (Multicenter UnSustained Tachycardia Trial)

n The Multicenter UnSustained Tachycardia Trial (MUSTT) was a primary prevention trial that
examined the ability of electrophysiologically guided antiarrhythmic therapy to reduce
mortality rates in patients with coronary artery disease, LVEF of less than or equal to 40%,
and asymptomatic nonsustained ventricular tachycardia.
Page 98 of 102
n Patients with inducible sustained ventricular tachycardia had a high mortality rate, which
was lowered by implantable ICDs but not by antiarrhythmic drug therapy.
Reference
Buxton AE, Lee KL, Fisher JD, et al., for the Multicenter UnSustained Tachycardia Trial
Investigators. A randomized study of the prevention of sudden death in patients with
coronary artery disease. N Engl J Med. 1999;341:1882-1890.
MADIT II (Multicenter Automatic Defibrillator

Implantation Trial II)
n This trial evaluated whether prophylactic defibrillator implantation would offer a survival
benefit in patients with prior MI and advanced left ventricular dysfunction who did not
have manifest ventricular arrhythmias and
who did not have a requirement for electrophysiologic study. P.113
n The rationale was that the scarred myocardium in such patients would serve as a substrate
for malignant ventricular arrhythmias and increase the risk of sudden death.
n All patients had an ejection fraction of 0.30 or less within a 3-month period prior to study
entry; these ejection fractions were documented by angiography, radionuclide scanning, or
echocardiography.
n Follow-up averaged 20 months with a range of 6 days to 53 months.
n The data and safety monitoring board recommended termination of the trial due to the
superiority of implantable defibrillation in terms of survival.
l Mortality rates were 19.8% in the conventional therapy group and 14.2% in the
defibrillator group.
l The hazard ratio for risk of death from any cause in the defibrillator group was 0.69 (CI
95%, 0.51-0.93; p = 0.016) when compared to the medical treatment group, representing
a 31% reduction in the risk of death for defibrillator patients.
Reference
Moss A, Zareba W, Hall J, et al. Prophylactic implantation of a defibrillator in patients
with myocardial infarction and reduced ejection fraction. N Engl J Med. 2002;346
(12):877-883.
SCD-HeFT (Sudden Cardiac Death in Heart Failure Trial)

n Patients with class II and class III heart failure (52% ischemic in origin and 48% nonischemic)
with ejection fractions of less than 35% were randomly assigned to receive an ICD,
Page 99 of 102
amiodarone, or a placebo.
n The 2,252 patients were followed for an average of 40 months.
n There was 23% less death in the ICD group regardless of the etiology of the heart disease
(ischemic or nonischemic). In addition, amiodarone was no better than the placebo.
P.114
Reference
Bardy GH, Lee KL, Mark DB, Poole JE, Packer DL, Boineau R, et al. Sudden Cardiac Death
in Heart Failure Trial (SCD-HeFT) Investigators. N Engl J Med. 2005;352(3):225-237.
▪ Sustained Ventricular Arrhythmia: Secondary

Prevention of SCD
AVID (Antiarrhythmics Versus Implantable Defibrillators)
n Survivors of cardiac arrest or symptomatic ventricular tachycardia were randomized to ICD
therapy or antiarrhythmic therapy (amiodarone or sotalol).
n A statistically significant 28% reduction in death was associated with ICD therapy.
Reference
Antiarrhythmics 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.
ESVEM (Electrophysiologic Study Versus

Electrocardiographic Monitoring)
n Survivors of cardiac arrest, symptomatic ventricular tachycardia, or syncope with inducible
arrhythmia at EPS and ventricular ectopic activity (more than 10 PCs/hr on 24-hour ECG
monitoring) were randomized to ventricular premature beat (VPB) suppression (24-hour
ECG and exercise treadmill testing [ETT]) or noninducibility at EPS with seven
antiarrhythmic drugs.
n Neither strategy was superior for predicting arrhythmia recurrence or death, but sotalol
appeared to be a superior antiarrhythmic agent.
Reference
Mason JW for the Electrophysiologic Study versus Electrocardiographic Monitoring
Investigators. A comparison of electrophysiologic testing with Holter monitoring to
predict antiarrhythmic-drug efficacy for ventricular tachyarrhythmias. N Engl J Med.
Page 100 of 102

1993;329:445-451.
Page 101 of 102

> Back of Book > Appendix II - 2005 Changes to the AHA's BLS and ACLS Guidelines
Appendix II
2005 Changes to the AHA's BLS and ACLS
Guidelines
Survival for an out of hospital cardiac arrest is less 5% in the US. This is likely due, in part, to
inconsistencies in the delivery of effective CPR, the availability of Automatic External
defibrillators (AEDs), as well as early intervention. Thus in 2005 changes were made in the BLS
and ACLS algorithms by the American Heart Association. The goal was to simplify resuscitation
training and improve outcomes.
Major changes include:
1. Changing compression rate to 100 per minute in all victims except newborns in order to
achieve effective coronary and cerebral perfusion
2. When attempting defibrillation, deliver a single shock followed by 5 cycles of CPR (2

minutes) beginning with chest compressions. After delivering a shock, rhythm analysis by
AEDs can take as long as 37 seconds, during which no CPR would potentially be delivered.
3. The delivery of normal breaths over one second, because longer breaths reduce coronary
blood flow and oppose chest compressions
4. Using a 30:2 compression to breath ratio for all victims except newborns
Reference
American Heart Association. 2005 American Heart Association Guidelines for
Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. International
Consensus on Science. Circulation. 2005;112:1-211.
Page 102 of 102

DX/RX: Arrhythmias, 1st Edition: Rosenthal, Lawrence S

Hochgeladen von

Dokumentinformationen

Originalbeschreibung:

Originaltitel

Copyright

Verfügbare Formate

Dieses Dokument teilen

Dokument teilen oder einbetten

Freigabeoptionen

Stufen Sie dieses Dokument als nützlich ein?

Sind diese Inhalte unangemessen?

Copyright:

Verfügbare Formate

DX/RX: Arrhythmias, 1st Edition: Rosenthal, Lawrence S

Hochgeladen von

Copyright:

Verfügbare Formate

This document is created with trial version of CHM2PDF Pilot 2.16.100.

Authors: Rosenthal, Lawrence S.

Copyright ©2008 Jones and Bartlett Publishers

Jones and Bartlett Publishers

Jones and Bartlett Publishers

40 Tall Pine Drive, Sudbury, MA 01776, 978-443-5000, info@jbpub.com , www.jbpub.com

Jones and Bartlett Publishers Canada

6339 Ormindale Way, Mississauga, Ontario L5V 1J2, Canada

Jones and Bartlett Publishers International

Barb House, Barb Mews, London W6 7PA, United Kingdom

Copyright © 2008 by Jones and Bartlett Publishers, Inc.

Library of Congress Cataloging-in-Publication Data

Dx/Rx. Arrhythmias / Lawrence S. Rosenthal.

p. ; cm. — (Jones and Bartlett publishers Dx/Rx cardiology series)

Includes bibliographical references and index.

ISBN-13: 978-0-7637-2354-5 (pbk. : alk. paper)

ISBN-10: 0-7637-2354-1 (pbk. : alk. paper)

1. Arrhythmia—Handbooks, manuals, etc. I. Title. II. Title:Arrhythmias. III. Series.

[DNLM: 1. Tachycardia—diagnosis—Handbooks. 2. Anti-Arrhythmia Agents— Handbooks. 3.

Executive Publisher: Christopher Davis

Acquisitions Editor: Janice Hackenberg

Associate Editor: Kathy Richardson

Production Director: Amy Rose

Production Editor: Carolyn F. Rogers

Senior Marketing Manager: Katrina Gosek

Associate Marketing Manager: Rebecca Wasley

Manufacturing Buyer: Therese Connell

Composition: ATLIS Graphics

Printing and Binding: Malloy, Inc.

Cover Printing: Malloy, Inc.

Printed in the United States of America

Copyright ©2008 Jones and Bartlett Publishers

> Front of Book > Authors

Copyright ©2008 Jones and Bartlett Publishers

> Front of Book > Editor's Preface

Copyright ©2008 Jones and Bartlett Publishers

▪ Ventricular Ectopic Activity and Sudden Cardiac Death:

BHAT (Beta-Blocker Heart Attack Trial)

n This randomized, double-blind, placebo-controlled study tested whether the administration

CAST I and II (Cardiac Arrhythmia Suppression Trial)

The Cardiac Arrhythmia Suppression Trial II Investigators. Effect of the antiarrhythmic

BASIS (Basel Antiarrhythmic Study of Infarct Survival)

EMIAT (European Myocardial Infarction Amiodarone

n This trial enrolled 1,486 patients.

n Patients were randomized to receive treatment with amiodarone or placebo.

n Retrospective analysis of the data demonstrated a significant reduction in cardiac deaths in

n The failure of an improvement in arrhythmic death to translate into an improvement in

SWORD (Survival With Oral D-Sotalol)

▪ Congestive Heart Failure

n Patients were randomly assigned to receive amiodarone or a placebo.

GESICA (Grupo de Estudio de la Sobrevida en la

▪ Nonsustained Ventricular Tachycardia: Primary

n In certain groups, treatment may improve survival.

MUSTT (Multicenter UnSustained Tachycardia Trial)

MADIT II (Multicenter Automatic Defibrillator

n Follow-up averaged 20 months with a range of 6 days to 53 months.

SCD-HeFT (Sudden Cardiac Death in Heart Failure Trial)

n The 2,252 patients were followed for an average of 40 months.

▪ Sustained Ventricular Arrhythmia: Secondary

ESVEM (Electrophysiologic Study Versus

Page 100 of 102

Page 101 of 102