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ICDs Benefit Survivors of Near-Fatal VF

Patients who survive ventricular fibrillation (VF) or symptomatic sustained ventricular tachycardia (VT) have a high risk for sudden death. The Antiarrhythmics versus Implantable Defibrillators (AVID) investigators sought to determine the relative efficacy of drug therapy versus defibrillators for survivors of life-threatening ventricular arrhythmias.

This multicenter study included 1,016 patients who were resuscitated from a near-fatal VF arrest or who had sustained VT with syncope or a left ventricular ejection fraction (LVEF) of 40 percent or less. Patients were randomized to receive either a state-of-the-art implantable cardioverter-defibrillator or contemporary antiarrhythmic drug therapy that usually included amiodarone. The mean age of the group was 65 years, and the vast majority were male and white. The mean LVEF was 32 percent in the defibrillator group and 31 percent in the antiarrhythmic-drug group.

At a mean follow-up of 18 months, the crude death rate was 16 percent in the defibrillator group and 24 percent in the antiarrhythmic-drug group. At three years, the defibrillator group survived an average of 2.7 months longer than the drug therapy group, and activation of the defibrillator took place in 85 percent of patients with VT and 69 percent of those with VF.

Comment: The AVID trial demonstrates that survivors of VF or sustained VT with symptoms and hemodynamic compromise can survive longer with the implantation of a cardioverter-defibrillator. The investigators conclude that ICDs should be offered as "first-line therapy" to these patients.

— HM Krumholz

Published in Journal Watch Cardiology December 31, 1998

Citation(s):

The 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 Nov 27 337 1576-1583.

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