However, little is known about incidence, risk factors, and treatment of early postoperative arrhythmias. There were 1189 patients 447 aas and 712 nonaas enrolled. Icd only on background of optimal medical rx patients. Clinical trials under scrutiny aapc knowledge center. The incidence of appropriate therapy in the s icd was somewhat similar to that in the sudden cardiac death in heart failure trial scdheft trial. May 11, 2007 the multicenter unsustained tachycardia trial mustt confirmed the hypothesis that patients with coronary artery disease, left ventricular lv ejection fraction ef trial mustt. The annual number of icd malfunctions increased during the study period, with more than 50% of the icd malfunctions occurring in the last 3 years of the study and close to one quarter occurring in the last year alone. Objectives using data from the multicenter unsustained tachycardia trial mustt, we examined the factors used to select antiarrhythmic drug therapy and their impact on outcomes. Request pdf prophylactic implantable cardioverter defibrillator trials. Although most of the variables used can be assessed at the bedside, electrophysiology study was required.
The multicenter unsustained tachycardia trial mustt was designed to test the effectiveness of electrophysiologically guided antiarrhythmic therapy in reducing the risk of arrhythmic death, cardiac arrest, and total mortality in patients with coronary artery disease, ejection fraction. Implantable cardioverter defibrillator icd registry full. Using data from the multicenter unsustained tachycardia trial mustt, we examined. Although mustt was not a specific icd trial for primary prevention of scd the results of the trial revealed that only with icd backupa significant reduction of arrhythmic death or cardiac. Both tachyarrhythmias and bradyarrhythmias can present in the postoperative period. Madit randomized trial to reduce inappropriate therapy. During the study, 17 323 devices 8834 pacemakers and 8489 icds were explanted due to confirmed malfunction. Madit i found a 54% reduction in mortality with icd treatment p 0. Objectives the study sought to analyze the risk of ventricular tachyarrhythmia vta or death in black and white subjects implanted with implantable cardioverterdefibrillators icds or defibrillator and combined cardiac resynchronization therapy crtd in the maditcrt multicenter automatic defibrillator implantation with cardiac resynchronization therapy trial. Implantable cardioverterdefibrillators in arrhythmias. Implantable cardioverter defibrillators icds have evolved from the treatment of last resort to the gold standard therapy for patients at high risk for ventricular tachyarrhythmias. Highrisk patients include those who have survived lifethreatening arrhythmias, and individuals with cardiac disease who are at risk for such arrhythmias, but are symptomless.
Oct 05, 2004 the multicenter unsustained tachycardia trial mustt tested the value of electrophysiologically guided antiarrhythmic drug therapy against no therapy in high risk coronary artery disease with poor left ventricular function lvef. Publications home of jama and the specialty journals of the. Prevention of sudden death in patients with coronary artery disease. The main trial was analyzed on an intentiontotreat basis. Antiarrhythmic drug therapy in the multicenter unsustained. The mortality rate at 24 and 60month followup showed that the antiarrhythmic therapy group 12% and 25%, respectively performed significantly better than the conservative group 18% and 32%, respectively, p0. Listing a study does not mean it has been evaluated by the u. Absolute risk reduction in total mortality with implantable. Sep 24, 2015 iimplantable cardioverter defibrillators icds dr prithvi puwar 1. Survival benefit of the primary prevention implantable.
History of icds indications for icds major trials 3. Incidence and electrophysiological characteristics of. Alkhatib and colleagues are to be commended for their evaluation of the costeffectiveness of implantable cardioverter defibrillators icd based on the multicenter automatic defibrillator implantation trial ii maditii. Effect of implantable defibrillators on arrhythmic events and. Epguided antiarrhythmic drug treatment had a lower incidence of scdca compared to no treatment 12% versus 25%, p 0. Effect of implantable defibrillators on arrhythmic events. The 1999 multicenter unsustained tachycardia trial mustt trial. Amiodarone or an implantable cardioverterdefibrillator for congestive heart failure scdheft trial. Oct 01, 2011 like all health care services, however, clinical trials icd9cm code v70. Do all patients with an icd indication need a biv pacing. Although patients were not randomized to icd or usual care in mustt, the trial was nevertheless included because the observed treatment effect of electrophysiologicallyguided antiarrhythmic therapy was due to better outcomes among icd recipients rather than antiarrhythmic drug recipients.
In a retrospective analysis of 65 consecutive patients undergoing icd placement between 1991 and 1993, age was not associated with readmission. Quality of life in the canadian implantable defibrillator study cids. The implantable cardioverter defibrillator the lancet. Prithvi puwar dnb cardiology registrar vijaya hospital, chennai 2. The definite trial randomized patients with nonischemic cardiomyopathy with an lvef of 36% or less and ambient arrhythmia to icd implantation or medical therapy in a 2arm study design. The multicenter unsustained tachycardia trial mustt 1 confirmed the hypothesis that patients with coronary artery disease, left ventricular ejection fraction. Dec 01, 2000 mustt and madit have clearly shown the survival benefit of an implantable cardioverter defibrillator icd in patients with previous myocardial infarction, left ventricular ejection fraction 1993. Implantable cardioverter defibrillator icd registry. To assess the incidence and electrophysiological characteristics of spontaneous ventricular tachyarrhythmias after implantable cardioverterdefibrillator icd implantation for primary prevention. By comparing outcomes of those patients in the ep group patients discharged on drugs predicted effective by electrophysiologic testing who received implanted cardioverter defibrillators icds to those randomized to no antiarrhythmic therapy. Multicenter unsustained tachycardia trial mustt 1999 design. In the antiarrhythmic therapy group, 45% of patients received antiarrhythmic drugs, 46% received an icd, and 7% received no therapy. The present guidelines for implantation of defibrillators icd are based on a. The icd has evolved to overcome the limitation of earlier devices that required thoracotomy for implantation and were fraught with inappropriate shock delivery.
Amiodarone or an implantable cardioverterdefibrillator for congestive hean. The multicenter unsustained tachycardia trial mustt was a prospective, randomized clinical trial designed to test the hypothesis that antiarrhythmic therapy, including drugs and implantable cardiac defibrillators icd, guided by electrophysiological ep testing can reduce the risk of arrhythmic death or cardiac arrest in patients with. Role of pacing in heart failure postgraduate medical. Furthermore, mustt included only patients with coronary artery disease cad. The present guidelines for implantation of defibrillators icd are based on a careful analysis of recent scientific data on the therapy of ventricular tachyarrhythmias. The multicenter unsustained ta chycardia trial mustt. Outcomes in african americans undergoing cardioverter.
Designation and distribution of events in the multicenter. The role of implantable cardioverter defibrillators in ischemic and nonischemic cardiomyopathy and effect on mortality and sudden death shervin eshaghian albert einstein college of medicine bronx, new york 10461 initially, attempts at preventing scd were aimed at suppression of ventricular ectopy, but it was not until the. Sudden cardiac death in heart failure trial scdheft investigators. Predictors and risk of ventricular tachyarrhythmias or.
M r the role of implantable cardioverter defibrillators in. This was a randomized controlled clinical trial evaluating the utility of clinical electrophysiologic studies to guide therapy of patients with coronary disease, ejection fraction. The role of implantable cardioverter defibrillators in ischemic and nonischemic cardiomyopathy and effect on. Seven randomised controlled trials, published between 1993 and 2000, met the inclusion. Publications home of jama and the specialty journals of.
In this issue of the journalthe mustt multicenter unsustained tachycardia trial investigators, extend their post hoc analyses of the original trial. Aug 01, 2004 the multicenter unsustained tachycardia trial mustt study was a trial to study the approach of electrophysiologically guided therapy versus no antiarrhythmic therapy for a population at high risk for mortality from sudden death. Multicenter unsustained tachycardia trial mustt full text. Predictors and risk of ventricular tachyarrhythmias or death. A randomized study of the prevention of sudden death in. Clinical and economic implications of the multicenter. The trial had similar inclusion criteria to madit prior infarct, lvef. Patients induced into sustained vt and randomized to antiarrhythmic. Citations were limited to randomized controlled trials or randomized clinical trials. Multicenter unsustained tachycardia trial mustt american. Mustt, reported in 1999, also showed a survival benefit to icd therapy. Effect of implantable defibrillators on arrhythmic.
Current status of the implantable cardioverterdefibrillator. What were the results of the mustt study of implantable. An entirely subcutaneous implantable cardioverterdefibrillator. Quality of life six months after cabg surgery in patients randomized to icd versus no icd therapy. Implantable cardioverter defibrillator icd registry the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Significant information on risk stratification was gathered by the followup of patients that were noninducible. They represent a modified and updated version of the guidelines published by the german cardiac society in 1993 1. The multicenter unsustained tachycardia trial mustt. Multicenter unsustained tachycardia trial mustt the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Incidence and electrophysiological characteristics.
Do all patients with an icd indication need a biv pacing device. Multicenter unsustained tachycardia trial mustt full. Guidelines for implantation of automatic cardioverter. Background the mustt examined the use of programmed ventricular stimulation pvs to guide antiarrhythmic therapy in patients with coronary arteriosclerosis, left ventricular dysfunction and asymptomatic, unsustained. Iimplantable cardioverter defibrillators icds dr prithvi. The icd effectiveness results from mustt randomised multicenter. Clinical implications of madit, avid, cids, cabg patch trial. Multicenter automatic defibrillator trial i madit i 1996. Nonsustained vt with coronary disease, prior mi, lv dysfunction, and inducible vf or sustained vt at ep study that is not suppressible by a class i antiarrhythmic drug. Survival benefit of the primary prevention implantable cardioverter.
The multicenter unsustained tachycardia trial mustt was a randomized, controlled trial of programmed ventricular stimulation pvs for management of patients with coronary arteriosclerosis, left ventricular dysfunction and asymptomatic, unsustained ventricular tachycardia vt. Arrhythmias are a known complication after cardiac surgery and represent a major cause of morbidity, increased length of hospital stay, and economic costs. The multicenter unsustained tachycardia trial mustt was a prospective. Risk assessment was performed by testing inducibility of a sustained ventricular tachycardia. Clinical trials have established the superiority of the implantable cardioverterdefibrillator icd over antiarrhythmic drug therapy in survivors of sudden cardiac death and in highrisk patients with coronary artery disease. Mustt, madit, and beyond mustt and madit have clearly shown the survival benefit of an implantable cardioverter.