Can antiarrhythmic drugs survive survival trials?

The American Journal of Cardiology
C M PrattA J Camm

Abstract

Sudden cardiac death due to arrhythmic events is the major cause of mortality among early post-myocardial infarction (MI) patients, accounting for > 250,000 deaths annually in the United States alone. Antiarrhythmic drugs can be used in such patients as well as in those who have not had a recent MI but are at high risk for sudden cardiac death (e.g., those with ventricular tachycardia/fibrillation, or who have survived cardiac arrest). Most antiarrhythmic drugs available, however, have limitations arising from their toxic and proarrhythmic potential. Thus, research and development of new agents and treatment modalities are desirable. This article seeks to enumerate the lessons of past clinical trials with these agents and to provide guidelines for future trials. That a variety of antiarrhythmic drugs have been associated with an increased mortality has been a disturbing observation. It is therefore imperative that candidates for antiarrhythmic therapy be selected appropriately. We recommend that future clinical trials use stringent criteria for the identification of patients at "high risk" for arrhythmia or sudden cardiac death, and limit recruitment to such patients. Traditional markers, such as the increased frequency and com...Continue Reading

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Citations

Jun 21, 2002·Circulation Journal : Official Journal of the Japanese Circulation Society·Tsuyoshi ShigaHiroshi Kasanuki
Mar 14, 2007·International Journal of Cardiology·Nipon ChattipakornSiriporn Chattipakorn
Feb 9, 2007·Pharmacology & Therapeutics·Juan TamargoEva Delpón
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Jun 13, 2000·Cardiology Clinics·J M MillerL R Scott
Jul 10, 2003·Journal of the American College of Cardiology·Kelley P Anderson
Jul 2, 2002·The American Journal of Geriatric Cardiology·Albert L Waldo
Feb 2, 2017·Biology·Anna Fernández-FalguerasOscar Campuzano
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Aug 28, 2003·Current Treatment Options in Cardiovascular Medicine·Stephen J. Hahn, Joseph M. Smith

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