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(Circulation. 2004;110:3624-3626.)
© 2004 American Heart Association, Inc.

Editorial

The Shocking Story of Azimilide

Ibrahim R. Hanna, MD; Jonathan J. Langberg, MD

From the Division of Cardiology, Section of Cardiac Electrophysiology, Emory University School of Medicine, Atlanta, Ga.

Correspondence to Jonathan Langberg, MD, Emory University Hospital, 1364 Clifton Rd, Suite F414, Atlanta, GA 30322. E-mail jonathan_langberg@emoryhealthcare.org

Key Words: Editorials • defibrillation • tachyarrhythmias • pharmacology • antiarrhythmia agents

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Initially tested for the secondary prevention of life-threatening ventricular arrhythmias in survivors of cardiac arrest,¹ the effectiveness of implantable cardioverter-defibrillator (ICD) therapy has recently been validated for the primary prevention of sudden cardiac death in high-risk patients with left ventricular (LV) dysfunction.^2,3 Despite an improvement in survival (30% relative risk reduction) comparable to that of ß-blockers⁴ or angiotensin-converting enzyme (ACE) inhibitors,⁵ ICD therapy remains limited by impairment in quality of life in some of its recipients. As may be expected, the psychosocial consequences of device implantation, including anxiety disorders, depression, phobias, and sexual and employment problems, have been linked to the frequency of ICD discharges.⁶ In a recent publication, Godemann et al⁷ demonstrated a 3-fold increase in panic disorders and agoraphobia in patients with 2 ICD shocks annually. When severe enough, these symptoms necessitate psychiatric intervention⁸ or, in extreme cases, even device explantation.

See p 3646

Enhancements in detection algorithms have reduced the rate of inappropriate shocks for supraventricular arrhythmias,⁹ and the empirical programming of antitachycardia pacing (ATP) has proved effective in reducing the frequency of shocks for conversion of ventricular tachycardia (VT). Nevertheless, ATP has been routinely programmed only in patients with slower VTs, despite recent data suggesting its effectiveness as an initial therapy in faster VTs up to 250 bpm. In the PainFREE Rx (Does PAcINg Fast VT REducE Shock Rx) trial, this strategy of "aggressive" programming resulted in a significant improvement in quality of life without compromising patient safety,¹⁰ further . . . [Full Text of this Article]

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Placebo-Controlled, Randomized Clinical Trial of Azimilide for Prevention of Ventricular Tachyarrhythmias in Patients With an Implantable Cardioverter Defibrillator

Paul Dorian, Martin Borggrefe, Hussein R. Al-Khalidi, Stefan H. Hohnloser, Jose M. Brum, Daljit S. Tatla, Johannes Brachmann, Robert J. Myerburg, David S. Cannom, Michael van der Laan, Michael J. Holroyde, Igor Singer, Craig M. Pratt on Behalf of the SHock Inhibition Evaluation with azimiLiDe (SHIELD) Investigators
Circulation 2004 110: 3646-3654. [Abstract] [Full Text]

Placebo-Controlled, Randomized Clinical Trial of Azimilide for Prevention of Ventricular Tachyarrhythmias in Patients With an Implantable Cardioverter Defibrillator

Paul Dorian, Martin Borggrefe, Hussein R. Al-Khalidi, Stefan H. Hohnloser, Jose M. Brum, Daljit S. Tatla, Johannes Brachmann, Robert J. Myerburg, David S. Cannom, Michael van der Laan, Michael J. Holroyde, Igor Singer, Craig M. Pratt on Behalf of the SHock Inhibition Evaluation with azimiLiDe (SHIELD) Investigators
Circulation 2004 110: 3646-3654. [Abstract] [Full Text]

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				T. Christ and U. Ravens Do we need new antiarrhythmic compounds in the era of implantable cardiac devices and percutaneous ablation? Cardiovasc Res, December 1, 2005; 68(3): 341 - 343. [Full Text] [PDF]