Abstract 18861: Effects of Class III Antiarrhythmics on ICD Therapies and Clinical Outcomes: A Meta-analysis of Randomized Controlled Trials
Introduction: Implantable cardioverter defibrillators (ICD) prolong survival in patients with heart failure, reduced left ventricular ejection fraction (LVEF <= 35%) and/or sustained ventricular arrhythmias (VA) by terminating VA with either anti-tachycardia pacing (ATP) or shock. However, ICD therapies are associated with significant pain, psychological distress, and increased risk for hospitalization and mortality. Antiarrhythmic drugs are commonly used to reduce frequency of VA in patients with ICD. We attempt to study the effects of class III antiarrhythmics on the frequency of ICD therapies, hospitalization and mortality.
Methods: PubMed database was queried to identify prospective randomized controlled trials comparing class III antiarrhytmics to placebo on a standard background medical therapy in patients with an ICD and prior history of sustained VA (spontaneous/ treated/ induced) and/or sudden cardiac death. Information on appropriate ICD therapy, hospitalization and mortality was extracted. Fixed effect analysis was used when I2 ≤ 25% and p >0.1, otherwise random effect analysis was performed.
Results: After reviewing 2931 articles, seven trials that studied Amiodarone, Sotalol, Azimilide or Celivarone were included. A total of 2117 patients (87% males, mean age 63.8 years, mean LVEF 32.8%) were analyzed. 50.6% of the patients had at least one appropriate ICD therapy delivered and 4.5% died during the follow up. Antiarrhythmic drug usage significantly reduced the number of patients receiving ICD therapy by 55% (OR=0.45, 95% confidence interval [CI] 0.26-0.77, P=.004). There was no significant difference in mortality between treatment and placebo arms. Only 2 of the 7 trials reported number of hospitalizations and the sample size was insufficient for analysis.
Conclusions: Class III antiarrhythmics significantly reduced ICD therapy for VA with no significant change in mortality.
Author Disclosures: K. Kancharla: None. A.A. Oktay: None. S. Kumar: None. F. Kaddaha: None. C. Pamidimukala: None. G. El Hayek: None. C. Benjo: None. M. Molina: None. S. Kanaan: None. E. Herzog: None. E. Aziz: None. A.M. Benjo: None.
- © 2015 by American Heart Association, Inc.