Resumen
Introduction: In patients with ischemic heart disease and ventricular tachycardia (VT) refractory to high dose amiodarone, the two most common therapeutic options are adjunctive mexiletine therapy or catheter ablation. There are little existing data on the efficacy of these strategies. We examined the relative efficacy of adjunctive mexiletine and catheter ablation among patients enrolled in the VANISH trial. Methods: All subjects enrolled in the VANISH trial who had VT refractory to high dose (≥ 300 mg daily) amiodarone at baseline were included. Per protocol, subjects randomized to escalated drug therapy received adjunctive mexiletine. Results: Nineteen of the 259 patients were receiving high-dose amiodarone at baseline and 11 were randomized to escalated therapy with mexiletine and 8 to ablation. The adjunctive mexiletine group had a higher rate of the primary composite outcome (death, VT storm, or appropriate shock) in comparison to catheter ablation (HR 6.87 [2.08–22.8]). Over 90% of the patients in the adjunctive mexiletine/group experienced a primary endpoint during a median 9.2 months’ follow-up. There was no difference in the rate of adverse events between the two groups. Conclusions: Mexiletine has limited efficacy in the treatment of recurrent VT despite high-dose amiodarone therapy, in patients with ischemic heart disease. Catheter ablation is a superior strategy in this population.
Idioma original | English |
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Páginas (desde-hasta) | 603-608 |
Número de páginas | 6 |
Publicación | Journal of Cardiovascular Electrophysiology |
Volumen | 29 |
N.º | 4 |
DOI | |
Estado | Published - abr. 2018 |
Publicado de forma externa | Sí |
Nota bibliográfica
Funding Information:Biosense Webster; Michael Smith Foundation for Health Research, Grant/Award Number: 5967; Canadian Institutes of Health Research, Grant/Award Number: 102695; St. Jude Medical The VANISH trial was supported by the Canadian Institutes of Health Research (Grant 102695) with additional financial support from St. Jude Medical Inc. and Biosense-Webster Inc. Dr. Deyell is supported by a Career Scholar Award from the Michael Smith Foundation for Health Research (5967). Dr. Essebag is supported by a Clinical Research Scholar Award from the Fonds de recherche du Quebec-Santé (FRQS). Dr. Healy is the Population Health Research Institute Chair in Cardiology Research, and is the recipient of Heart and Stroke Foundation of Ontario Mid-Career Award (MC7450).
Funding Information:
We would like to thank Karen Giddens at Dalhousie University for her tireless efforts.
Funding Information:
Biosense-Webster Inc. and St. Jude Medical Inc. Dr. Parkash has received research grants from St. Jude Medical Inc. Dr. Sapp has received honoraria and research grants from Biosense-Webster and research grants from Abbott. Other authors: No disclosures.
Funding Information:
Dr. Deyell has received honoraria and research grants from Biosense-Webster Inc. Dr. Essebag has received honoraria from Biosense Webster Inc. and St. Jude Medical Inc. Dr. Gardner has received honoraria from St. Jude Medical Inc. Dr. Leong-Sit has received honoraria from
Publisher Copyright:
© 2018 Wiley Periodicals, Inc.
ASJC Scopus Subject Areas
- Cardiology and Cardiovascular Medicine
- Physiology (medical)
PubMed: MeSH publication types
- Comparative Study
- Journal Article
- Randomized Controlled Trial
- Research Support, Non-U.S. Gov't