improved survival with an implanted defibrillator in patients with coronary disease

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1、TheNewEnglandJournalofMedicine©Copyright,1996,bytheMassachusettsMedicalSocietyVOLUME335DECEMBER26,1996NUMBER26IMPROVEDSURVIVALWITHANIMPLANTEDDEFIBRILLATORINPATIENTSWITHCORONARYDISEASEATHIGHRISKFORVENTRICULARARRHYTHMIAARTHURJ.MOSS,M.D.,W.JACKSONHALL,PH.D.,DAVIDS.CANNOM,M.D.,JAMESP.DAUBER

2、T,M.D.,STEVENL.HIGGINS,M.D.,HELMUTKLEIN,M.D.,JOSEPHH.LEVINE,M.D.,SANJEEVSAKSENA,M.D.,ALBERTL.WALDO,M.D.,DAVIDWILBER,M.D.,MARYW.BROWN,M.S.,ANDMOONSEONGHEO,PH.D.,FORTHEMULTICENTERAUTOMATICDEFIBRILLATORIMPLANTATIONTRIALINVESTIGATORS*ABSTRACTNSUSTAINEDventriculartachycardiainBackgroundUnsus

3、tainedventriculartachycardiapatientswhohavehadapreviousmyo-inpatientswithpreviousmyocardialinfarctionandcardialinfarctionandhaveleftventricularleftventriculardysfunctionisassociatedwithatwo-Udysfunctionhasbeenassociatedwithayearmortalityrateofabout30percent.Westudiedtwo-yearmortalityrat

4、eintherangeof30percent.1-3whetherprophylactictherapywithanimplantedcar-Antiarrhythmictherapyhasbeenwidelyusedforun-dioverter–defibrillator,ascomparedwithconvention-sustainedventriculartachycardia,buttherehasbeenalmedicaltherapy,wouldimprovesurvivalinthisnoevidenceofimprovedsurvivalwitht

5、histreat-high-riskgroupofpatients.ment.4-6InDecember1990,weinitiatedaprophy-MethodsOverthecourseoffiveyears,196pa-lactictrialinwhichhigh-riskpatientswithcoronarytientsinNewYorkHeartAssociationfunctionalclassheartdiseaseandasymptomaticunsustainedventric-I,II,orIIIwithpriormyocardialinfar

6、ction;aleftven-tricularejectionfraction0.35;adocumentedepi-ulartachycardiawererandomlyassignedtoreceiveansodeofasymptomaticunsustainedventriculartach-implantablecardioverter–defibrillatororconvention-ycardia;andinducible,nonsuppressibleventricularalmedicaltherapy.Toensureapopulationath

7、ighrisktachyarrhythmiaonelectrophysiologicstudywereformalignantventriculararrhythmias,7,8eligiblepa-randomlyassignedtoreceiveanimplanteddefibril-tientshadtohaveaninducible,sustained,nonsup-lator(n95)orconventionalmedicaltherapy(n101).pressibleventriculartachyarrhythmiaonelect