AVID

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AVID Investigators. "A comparison of antiarrhythmic-drug therapy with implantable defibrillators in patients resuscitated from near-fatal ventricular arrhythmias". The New England Journal of Medicine. 1997. :.
PubMed

Clinical Question

In patients with a history of life-threatening ventricular arrhthmias, can treatment with ICD of antiarrthmic drugs improve outcomes?

Bottom Line

ICD implantation is superior to antiarrhythmic drugs in patients with a history of ventricular arrhythmia.

Major Points

This 1997 landmark study compared antiarrythmics (amiodarone or sotalol)to ICD implantation was stopped early when outcomes between the two groups reached statistical significance. Fewer deaths occurred among the patients assigned to receive an implantable defibrillator (80 deaths) than in the antiarrhythmic-drug group (122).

Guidelines

Design

  • Multicenter, randomized, controlled trial
  • 6035 patients screened
  • N= 1885 eligable, 1016 randomized.
    • ICD implantation (n=507)
    • Antiarrhythmic therapy (n=509)
  • Mean follow-up: 18.2 months
  • Analysis: Intention-to-treat
  • Primary outcome: Death

Population

Inclusion Criteria

  • Patients resuscitated from near fatal ventricular fibrillation
  • Patients with sustained ventricular tachycardia with syncope
  • Patients with sustained ventricular tachycardia with an LVEF less than 40% and symptoms of hemodynamic compromise due to arryhthmia.

Exclusion Criteria

  • If patients were revascularized, LVEF had to be less than 40%.

Baseline Characteristics

  • Mean age: 65 years
  • Male: 79%
  • Mean LVEF 29%

Interventions

  • Randomized to ICD implantation or antiarrythmic therapy with amiodarone or sotalol.
    • Patients evaluated every three months.

Outcomes

Comparisons are intensive therapy vs. standard therapy.

Primary Outcomes

Fewer deaths occurred among the patients assigned to receive an implantable defibrillator (80

deaths) than in the antiarrhythmic-drug group (122).

Secondary Outcomes

Time to rehospitalization
83% in defibrillator group
75.5% in Antiarrhthmic drug group

Adverse Events

Criticisms

Funding

Further Reading