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Ambulatory Cardiac Monitoring for the Evaluation of Antiarrhythmic Agents

Published online by Cambridge University Press:  10 March 2009

Alexia Antczak-Bouckoms ,
J. F. C. Tulloch  and
Miriam E. Adams
Alexia Antczak-Bouckoms
Affiliation:
Harvard School of Public Health
J. F. C. Tulloch
Affiliation:
University of North Carolina School of Dentistry
Miriam E. Adams
Affiliation:
Harvard School of Public Health
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Abstract

This decision-analysis model assesses ambulatory cardiac monitoring (ACM), ACM followed by exercise testing, and electrophysiologic studies (EPS) in the evaluation and selection of antiarrhythmic agents in postinfarct patients with malignant arrhythmias. With existing data, we find no consistent advantage for one method of drug testing over another, although ACM appears to require fewer resources than does EPS. More patients qualify for EPS, but this fact does not increase the proportion of patients for whom a drug can be identified. These methods may test different aspects of arrhythmia activity and drug response, and sequential use may provide additional benefits. Such benefits must be determined empirically.

Type
General Essays
Information
International Journal of Technology Assessment in Health Care , Volume 9 , Issue 1 , Winter 1993 , pp. 124 - 138
Copyright
Copyright © Cambridge University Press 1993

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References

REFERENCES

1.Bigger, J. T.Pharmacologic prevention of sudden cardiac death: Role of antiarrhythmic drugs. In Kostis, J. B. & Sanders, M. (eds.), The prevention of sudden cardiac death. New York: Wiley-Liss, 1990.Google Scholar
2.Bigger, J. T, Reiffel, J. A., Livelli, F. D., & Wang, P. J.Sensitivity, specificity, and reproducibility of, programmed ventricular stimulation, Circulation, 1986, 73(suppl. II), 1173–78.Google ScholarPubMed
3.CAPS Investigators. The cardiac arrhythmia pilot study. American Journal of Cardiology, 1986, 57, 91–95.CrossRefGoogle Scholar
4.CAST Investigators. Preliminary report: Effect of encainide and flecainide on mortality in a randomized trial of arrhythmia suppression after myocardial infarction. New England Journal of Medicine, 1989, 321, 406–12.CrossRefGoogle Scholar
5.Ezri, M. D., Huang, S. K., & Denes, P.The role of Holter monitoring in patients with recurrent sustained ventricular tachycardia: An electrophysiologic correlation. American Heart Journal, 1984, 108, 1229–36.CrossRefGoogle ScholarPubMed
6.Graboys, T. B., Lown, B., Podrid, P. J., & DeSilva, R.Long-term survival of patients with malignant ventricular arrhythmia treated with antiarrhythmic drugs. American Journal of Cardiology, 1982, 50, 437–43.CrossRefGoogle ScholarPubMed
7.Hoffman, A., Schutz, E., White, R., et al. Suppression of high-grade ventricular ectopic activity by antiarrhythmic drug treatment as a marker for survival in patients with chronic coronary artery disease. American Heart Journal, 1984, 107, 1103–08.CrossRefGoogle Scholar
8.Hohnloser, S. H., Raeder, E. A., Podrid, P. J., et al. Predictors of antiarrhythmic drug efficacy in patients with malignant ventricular tachyarrhythmias. American Heart Journal, 1987, 114, 1–7.CrossRefGoogle ScholarPubMed
9.Holter, N. J.New method for heart studies. Science, 1961, 134, 1214–20.CrossRefGoogle ScholarPubMed
10.Kennedy, H. L., Chandra, V., Sayther, K. L., & Caralis, D. G.Effectiveness of increasing hours of continuous ambulatory electrocardiography in detecting maximal ventricular ectopy. American Journal of Cardiology, 1978, 42, 925–30.CrossRefGoogle ScholarPubMed
11.Kim, S. G., Seiden, S. W., Felder, S. D., et al. Is programmed stimulation of value in predicting the long-term success of antiarrhythmic therapy for ventricular tachycardias? New England Journal of Medicine, 1988, 315, 356–62.CrossRefGoogle Scholar
12.Lampert, S., Lown, B., Graboys, T. B., et al. Determinants of survival in patients with malignant ventricular arrhythmia associated with coronary artery disease. American Journal of Cardiology, 1988, 61, 791–97.CrossRefGoogle ScholarPubMed
13.Mason, J. W.Amiodarone. New England Journal of Medicine, 1987, 316, 455–66.Google ScholarPubMed
14.Mason, J. W., & the ESVEM Investigators. The ESVEM trial. Electrophysiological study versus electrocardiographic monitoring for selection of antiarrhythmic therapy of ventricular tachyarrhythmias. Circulation, 1989, 79, 1354–60.Google Scholar
15.Mason, J. W., Swerdlow, C. D., Winkle, R. A., et al. Ventricular tachyarrhythmia induction for drug selection: Experience with 311 patients. In Lucchesi, B. R., Dingell, J. V., & Schwartz, R. P. Jr., (eds.), Clinical pharmacology of antiarrhythmic therapy. New York: Raven Press, 1990.Google Scholar
16.Mason, J. W., & Winkle, R. A.Accuracy of the ventricular tachycardia-induction study for predicting long-term efficacy of antiarrhythmic drugs. New England Journal of Medicine, 1980, 303, 1073–77.CrossRefGoogle ScholarPubMed
17.Mitchell, L. B., Duff, H. J., Manyari, D. E., & Wyse, D. G.A randomized clinical trial of the noninvasive and invasive approaches to drug therapy for ventricular tachycardia. New England Journal of Medicine, 1987, 317, 1681–87.CrossRefGoogle ScholarPubMed
18.Platia, E. V., & Reid, P. R.Comparison of programmed electrical stimulation and ambulatory electrocardiographic (Holter) monitoring in the management of ventricular tachycardia and ventricular fibrillation. Journal of the American College of Cardiology, 1984, 4, 493–500.CrossRefGoogle ScholarPubMed
19.Podrid, P. J., Graboys, T. B., Lampert, S., & Clatt, C.Exercising testing for exposure of arrhythmias. Circulation, 1987, 75(suppl. Ill), III60–65.Google ScholarPubMed
20.Skale, B. T., Miles, W. M., Heger, J. J., et al. Survivors of cardiac arrest: Prevention of recurrence by drug therapy as predicted by electrophysiologic testing or electrocardiographic monitoring. American Journal of Cardiology, 1986, 57, 113–19.CrossRefGoogle ScholarPubMed
21.Swerdlow, C. D., & Peterson, J.Prospective comparison of Holter monitoring and electrophysiologic study in patients with coronary artery disease and sustained ventricular tachyarrhythmias. American Journal of Cardiology, 1985, 56, 577–80.CrossRefGoogle ScholarPubMed
22.Swerdlow, C. D., Winkle, R. A., & Mason, J. W.Determinants of survival in patients with ventricular tachyarrhythmias. New England Journal of Medicine, 1983, 308, 1436–42.CrossRefGoogle ScholarPubMed
23.Vlay, S. C., Kallman, C. H., & Reid, P. R.Prognostic assessment of survivors of ventricular tachycardia and ventricular fibrillation with ambulatory monitoring. American Journal of Cardiology, 1984, 54, 87–90.CrossRefGoogle ScholarPubMed
24.Wellens, H. J. J., & Brugada, P.Treatment of cardiac arrhythmias: When, how and where? Journal of the American College of Cardiology, 1989, 14, 417–28.CrossRefGoogle ScholarPubMed