Preliminary report: effect of encainide and flecainide on mortality in a randomized trial of arrhythmia suppression after myocardial infarction.

@article{Rogers1989PreliminaryRE,
  title={Preliminary report: effect of encainide and flecainide on mortality in a randomized trial of arrhythmia suppression after myocardial infarction.},
  author={William J. Rogers and Andrew E. Epstein and J G Arciniegas and Sharon M. Dailey and George Neal Kay and R E Little and W A Maclean and S E Papapietro and Vance J. Plumb and S. Silber and A. R. Baker and M Cox and Capt. John Thomas and D Vonhagel and A. E. Walton and Craig M. Pratt and John J. Mahmarian and T Eaton and G Morris},
  journal={The New England journal of medicine},
  year={1989},
  volume={321 6},
  pages={
          406-12
        }
}
The occurrence of ventricular premature depolarizations in survivors of myocardial infarction is a risk factor for subsequent sudden death, but whether antiarrhythmic therapy reduces the risk is not known. The Cardiac Arrhythmia Suppression Trial (CAST) is evaluating the effect of antiarrhythmic therapy (encainide, flecainide, or moricizine) in patients with asymptomatic or mildly symptomatic ventricular arrhythmia (six or more ventricular premature beats per hour) after myocardial infarction… Expand

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Interventional Clinical Trial
The purpose of this pilot trial is to determine the feasibility of a large, multi-center randomized clinical trial aimed to test whether a treatment strategy of percutaneous catheter… Expand
ConditionsVentricular Tachycardia
InterventionDevice, Drug
Blog Post
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The suppression of asymptomatic or mildly symptomatic ventricular arrhythmias after myocardial infarction does not improve survival and can increase mortality, and treatment strategies designed solely to suppress these arrhythias should no longer be followed. Expand
Interaction of ischaemia and encainide/flecainide treatment: a proposed mechanism for the increased mortality in CAST I.
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The interaction between active ischaemia and treatment with encainide or flecainide may have been responsible for the increased mortality seen in the treatment group in CAST I, suggesting the need for future antiarrhythmic drugs to be screened in ischaemic models. Expand
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  • Medicine
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  • 2004
TLDR
There are currently no data showing that patients with symptomatic reentry supraventricular and life-threatening ventricular arrhythmias are at increased risk with encainide therapy, andEncainide should be reserved for those patients who are refractory or intolerant to other antiarrhythmic agents. Expand
Inefficacy and proarrhythmic effects of flecainide and encainide for sustained ventricular tachycardia and ventricular fibrillation.
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The aim of this review is to evaluate the available data on efficacy and safety of flecainide in all the spectrum of its indications including cardioversion of recent-onset AF, sinus rhythm maintenance in paroxysmal AF and management of ventricular tachyarrhythmias. Expand
Mortality in patients treated with flecainide and encainide for supraventricular arrhythmias.
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Describing comparisons did not demonstrate any excess mortality when flecainide and encainide were used in patients with supraventricular arrhythmias, as expected. Expand
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The observation of increased mortality in CAST associated with the administration of encainide and flecainide for suppression of ventricular premature depolarizations is probably applicable to any comparably defined group of patients in the postmyocardial infarction period. Expand
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References

SHOWING 1-10 OF 23 REFERENCES
Effects of encainide, flecainide, imipramine and moricizine on ventricular arrhythmias during the year after acute myocardial infarction: the CAPS.
TLDR
The National Heart, Lung, and Blood Institute initiated the Cardiac Arrhythmia Pilot Study (CAPS) to evaluate the feasibility of suppressing ventricular arrhythmias after acute myocardial infarction and found encainide and flecainide had higher efficacy rates than imipramine, moricizine, or placebo, as first drugs. Expand
Classification of deaths after myocardial infarction as arrhythmic or nonarrhythmic (the Cardiac Arrhythmia Pilot Study).
TLDR
The Cardiac Arrhythmia Pilot Study tested the feasibility of performing a larger study to determine if suppression of ventricular ectopic activity after acute myocardial infarction could improve survival. Expand
Safety of encainide for the treatment of ventricular arrhythmias.
  • L. Soyka
  • Medicine
  • The American journal of cardiology
  • 1986
TLDR
The use of reduced doses and gradual titration of encainide has markedly decreased the incidence of proarrhythmia, and high initial doses, prior myocardial infarction and congestive heart failure (CHF) were positively associated with sudden cardiac death. Expand
A prospective randomized trial of tocainide in patients following myocardial infarction.
TLDR
Although ventricular arrhythmias were suppressed, the number of patients in the study was too small to draw conclusions regarding the mortality rate and there was no conclusive evidence of myocardial depression, heart rate and blood pressure being unchanged over the 6-month period. Expand
Effect on survival after myocardial infarction of long-term treatment with phenytoin.
TLDR
Phenytoin treatment showed no beneficial effects on mortality and was associated with a high incidence of side effects, while the control group did not have any side effects. Expand
Effect of antiarrhythmic drugs on mortality after myocardial infarction.
  • C. Furberg
  • Medicine
  • The American journal of cardiology
  • 1983
TLDR
Increased attention to methodologic issues, such as selection of appropriate study populations, intervention strategies and larger sample sizes, is required to resolve the uncertainty in the treatment of coronary patients with ventricular arrhythmias. Expand
Prophylactic antiarrhythmic therapy of high-risk survivors of myocardial infarction: lower mortality at 1 month but not at 1 year.
TLDR
Although antiarrhythmic treatment with aprindine of high-risk patients after myocardial infarction does not affect 1 year survival, mortality appears to be delayed; thus there may be a role for short-term treatment before more definitive therapy such as surgery. Expand
Risk factors for the development of proarrhythmic events.
TLDR
Structural heart disease, sustained ventricular tachycardia, inpatient initiation and large-dose escalation of class IC drugs are the primary risk factors for development of proarrhythmic events. Expand
Congestive heart failure after acute myocardial infarction in patients receiving antiarrhythmic agents for ventricular premature complexes (Cardiac Arrhythmia Pilot Study).
TLDR
Although patients with severely impaired ejection fraction were excluded, new or worsened congestive heart failure was common in follow-up during CAPS, and sixty-one of 502 patients required hospitalization for CHF in the 1-year follow- up. Expand
ORAL MEXILETINE IN HIGH-RISK PATIENTS AFTER MYOCARDIAL INFARCTION
TLDR
Mxiletine reduced the prevalence of ventricular arrhythmias in a high-risk group of patients with recent myocardial infarction, but no favourable effect on mortality was observed. Expand
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