CLINICAL STUDIES
Beta-blocker use and survival in patients with ventricular fibrillation or symptomatic ventricular tachycardia: the antiarrhythmics versus implantable defibrillators (AVID) trial
Derek V. Exner, MD, MPH*,
James A. Reiffel, MD, FACC ,
Andrew E. Epstein, MD, FACC,
Robert Ledingham, MS ,
Michael J. Reiter, MD, PhD, FACC,
Qing Yao, PhD,
Henry J. Duff, MD,
Dean Follmann, PhD*,
Eleanor Schron, RN*,
H. Leon Greene, MD, FACC,
Mark D. Carlson, MD, FACC,
Michael A. Brodsky, MD, FACC,
Toshio Akiyama, MD, FACC,
Christina Baessler, MSN,
Jeffrey L. Anderson, MD, FACC the AVID Investigators,1
* National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
University of Washington, Seattle, Washington, USA
Antiarrythmics Versus Implantable Defribillators (AVID) clinical sites, USA
Manuscript received October 5, 1998;
revised manuscript received February 23, 1999,
accepted April 30, 1999.
Reprint requests and correspondence: Dr. Derek V. Exner, National Heart, Lung, and Blood Institute, 6701 Rockledge Drive, Room 8146, Bethesda, Maryland 20892.
Derek_Exner{at}nih.gov
OBJECTIVES
To evaluate whether use of beta-adrenergic blocking agents, alone or in combination with specific antiarrhythmic therapy, is associated with improved survival in persons with ventricular fibrillation (VF) or symptomatic ventricular tachycardia (VT).
BACKGROUND
The ability of beta-blockers to alter the mortality of patients with VF or VT receiving contemporary medical management is not well defined.
METHODS
Survival of 1,016 randomized and 2,101 eligible, nonrandomized patients with VF or symptomatic VT followed in the Antiarrhythmics Versus Implantable Defibrillators (AVID) trial through December 31, 1996 was assessed using Cox proportional hazards analysis.
RESULTS
The 817 (28%) patients discharged from hospital receiving beta-blockers had less ventricular dysfunction, fewer symptoms of heart failure and a different pattern of medication use compared with patients not receiving beta-blockers. Before adjustment for important prognostic variables, beta-blockade was not significantly associated with survival in randomized or in eligible, nonrandomized patients treated with specific antiarrhythmic therapy. After adjustment, beta-blockade remained unrelated to survival in randomized or in eligible, nonrandomized patients treated with amiodarone alone (n = 1142; adjusted relative risk [RR] = 0.96; 95% confidence interval [CI] 0.64–1.45; p = 0.85) or a defibrillator alone (n = 1347; adjusted RR = 0.88; 95% CI 0.55 to 1.40; p = 0.58). In contrast, beta-blockade was independently associated with improved survival in eligible, nonrandomized patients who were not treated with specific antiarrhythmic therapy (n = 412; adjusted RR = 0.47; 95% CI 0.25 to 0.88; p = 0.018).
CONCLUSIONS
Beta-blocker use was independently associated with improved survival in patients with VF or symptomatic VT who were not treated with specific antiarrhythmic therapy, but a protective effect was not prominent in patients already receiving amiodarone or a defibrillator.
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Abbreviations and Acronyms
| | ACE | = angiotensin-converting enzyme | | AVID | = Antiarrhythmics Versus Implantable Defibrillators | | CAMIAT | = Canadian Amiodarone Myocardial Infarction Arrhythmia Trial | | EMIAT | = European Myocardial Infarct Amiodarone Trial | | CI | = confidence interval | | ICD | = implantable cardioverter defibrillator | | LV | = left ventricular | | MI | = myocardial infarction | | NYHA | = New York Heart Association | | RR | = relative risk | | VF | = ventricular fibrillation | | VT | = ventricular tachycardia |
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