Reduction in Ventricular Tachyarrhythmia Burden in Patients Enrolled in the RAID Trial.
Reduction in Ventricular Tachyarrhythmia Burden in Patients Enrolled in the RAID Trial.
复制标题
DOI：
10.1016/j.jacep.2022.02.018
复制
发表时间：
2022-06
影响因子：
7
通讯作者：
Zareba, Wojciech
中科院分区：
文献类型：
--
作者：
Younis, Arwa;Goldenberg, Ilan;Farooq, Shamroz;Yavin, Hagai;Daubert, James;Raitt, Merritt;Mazur, Alexander;Huang, David T.;Mitchell, Brent L.;Rashtian, Mayer R.;Winters, Stephen;Vloka, Margot;Aktas, Mehmet;Bernabei, Matthew A.;Beck, Christopher A.;McNitt, Scott;Zareba, Wojciech
我们的目的是确定雷诺嗪治疗可最大程度地降低室性快速心律失常 (VTA) 负担的患者群体。雷诺嗪植入式心脏复律除颤器 (RAID) 随机安慰剂对照试验表明，雷诺嗪治疗与减少复发性室性心动过速 (VT) 相关，需要适当的植入式心脏复律除颤器 (ICD) 治疗。对参加 RAID 的 1,012 名患者进行了 Andersen-Gill 分析，以确定与 VTA 负担风险相关的变量。主要终点是 VTA 负担，定义为需要适当治疗的 VTA 发作。多变量分析确定了与 VTA 负担增加相关的 7 个因素：VTA 病史、年龄 ≥ 65 岁、纽约心脏协会≥ III 级、QRS（≥130 毫秒）、低射血分数（<30%）、心房颤动和伴随抗心律失常药物（AAD）治疗。在未同时接受 AAD 治疗的患者中观察到雷诺嗪对 VTA 负荷的影响（HR=0.68；95% CI 0.55-0.84；p<0.001），而在同时接受其他 AAD 治疗的患者中则没有观察到影响（HR=1.33；95% CI 0.90-1.96；p=0.16）；对于相互作用，p=0.003。在接受心脏再同步化治疗 (CRT) ICD 的患者中，雷诺嗪治疗可使 VTA 复发风险降低 36%（HR=0.64；95% CI 0.47–0.86；p<0.001），而在未接受 CRT 的 ICD 患者中，没有发现显着效果（HR=0.94；95% CI 0.74–1.18；p=0.57）。交互作用 p=0.047。对于 VTA 高风险患者，雷诺嗪可有效减轻 VTA 负担，对于接受 CRT 治疗的患者、无 AF 的患者以及未同时接受 AAD 治疗的患者效果显着更大。在已经服用 AAD 或患有 AF 的患者中，添加雷诺嗪不会影响 VTA 负担。雷诺嗪植入式心脏复律除颤器 (RAID) 随机安慰剂对照试验表明，雷诺嗪治疗与植入式心脏复律除颤器高危患者复发性室性快速心律失常 (VTA) 的减少相关。本研究确定了雷诺嗪可最大程度降低 VTA 的亚组。我们的结果表明，雷诺嗪对接受心脏再同步治疗（CRT）治疗的患者、无房颤的患者以及未同时接受抗心律失常药物治疗的患者具有更大的效果。
We aimed to identify groups of patients in whom ranolazine treatment would result in the highest reduction of ventricular tachyarrhythmia (VTA) burden. The Ranolazine Implantable Cardioverter-Defibrillator (RAID) randomized placebo-controlled trial showed that ranolazine treatment was associated with reduction in recurrent ventricular tachycardia (VT) requiring appropriate implantable cardioverter-defibrillator (ICD) therapy. Andersen-Gill analyses were performed to identify variables associated with risk for VTA burden among 1,012 patients enrolled in RAID. The primary endpoint was VTA burden defined as VTA episodes requiring appropriate treatment. Multivariate analysis identified 7 factors associated with increased VTA burden: history of VTA, age ≥ 65 years, New York Heart Association≥ III class, QRS (≥130 msec), low ejection fraction (<30%), atrial fibrillation, and concomitant anti-arrhythmic drug (AAD) therapy. The effect of ranolazine on VTA burden was seen among patients without concomitant AAD therapy (HR=0.68; 95% CI 0.55–0.84; p<0.001), whereas no effect was seen among those who are concomitantly treated with other AADs (HR=1.33; 95% CI 0.90–1.96; p=0.16); p=0.003 for interaction. In patients with cardiac resynchronization-therapy (CRT) ICDs, ranolazine treatment was associated with a 36% risk reduction for VTA recurrence (HR=0.64; 95% CI 0.47–0.86; p<0.001), whereas among patients with ICDs without CRT no significant effect was noted (HR=0.94; 95% CI 0.74–1.18; p=0.57); p=0.047 for interaction. In patients with high risk for VTA ranolazine is effective in reducing VTA burden, with significantly greater effect in CRT-treated patients, those without AF, and those not treated with concomitant AADs. In patients already on AADs or those with AF, the addition of ranolazine did not affect VTA burden. The Ranolazine Implantable Cardioverter-Defibrillator (RAID) randomized placebo-controlled trial showed that ranolazine treatment was associated with reduction in recurrent ventricular tachyarrhythmia (VTA) in high-risk patients with implantable cardioverter-defibrillators. The present study identifies subgroups in whom ranolazine would result in the highest reduction in VTA. Our results suggest that ranolazine has greater effect in cardiac resynchronization-therapy (CRT) treated patients, those without atrial fibrillation, and those not treated with concomitant anti-arrhythmic drug therapy.
登录
查看更多内容
影响因子：
5.5
作者：
Tung R;Vaseghi M;Frankel DS;Vergara P;Di Biase L;Nagashima K;Yu R;Vangala S;Tseng CH;Choi EK;Khurshid S;Patel M;Mathuria N;Nakahara S;Tzou WS;Sauer WH;Vakil K;Tedrow U;Burkhardt JD;Tholakanahalli VN;Saliaris A;Dickfeld T;Weiss JP;Bunch TJ;Reddy M;Kanmanthareddy A;Callans DJ;Lakkireddy D;Natale A;Marchlinski F;Stevenson WG;Della Bella P;Shivkumar K
通讯作者：
Shivkumar K
DOI：
10.1056/nejmoa071098
发表时间：
2008-09-04
期刊：
The New England journal of medicine
影响因子：
--
作者：
Poole JE;Johnson GW;Hellkamp AS;Anderson J;Callans DJ;Raitt MH;Reddy RK;Marchlinski FE;Yee R;Guarnieri T;Talajic M;Wilber DJ;Fishbein DP;Packer DL;Mark DB;Lee KL;Bardy GH
通讯作者：
Bardy GH
影响因子：
37.8
作者：
Yancy, Clyde W.;Jessup, Mariell;Westlake, Cheryl
通讯作者：
Westlake, Cheryl
影响因子：
2.1
作者：
Lee, Wei-Chieh;Chen, Huang-Chung;Chen, Mien-Cheng
通讯作者：
Chen, Mien-Cheng
影响因子：
24
作者：
Fish, JM;Brugada, J;Antzelevitch, C
通讯作者：
Antzelevitch, C