Cardio Trial Files: Shock +/- ATP in VT, Amiodarone vs. ICD in Chagas Cardiomyopathy, and TAVI vs. Surgery in Severe AS
Assessment of Antitachycardia Pacing in Primary Prevention Patients (APPRAISE ATP)
Schuger C et al. JAMA (October 2024)
Bottom Line: This global, prospective, double-blind, randomized clinical trial aimed to assess the role of antitachycardia pacing (ATP) in terminating fast ventricular tachycardia s(VTs) in primary prevention implantable cardioverter-defibrillator (ICD) recipients with contemporary programming. A total of 2595 patients were enrolled and randomized in a 1:1 ratio to receive ATP plus shock or shock only. The primary outcome was time to first all-cause shock, and the results showed that the intervention group had a statistically significant lower risk of experiencing first all-cause shock compared to the comparator group (HR, 0.72; 95.9% CI, 0.57-0.92). The conclusion was that the use of ATP prior to shock in primary prevention ICD recipients with modern ICD detection programming prolonged the time to first all-cause ICD shock.
Amiodarone or Implantable Cardioverter-Defibrillator in Chagas Cardiomyopathy (CHAGASICS)
Martinelli-Filho M et al. JAMA Cardiology (October 2024)
Bottom Line: CHAGASICS is an open-label, randomized clinical trial that aimed to compare the effectiveness of implantable cardioverter-defibrillator (ICD) and amiodarone therapy in preventing all-cause mortality in patients with chronic Chagas cardiomyopathy and moderate to high mortality risk. The study enrolled 323 patients and was stopped prematurely for administrative reasons. While there was no significant difference in all-cause mortality between the two groups, the ICD group had lower rates of sudden cardiac death (HR, 0.25; 95%CI, 0.10-0.61), bradycardia requiring pacing (HR, 0.10; 95%CI, 0.03-0.34) and heart failure hospitalization (HR, 0.46; 95%CI, 0.24-0.87) compared to the amiodarone group. Further studies are needed to confirm these findings.
Transcatheter aortic valve implantation in low-risk tricuspid or bicuspid aortic stenosis (NOTION-2)
Jørgensen TH et al. European Heart Journal (May 2024)
Bottom Line: The NOTION-2 trial compared transcatheter aortic valve implantation (TAVI) with surgery in low-risk patients aged ≤75 years with severe symptomatic aortic stenosis (AS). The primary endpoint was a composite of all-cause mortality, stroke, or rehospitalization at 12 months. A total of 370 patients were enrolled, with a mean age of 71.1 years and a median Society of Thoracic Surgeons risk score of 1.1%. The 1-year incidence of the primary endpoint was 10.2% in the TAVI group and 7.1% in the surgery group (absolute risk difference, 3.1%; 95%CI, -2.7-8.8%; HR, 1.4; 95%CI, 0.7-2.9; p=0.3). Patients with TAVI had lower risk of major bleeding and new-onset atrial fibrillation, but higher risk of non-disabling stroke, permanent pacemaker implantation, and moderate or greater paravalvular regurgitation compared to surgery. The primary composite endpoint was similar between TAVI and surgery groups. However, in patients with bicuspid AS, TAVI had a higher risk of the primary endpoint compared to surgery. Further investigation is needed for transcatheter aortic valve implantation outcomes in young bicuspid AS patients.
Cardio Trial Files Issue #CRD-2024-26
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