PMID- 12574892
OWN - NLM
STAT- MEDLINE
DCOM- 20030606
LR  - 20131121
IS  - 0340-9937 (Print)
IS  - 0340-9937 (Linking)
VI  - 27
IP  - 8
DP  - 2002 Dec
TI  - Sudden cardiac death in dilated cardiomyopathy -- therapeutic options.
PG  - 750-9
AB  - BACKGROUND: Despite routine use of angiotensin-converting enzyme (ACE) 
      inhibitors, beta-blockers and spironolactone in patients with heart failure due 
      to dilated cardiomyopathy (DCM), these patients still have a considerable annual 
      mortality rate of 5-10%. Sudden unexpected death accounts for up to 50% of all 
      deaths and is most often due to rapid ventricular tachycardia or ventricular 
      fibrillation and less often due to bradyarrhythmias or asystole. THERAPEUTIC 
      OPTIONS: The use of beta-blockers in patients with heart failure has been shown 
      to improve overall mortality considerably. This survival benefit has been 
      demonstrated for bisoprolol, metoprolol and carvedilol. Therefore, one of these 
      three beta-blocking agents should be administered routinely starting with low 
      doses in all patients with New York Heart Association (NYHA) class II or III 
      heart failure in addition to ACE inhibitors, unless there is a contraindication 
      to beta-blocker use. In addition, NYHA class IV heart failure patients have been 
      shown to benefit from carvedilol therapy, if tolerated. The conflicting results 
      of GESICA and CHF-STAT studies do not support a strategy of "prophylactic" 
      amiodarone therapy in patients with DCM in order to prevent sudden cardiac death. 
      Despite growing evidence that implantable cardioverter defibrillator (ICD) 
      therapy results in improved overall survival py preventing sudden cardiac death 
      in patients at high risk for serious arrhythmic events, arrhythmia risk 
      stratification with regard to prophylactic ICD implantation remains highly 
      controversial in patients with DCM. CONCLUSION: This review describes potential 
      arrhythmia mechanisms in DCM and summarizes the results of antiarrhythmic drug 
      trials and of prophylactic ICD trials in patients with heart failure as well as 
      our knowledge concerning arrhythmia risk stratification in patients with DCM.
FAU - Grimm, Wolfram
AU  - Grimm W
AD  - Department of Cardiology, Hospital of the Philipps University Marburg, Germany. 
      Wolfram.Grimm@med.uni-marburg.de
FAU - Maisch, Bernhard
AU  - Maisch B
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PT  - Review
PL  - Germany
TA  - Herz
JT  - Herz
JID - 7801231
RN  - 0 (Adrenergic beta-Antagonists)
RN  - 0 (Angiotensin-Converting Enzyme Inhibitors)
RN  - N3RQ532IUT (Amiodarone)
SB  - IM
MH  - Adrenergic beta-Antagonists/adverse effects/*therapeutic use
MH  - Amiodarone/adverse effects/*therapeutic use
MH  - Angiotensin-Converting Enzyme Inhibitors/adverse effects/*therapeutic use
MH  - Cardiomyopathy, Dilated/mortality/*therapy
MH  - Clinical Trials as Topic
MH  - Death, Sudden, Cardiac/epidemiology/*prevention & control
MH  - *Defibrillators, Implantable
MH  - Heart Failure/*drug therapy/mortality
MH  - Humans
RF  - 41
EDAT- 2003/02/08 04:00
MHDA- 2003/06/07 05:00
CRDT- 2003/02/08 04:00
PHST- 2003/02/08 04:00 [pubmed]
PHST- 2003/06/07 05:00 [medline]
PHST- 2003/02/08 04:00 [entrez]
AID - 10.1007/s00059-002-2425-0 [doi]
PST - ppublish
SO  - Herz. 2002 Dec;27(8):750-9. doi: 10.1007/s00059-002-2425-0.