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ID6: The Midlands trial of empirical Amiodarone Versus ElectRophysiology-guided Inteverntions and implantable Cardioverter-defibrillators (MAVERIC)

  • Last modified date:
    9 February 2007

Dr Michael J Griffith

Background

The Midlands trial of empirical Amiodarone Versus ElectRophysiology-guided Inteverntions and implantable Cardioverter-defibrillators (MAVERIC) is a prospective randomised trial on the secondary prevention of sudden cardiac death.

Methods

Survivors of sustained ventricular tachydcardia, ventricular fibrillation or sudden death were randomised to either empirical amiodarone or electro-physiology-guided interventions (EP), which included anti-arrhythmic drugs, coronary revascularisation and the implantable cardioverter-defibrillator (ICD). Randomisation was pre-stratified with respect to haemodynamic stability at initial presentation. Recruitment started in February 1997 in the Midlands region of the UK and ended in January 1999.

Results

214 patients were recruited into the trial , of whom 122 were haemodynamically stable and 92 were haemodynamically unstable at initial presentation. After a mean follow-up of two years, no significant difference existed for (recurrence-free) survival between the two treatment arms. EP appeared worse that amiodarone for patients who were haemodynamically stable at initial presentation, but produced a significant delayed benefit over amiodarone in patients who were haemodynamically unstable at initial presentation. Haemodynamic stability confers a better prognosis than instability (1 year survival 86% vs. 75%, 2 year 81% vs. 68%, 3 year 79% vs. 63%; relative risk reduction 48% (11%-70%)), and the effect is independent of left ventricular function.

Conclusions

Haemodynamic stability at initial presentation is an important new prognostic marker. Patients haemodynamically stable at initial presentation with good left ventricular function can be safely treated with amiodarone alone, whereas patients haemodynamically unstable or with poor left ventricular function should be considered for empirical therapy.

Publications

Forthcoming

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