Mortality and morbidity in patients receiving encainide, flecainide, or placebo: The Cardiac Arrythmia Suppression Trial

Article Abstract:

Arrhythmias, or deviations from the normal rhythmic heartbeat, are an important risk factor for cardiac death. In several studies of patients recovering from heart attacks, it was found that, despite the high risk associated with arrhythmias, treatment with antiarrhythmic drugs provided no benefit. A major study was designed to reliably establish the role, if any, that antiarrhythmic drugs might have in the treatment of heart attack victims. A total of 1,498 patients were enrolled in the study; all had suffered a heart attack within the previous two years and all had premature ventricular contractions at least six times per hour as determined by electrocardiographic monitoring. These patients received encainide, flecainide, or placebo. The study was terminated before its planned date as it became clear that the antiarrhythmic drugs were causing significant harm. Of the 755 patients taking active drugs, 43 died of factors relating to arrhythmia, while only 16 of 743 patients taking placebo died of similar causes. Furthermore, 17 patients taking active drugs died of cardiac causes unrelated to arrhythmias, compared with only 5 patients receiving placebo. With such an excess of deaths in the drug-treatment groups, it would be expected that these groups would also have an excess of nonfatal cardiac events as well. However, this was not observed. Nonfatal events, which included tachycardia (rapid heart rate), fainting, requiring a pacemaker, heart attack, heart failure, and angina, were equally distributed among the experimental and control groups. The mechanisms by which encainide and flecainide treatment contribute to increased mortality without contributing to increased nonfatal illness are not known. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Drug therapy, Heart attack, Arrhythmia, Flecainide, Encainide hydrochloride, Encainide, Anti-arrhythmia drugs, Antiarrhythmia agents

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Driving after ventricular arrhythmias

Article Abstract:

Patients who have had a serious arrhythmia called a ventricular arrhythmia can resume driving after they are treated but it may be a good idea to wait a few months before doing so. A study published in 2001 found that the accident rate among such patients was less than the accident rate in the general population.

Editorial

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Resumption of driving after life-threatening ventricular tachyarrhythmia

Article Abstract:

Most patients who are receiving treatment for an arrhythmia called ventricular tachyarrhythmia can continue driving a car. In a study of 758 such patients, 78% had resumed driving within six months and the accident rate was lower than in the general population.

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