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The Midlands Trial of Empirical Amiodarone versus Electrophysiology-guided Interventions and Implantable Cardioverter-defibrillators (MAVERIC): a multi-centre prospective randomised clinical trial on the secondary prevention of sudden cardiac death.
Europace. 2004 Jul; 6(4):257-66.E

Abstract

AIMS

MAVERIC was a randomised clinical trial designed to test the possibility of prospectively identifying patients who would benefit most from the implantable cardioverter-defibrillator (ICD) by electrophysiology (EP) study in the context of secondary prevention of sudden cardiac death (SCD) through comparing EP-guided interventions (anti-arrhythmic drugs, coronary revascularization, and ICD) against empirical amiodarone therapy.

METHODS

Two hundred and fourteen survivors of sustained ventricular tachycardia (VT), ventricular fibrillation (VF) or SCD were randomized to either treatment strategy, pre-stratified for haemodynamic status at index event, and followed up for a median of 5 years.

RESULTS

Of the 106 amiodarone arm patients, 89 (84%) received the drug and 5 (5%) received an ICD after crossing over. Of the 108 EP arm patients, 31 (29%) received an ICD, 46 (43%) received anti-arrhythmic drugs only (mainly amiodarone or sotalol) and 18 (17%) received coronary revascularization but no ICD. No significant differences in survival or arrhythmia recurrence existed between the two treatment arms after 6 years. However, ICD recipients had a lower mortality than non-ICD recipients, regardless of allocated treatment (hazard ratio=0.54, p=0.0391).

CONCLUSIONS

Prospective selection of patients to receive the ICD by EP study did not improve survival compared with empirical amiodarone therapy among survivors of VT, VF or SCD, whereas ICD implantation improved survival regardless of allocated treatment. On this basis, routine EP study has no role in the management of such patients, who should be offered empirical ICD therapy according to the results of other secondary prevention ICD trials.

Authors+Show Affiliations

Queen Elizabeth Hospital, Birmingham B15 2TH, UK.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial

Language

eng

PubMed ID

15172648

Citation

Lau, E W., et al. "The Midlands Trial of Empirical Amiodarone Versus Electrophysiology-guided Interventions and Implantable Cardioverter-defibrillators (MAVERIC): a Multi-centre Prospective Randomised Clinical Trial On the Secondary Prevention of Sudden Cardiac Death." Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups On Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology, vol. 6, no. 4, 2004, pp. 257-66.
Lau EW, Griffith MJ, Pathmanathan RK, et al. The Midlands Trial of Empirical Amiodarone versus Electrophysiology-guided Interventions and Implantable Cardioverter-defibrillators (MAVERIC): a multi-centre prospective randomised clinical trial on the secondary prevention of sudden cardiac death. Europace. 2004;6(4):257-66.
Lau, E. W., Griffith, M. J., Pathmanathan, R. K., Ng, G. A., Clune, M. M., Cooper, J., Marshall, H. J., Forsey, P. R., Stafford, P. J., Gray, R. G., Skehan, J. D., & Garratt, C. J. (2004). The Midlands Trial of Empirical Amiodarone versus Electrophysiology-guided Interventions and Implantable Cardioverter-defibrillators (MAVERIC): a multi-centre prospective randomised clinical trial on the secondary prevention of sudden cardiac death. Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups On Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology, 6(4), 257-66.
Lau EW, et al. The Midlands Trial of Empirical Amiodarone Versus Electrophysiology-guided Interventions and Implantable Cardioverter-defibrillators (MAVERIC): a Multi-centre Prospective Randomised Clinical Trial On the Secondary Prevention of Sudden Cardiac Death. Europace. 2004;6(4):257-66. PubMed PMID: 15172648.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The Midlands Trial of Empirical Amiodarone versus Electrophysiology-guided Interventions and Implantable Cardioverter-defibrillators (MAVERIC): a multi-centre prospective randomised clinical trial on the secondary prevention of sudden cardiac death. AU - Lau,E W, AU - Griffith,M J, AU - Pathmanathan,R K, AU - Ng,G A, AU - Clune,M M, AU - Cooper,J, AU - Marshall,H J, AU - Forsey,P R, AU - Stafford,P J, AU - Gray,R G, AU - Skehan,J D, AU - Garratt,C J, PY - 2003/08/04/received PY - 2004/03/28/accepted PY - 2004/6/3/pubmed PY - 2004/9/24/medline PY - 2004/6/3/entrez SP - 257 EP - 66 JF - Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology JO - Europace VL - 6 IS - 4 N2 - AIMS: MAVERIC was a randomised clinical trial designed to test the possibility of prospectively identifying patients who would benefit most from the implantable cardioverter-defibrillator (ICD) by electrophysiology (EP) study in the context of secondary prevention of sudden cardiac death (SCD) through comparing EP-guided interventions (anti-arrhythmic drugs, coronary revascularization, and ICD) against empirical amiodarone therapy. METHODS: Two hundred and fourteen survivors of sustained ventricular tachycardia (VT), ventricular fibrillation (VF) or SCD were randomized to either treatment strategy, pre-stratified for haemodynamic status at index event, and followed up for a median of 5 years. RESULTS: Of the 106 amiodarone arm patients, 89 (84%) received the drug and 5 (5%) received an ICD after crossing over. Of the 108 EP arm patients, 31 (29%) received an ICD, 46 (43%) received anti-arrhythmic drugs only (mainly amiodarone or sotalol) and 18 (17%) received coronary revascularization but no ICD. No significant differences in survival or arrhythmia recurrence existed between the two treatment arms after 6 years. However, ICD recipients had a lower mortality than non-ICD recipients, regardless of allocated treatment (hazard ratio=0.54, p=0.0391). CONCLUSIONS: Prospective selection of patients to receive the ICD by EP study did not improve survival compared with empirical amiodarone therapy among survivors of VT, VF or SCD, whereas ICD implantation improved survival regardless of allocated treatment. On this basis, routine EP study has no role in the management of such patients, who should be offered empirical ICD therapy according to the results of other secondary prevention ICD trials. SN - 1099-5129 UR - https://www.unboundmedicine.com/medline/citation/15172648/The_Midlands_Trial_of_Empirical_Amiodarone_versus_Electrophysiology_guided_Interventions_and_Implantable_Cardioverter_defibrillators__MAVERIC_:_a_multi_centre_prospective_randomised_clinical_trial_on_the_secondary_prevention_of_sudden_cardiac_death_ L2 - https://academic.oup.com/europace/article-lookup/doi/10.1016/j.eupc.2004.03.009 DB - PRIME DP - Unbound Medicine ER -