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Dr Doug Zipes discusses ROC-ALPS, FIRE
AND ICE and INOVATE-HF trials
Douglas P Zipes MD is Editor-in-Chief of PracticeUpdate
Cardiology. Here are his top abstracts, and their take-home
message, from ACC 2016.
Session 410
: Joint American College
of Cardiology/
New England Journal of
Medicine
late-breaking clinical trials
Antiarrhythmic drugs for shock-refractory out-
of-hospital cardiac arrest: the Resuscitation
Outcomes Consortium Amiodarone, Lidocaine
or Placebo Study.
PJ Kudenchuk
•
In patients with out-of-hospital cardiac
arrest (OHCA), antiarrhythmic drugs are
often used for shock-refractory ventricular
fibrillation or pulseless ventricular
tachycardia, even though there is no proven
survival benefit. Researchers randomised
3027 patients with shock-refractory
ventricular fibrillation or pulseless
ventricular tachycardia OHCA to receive
standard care along with amiodarone,
lidocaine, or placebo. They did not find
differences in survival or neurologic
outcome between the groups.
•
Researchers concluded that survival and
neurologic outcomes were not improved
with amiodarone or lidocaine when
compared with placebo for OHCA due
to initial shock-refractory ventricular
fibrillation or pulseless ventricular
tachycardia.
Largest randomised trial demonstrates an
effective ablation of atrial fibrillation: the FIRE
AND ICE Trial (NCT01490814).
K Heinz Kuck
•
In order to compare the efficacy of the
two most common methods for ablation,
the researchers of the FIRE AND ICE
trial randomised 762 patients with drug-
refractory paroxysmal atrial fibrillation
(AF) to undergo cryoballoon ablation or
radiofrequency ablation. After 90 days,
138 patients in the cryoballoon group and
143 patients in the radiofrequency group
experienced clinical failure (HR 0.96; P <
0.001 for noninferiority). Researchers did
not find a difference in safety between the
groups.
•
Results showed that cryoballoon ablation
was noninferior to radiofrequency ablation
for the treatment of drug-refractory
paroxysmal AF.
A randomised trial of rate control versus
rhythm control for atrial fibrillation after
cardiac surgery.
AM Gillinov, E Bagiella,
A Moskowitz, et al
•
In order to compare the efficacy of rate
and rhythm control for postoperative atrial
fibrillation, researchers randomised 523
patients to receive rate control or rhythm
control treatment. The majority of patients
had undergone either coronary artery
bypass surgery or isolated valve surgery.
Researchers did not find a difference in
the total number of hospital days, rates of
death, or serious adverse events. At 60 days,
significantly more patients in the rhythm-
control group had a stable heart rhythm
without AF in the previous 30 days than
patients in the rate-control group (97.9%
vs 93.8%; P = 0.02), but there was no
significant difference in the rate of patients
free from AF from discharge to 60 days.
•
Researchers concluded that rate and rhythm
control for postoperative AF are associated
with similar treatment outcomes.
Session 412:
Late-breaking clinical
trials
The effect of vagal nerve stimulation in heart
failure: primary results of the INcrease Of
VAgal TonE in chronic Heart Failure (INOVATE-
HF) Trial.
MR Gold, BJ Berman, M Borggrefe,
et al
•
In order to evaluate the safety and efficacy
of vagal stimulation, researchers of the
INOVATE-HF trial randomised more than
700 patients with heart failure to undergo
implantation of a vagal stimulation device
or to continue medical management.
Researchers did not find a difference in
the rates of hospitalisation for heart failure
or death between the groups. There were
no major safety concerns.
•
The trial was ended early for clinical futility,
and researchers concluded that vagal
stimulation in patients with heart failure
did not offer additional benefits compared
with medical management.
© 2016 Lagniappe Studio
PRACTICEUPDATE CARDIOLOGY
AMERICAN COLLEGE OF CARDIOLOGY SCIENTIFIC SESSIONS
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