Medtronic
 
 

Tachyarrhythmia
Management

MUSTT

Multicenter Unsustained Tachycardia Trial

ICD VS. Anitiarrythmic Drug Treatment in Post-MI Patients

Protocol:

Explination of MUST Trial

Hypothesis:

Antiarrhythmic (AA) therapy guided by EP testing can reduce the risk of arrhythmic death and cardiac arrest in patients with: coronary artery disease (CAD), EF<0.40, and asymptomatic nonsustained VT (>3 beats, <30 sec, rate >100 bpm).

Primary endpoint:

  • Arrhythmic death or cardiac arrest

Secondary endpoints:

  • Total mortality
  • Cardiac mortality
  • Spontaneous, sustained VT

Status:

Start: 1989
Completion: March, 1998
Sample size: 704 patients

Results:

For post-MI patients with EF < 40%, and asymptomatic NSVT:

  • 44% death rate in Registry Patients (non-inducible VT)
  • ICD therapy significantly reduced the incidence of death in the patients with inducible VT:
    Arrhythmic death or cardiac arrest (73% - 76% reduction)
    Overall mortality (55% - 60% reduction)
  • EP-guided pharmacologic antiarrhythmic therapy provides no survival benefit: neither the rate of cardiac arrest or death from arrhythmia nor the overall mortality rate was lower among the patients assigned to EP-guided therapy and treated with antiarrhythmic drugs than among the patients assigned to no antiarrhythmic therapy.
References
  1. Buxton AE. Prevention of sudden death in patients with coronary artery disease: the Multicenter Unsustained Tachycardia Trial (MUSTT). Prog Cardiovasc Dis. 1993;36:215-226.
  2. Buxton AE. Ongoing risk stratification trials: the primary prevention of sudden death. Control Clin Trials. 1196;1747S-51S.
  3. Buxton AE, et al. for the Multicenter Unsustained Tachycardia Trial investigators. A randomized study of the prevention of sudden death in patients with coronary artery disease. N Engl J Med. 1999;341:1882-90.

Primary Prevention Trials

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