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Defibrillator Versus Beta-Blockers for Unexplained Death in Thailand - DEBUT
Description:
The goal of this study was to assess the safety and efficacy of the implantable cardioverter/defibrillator (ICD) to reduce mortality in Thai patients who have survived an episode of cardiac arrest or syncope associated with the Sudden Unexplained Death Syndrome (SUDS).
Study Design
Study Design:
Patients Enrolled: 39
Mean Follow Up: 3 years
Patient Populations:
patients without structural heart disease who either survived an unexpected cardiac arrest or who had syncope, a right bundle branch block, ST-segment elevation in V1-V3, and inducible ventricular tachycardia/fibrillation during electrophysiologic testing
Drug/Procedures Used:
The subjects of this study were 86 patients without structural heart disease who either survived an unexpected cardiac arrest, or who had syncope, a right bundle branch block, ST-segment elevation in V1-V3, and inducible ventricular tachycardia/fibrillation during electrophysiologic testing. The patients were randomly assigned to receive either an ICD (47 patients) or long-acting propranolol, 40-160 mg/day (39 patients). The duration of the study was 3 years.
Principal Findings:
The mean age of the patients was approximately 42 years, and only 2 were women. The mortality rate during follow-up was 18% in the beta-blocker group, and there were no deaths in the ICD group. At least 1 episode of ventricular fibrillation (VF) was effectively terminated in 26% of patients who received an ICD. The annual event rate (sudden death and VF episodes) was 10% in the beta-blocker group and 20% in the ICD group.
Interpretation:
Among SUDS patients, the ICD is more effective than beta-blockers for preventing arrhythmic deaths. This is the first study to demonstrate that the ICD is uniformly effective in preventing arrhythmic deaths in patients at risk of VF who do not have structural heart disease. Because there is considerable overlap between SUDS in Southeast Asia and the Brugada syndrome, it is reasonable to expect that the results of this study also apply to symptomatic patients with the Brugada syndrome.
References:
Nadamanee K, Veerakul G, Mower M, et al. Defibrillator Versus Beta-Blockers for Unexplained Death in Thailand (DEBUT). A Randomized Clinical Trial. Circulation 2003;107:2221-26.
Keywords: Brugada Syndrome, Tachycardia, Ventricular, Follow-Up Studies, Propranolol, Ventricular Fibrillation, Syncope, Bundle-Branch Block, Death, Sudden, Cardiac, Defibrillators, Implantable
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