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The Effect of Spironolactone on Ventricular Tachyarrhythmias in Patients With Implantable Cardioverter-Defibrillators
Study Questions:
Does spironolactone reduce the incidence of ventricular tachycardia/ventricular fibrillation (VT/VF) in patients with an implantable cardioverter-defibrillator (ICD)?
Methods:
The subjects of this double-blind study were 90 patients (mean age 66 years, mean ejection fraction 34%) with an ICD who had received appropriate ICD therapy within the prior 2 years or who received the ICD for secondary prevention of VT/VF. None of the patients had a heart failure indication for treatment with spironolactone. The patients were randomly assigned to treatment with spironolactone, 25 mg/day (n = 44) or placebo (n = 46). The primary endpoint was recurrence of VT/VF requiring ICD therapy. The median duration of follow-up was 35 months.
Results:
There was not a significant difference in the proportion of patients requiring ICD therapy for VT/VF between the spironolactone group (84.7%) and the placebo group (68.7%).
Conclusions:
The authors concluded that spironolactone does not prevent VT/VF in patients who do not have a heart failure indication for spironolactone.
Perspective:
Prior randomized clinical trials have demonstrated that aldosterone antagonists may reduce the incidence of sudden death in patients with heart failure, suggesting that agents such as spironolactone or eplerenone may reduce the risk of VT/VF. The absence of an antiarrhythmic effect in the present study could be because the patients had responded well to treatment with beta-blockers and angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers, and did not require spironolactone for treatment of heart failure.
Keywords: Heart Diseases, Defibrillators, Recurrence, Follow-Up Studies, Secondary Prevention, Ventricular Fibrillation, Heart Failure, Spironolactone, Tachycardia
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