13th International Congress
THE "NEW FRONTIERS"
OF ARRHYTHMIAS 1998

January 24-31, 1998
Marilleva, Trento, Italy

RT-180

Holter sub-studies of the European Myocardial Infarct Amiodarone Trial

M. Malik, A.J. Camm, M.J. Janse*, D.G. Julian**, G.A. Frangin***, P.J. Schwartz° on behalf of the EMIAT Investigators.
Department of Cardiological Sciences, St. George's Hospital Medical School, London, UK, *Department of Clinical and Experimental Cardiology, Academic Medical Center, University of Amsterdam, The Netherlands, **Netherhall Gardens, London, UK, ***Sanofi Recherche, Montpellier, France, °Department of Cardiology, University of Pavia and Policlinico S. Matteo IRCCS, Pavia, Italy

Introduction

EMIAT, the European Myocardial Infarct Amiodarone Trial, was a randomised, double-blind placebo-controlled clinical trial designed to determine whether amiodarone reduces all-cause mortality, cardiac mortality, and presumed arrhythmic death in patients surviving a recent myocardial infarction with a left ventricular ejection fraction (LVEF) < 40%. The trial enrolled 1486 patients who were followed for a mean of 21 months. There was no difference between the two treatment groups with regard to all-cause mortality and cardiac mortality, but there was a 35% risk reduction in presumed arrhythmic deaths in patients treated with amiodarone¹. In other words, the reduction in arrhythmic deaths was offset by an excess in non-arrhythmic deaths in the amiodarone group.

Thus, the risk in patients with reduced ejection fraction is composed of both arrhythmic and non-arrhythmic death. Some patients probably died from heart failure after having an arrhythmic death prevented by amiodarone. At the same time, it is plausible to propose that some subgroups of patients rescued from sudden arrhythmic death are not necessarily vulnerable to other forms of deaths. It is therefore important to select post-infarction patients at high risk of predominantly arrhythmic death who would benefit from antiarrhythmic therapy and not be likely to succumb quickly to other causes.

Having this in mind, different sub-studies of the trial evaluated the association of subsequent mortality with different factors obtainable at baseline². Several of these sub-studies evaluated parameters derived from pre-randomisation Holter recordings.