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Flashcards in Trials Deck (59):
1

What did the AVID trial find

Vs AMIODARONE (III) - ICDs 30% reduction in mortality

2

What did AVID, CASH and CIDS investigate

ICD use to reduce mortality

3

What percentage of AVID, CASH and CIDS patients had CAD and what was their EF

73-83%

LVEF 32-45%

4

ICD is preferred treatment therapy for what 6 secondary prevention diseased states

CAD / MI
Non ischaemic DCM
HCM
ARVC
Genetic arrhythmia (brugada, CPVT)
Syncope with inducible VF in lab

5

What did MADIT I find

Relative risk reduction of 54% with ICD

6

The 4 MADIT I entry requirements

Prior MI
NSVT
Inducible VT
EF <35%

7

What did MUSTT find

Benefit seen only in group with ICDs

8

4 MUSTT entry requirements (same as MADIT I almost)

Prior MI
NSVT
Inducible VT
EF <40%

9

What did MADIT II find

AC Mortality = 20% control vs. 14.2% in ICD

31% relative risk reduction in ICD group

10

Two major findings of SCD-HeFT

Mortality relative risk reduction of 23% for ICD

Amiodarone has no effect on survival

11

On average what is the net risk reduction in mortality with ICD theapy

20-30%

12

Which two trials failed to show improved survival with ICD therapy

CABG-Patch

DINAMIT

13

What did the DEFINITE study find

6.2% absolute reduction // 35% relative risk reduction with ICD implantation for DCM

14

What 4 entry requirements are there for DEFINITE study

Non ichaemic cardiomyopathy
NYHA 1, 2 or 3
LVEF <35%
>10 PVCs/Hr

15

What are the 3 requirements of COMPANION

NYHA 3 or 4
DCM
QRS >120ms

16

What was the main outcome of COMPANION

CRT-D reduced all cause mortality by 36% vs Drugs alone

17

What percentage of children with non compacted LV demonstrate arrhythmia

40%

18

Is secondary prevention ICD therapy justified for short QT and idiopathic VF

YES

19

ICD therapy is indicated in patients with life expectancy <12m and class IV symptoms - TRUE/FALSE

False

20

What two things are predictors of worsening HF

QRS duration
Dyssynchrony

21

With CRT, what are the reductions in hospitalizations and mortality rate benefit

Hospitalizations = 30% decrease

Mortality rate benefit = 24-36%

22

Is CRT-D better than CRT-P according to COMPANION

Can't tell

23

What class is a QRS >150ms for CRT

Class I

24

What did the CARE-HF study find

36% death rate reduction vs medication

25

CRT response is best in patients above WHAT QRS duration

150ms

26

is QRS <150m s a risk factor for failure to respond to CRT therapy

Yes

27

What did the MADIT CRT trial discover

RV Apical lead position worsened HF symptoms

28

What did the DAVID trial find

>40% RV pacing worsened HF symptoms

29

What did MADIT II find with regards to RV pacing percentages

>50% RV pacing worsened HR symptoms

30

When gender is CRT-D more beneficial in

Women

31

What did the RAFT study find

Death was 33% in CRT vs 40% in ICD

32

What are the 3 requirements for RAFT

QRS >120ms
NYHA 2 or 3
LVEF <30%

33

What are the 3 requirements for REVERSE

NYHA 1 or 2
LVEF <40%
QRS >120ms

34

what is the overall improvement for CRT trials

35% reduction in death

35

CRT improves mortality for those at NYHA 2 and above but not 1 - TRUE/FALSE

TRUE

36

How long do people need to wait post MI or non ischaemic cardiomyopathy

3 months with optimal therapy

or 40 days if no PCI performed

37

On the basis of which study is pacing therapy not considered 1st line for patients with neurosyncope

VPS-II

38

What did the BLOCK HF study find

RV pacing (vs BiV) resulted in reduced EF and Larger systolic volumes

BiV = 26% reduction in combined end point mortality

39

Entry requirements for BLOCK HF

AV block requiring ventricular pacing
Mild/Moderate LV dysfunction (EF<50%)
NYHA 1, 2 or 3

40

Absence of data to show DDDR > DDD = TRUE/FALSE

TRUE - never programme RR on unless strong clinical need

RR promotes RV pacing = HF

41

Shocked VT associated with 32% increased risk of mortality vs ATP - TRUE/FALSE

True

42

Findings of PREPARE study

Prolonged detection 30/40 beats = lower 1yr risk of shocks (17% to 9%) // lower morbidity and doesn't increase adverse sequelae

43

Findings of RELEVANT study

Built on PREPARE

81% reduction of ICD interventions - less hospitalisations

44

Findings of MADIT RIT

Prolonged detection group (ARM C) = 76% reduction in primary end point

45

What were the 3 arms of MADIT RIT

Conventional - VF 1sec // VT 2.5sec
High rate cut off VF>200
Delayed therapy 170-199=60sec // 200-249=12sec // >250=2.5sec

46

Which 5 trials investigated delayed ICD therapy

PREPARE
RELEVANT
MADIT-RIT
PROVIDE
ADVANCE III

47

Findings of PROVIDE

Extended beat detection = 36% reduction in 2yr shock rate

48

PREPARE // RELEVANT // MADIT RIT // ADVANCE III used 30/40 detection and observed what

Extended detection doesn't negatively impact the rate of syncopal events

49

What did the ADVANCE III include that PREPARE // RELEVANT // MADIT RIT // PROVIDE didn't

They all investigated Primary prevention only

ADVANCE III = Both Primary and Secondary prevention

50

Meta-analysis of all delayed ICD settings found what two points

50% reduction in inappropriate shocks

30% reduction in risk of death and All cause Mortality

51

What did the PAINFREE RX II trial find

71% relative risk shock reduction

52

What did the EMPIRIC study find

Standardised VT & ATP > than Physician Tailored

53

Findings of ADVANCE-D

8 pulse ATP just as good as 15 pulses

54

Findings of PITAGORA ICD

88% coupling BURST better than 91% coupling RAMP

55

What did the MOST trial find

HF hospitalisation increased 20% for every 10% increase in RV pacing

RV >40% = 2.5x greater risk of hospitalisation vs <40%

56

What did the SIMPLE trial show

That DFT testing was well tolerated however didn't improve shock efficacy or reduce incidence of arrhythmia death

8% vs 7% primary outcome

57

Reasonable to omit DFT testing in Transvenous ICD implants is what class

IIa

58

Reasonable to perform DFT S-ICD testing is what class

I

59

Reasonable to perform DFT testing in transvenous ICD RIGHT SIDED implants is what class

IIA