Pathmanathan R K, Lau E W, Cooper J, Newton L, Skehan J D, Garratt C J, Griffith M J
Department of Cardiology, Glenfield Hospital NHS Trust, Leicester, UK.
Heart. 1998 Jul;80(1):68-70.
Survival was prolonged in selected patients with sustained ventricular arrhythmias who received implantable cardioverter defibrillators (ICDs) in the antiarrhythmics versus implantable defibrillators (AVID) study. The Midlands trial of empirical amiodarone versus electrophysiologically guided intervention and cardioverter implant in ventricular arrhythmias (MAVERIC) registry is a population based trial.
To determine the number of patients who satisfy the AVID criteria because of the high cost of ICDs.
Observational study, based on a continuing trial.
All coronary care units in the Midlands region in the United Kingdom (population 9.1 million).
Patients presenting to a coronary care unit with sustained ventricular arrhythmias not related to an acute myocardial infarction are entered onto the registry. Those who consent to the MAVERIC study are randomised to receive either empirical amiodarone or electrophysiologically guided treatment. Demographic data, details of clinical presentation, and echocardiographic findings are collected. These data have been used to calculate the number of patients who satisfy the AVID criteria and would benefit from ICD implantation. The financial implications have been calculated for the region and nationally.
132 patients were entered onto the registry during the first five months of the MAVERIC study; 69 patients fulfilled the AVID criteria. Extrapolation of these data over a 12 month period suggests implantation of at least 166 new ICDs (compared with 23 implants in 1996). This would increase the UK ICD implant rate from five to at least 18 per million of the population, costing the National Health Service 24.1 Pounds million per annum.
Application of the AVID criteria in the UK will cause a great increase in the ICD implant rate, with serious financial implications.
在抗心律失常药物与植入式除颤器（AVID）研究中，植入式心脏复律除颤器（ICD）可延长部分持续性室性心律失常患者的生存期。米德兰兹经验性胺碘酮与室性心律失常的电生理指导干预及心脏复律器植入试验（MAVERIC）登记研究是一项基于人群的试验。
确定因ICD成本高昂而符合AVID标准的患者数量。
基于一项正在进行的试验的观察性研究。
英国米德兰兹地区的所有冠心病监护病房（人口910万）。
因持续性室性心律失常入住冠心病监护病房且与急性心肌梗死无关的患者被纳入登记研究。同意参加MAVERIC研究的患者被随机分配接受经验性胺碘酮治疗或电生理指导治疗。收集人口统计学数据、临床表现细节和超声心动图检查结果。这些数据已用于计算符合AVID标准且将从ICD植入中获益的患者数量。已计算该地区及全国的经济影响。
在MAVERIC研究的前五个月，132名患者被纳入登记研究；69名患者符合AVID标准。将这些数据外推至12个月期间表明，至少需要植入166台新的ICD（相比1996年的23台植入量）。这将使英国的ICD植入率从每百万人口5台增加到至少18台，每年将花费国民医疗服务体系2410万英镑。
在英国应用AVID标准将导致ICD植入率大幅上升，带来严重的经济影响。
