Can we halt sudden cardiac death?
At the recent conference on sudden coronary death sponsored by the New York Academy of Sciences, the primacy of ventricular arrhythmias as a cause of sudden death was questioned (see last week's JAMA MEDICAL NEWS).
When the discussion turned to therapy, the question naturally arose as to whether there is evidence that antiarrhythmic agents prevent sudden coronary death, and at the outset, Roger Winkle, MD, of Stanford University Medical Center, Palo Alto, Calif, conceded that "there are no controlled data to suggest such efficacy."
The Australian phenytoin sodium trial was the largest, he said, involving 568 patients. Ventricular ectopic beats were suppressed more often in the treated than in the control group, but there was no difference in the occurrence of sudden death. Because retrospective analysis showed subtherapeutic plasma phenytoin levels in many patients, a smaller trial was carried out using plasma monitoring and
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