Open AccessMADIT and the Implications for Holter Monitoring: Results of a 100‐Physician Survey
Author(s) -
Nisam Seah
Publication year - 1997
Publication title -
annals of noninvasive electrocardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.494
H-Index - 48
eISSN - 1542-474X
pISSN - 1082-720X
DOI - 10.1111/j.1542-474x.1997.tb00203.x
Subject(s) - medicine , asymptomatic , amiodarone , cardiology , holter monitor , implantable cardioverter defibrillator , electrocardiography , atrial fibrillation
The MADIT study demonstrated a dramatic reduction in all‐cause mortality for asymptomatic but high risk chronic coronary patients when treated with an implanted cardioverter defibrillator (ICD), in comparison to (mostly amiodarone) medical management. On January 10–11, 1997 (2 weeks after publication of the study), 100 leading electrophysiologists in Europe attended a “MADIT Workshop,” to focus on clearly understanding the study. We report on the results of the anonymous survey following that meeting, noting that the survey preceded the publication of the AVID trial, which likewise showed far better survival for patients treated with ICDs compared almost exclusively to amiodarone. Three‐quarters of the physicians accepted the validity of the MADIT results and would implement the protocol. However, overcoming financial and administrative obstacles may take several years. They responded that Holter Monitoring to verify presence of nonsustained ventricular tachycardia—an essential step in identifying the MADIT patients—is not their current routine, although approximately 50% do Hollers on coronary patients with disturbed left ventricular function, that is, the MADIT type patients, and this number would increase gradually. About half felt that 5% or more of the patients with chronic coronary disease would fit the MADIT profile. Most saw no need for a “MADIT‐specific” device; over half felt the MADIT patient might live longer, pointing to the need for longer‐life ICDs. However, 22% felt that ICDs having dual chamber pacing would benefit MADIT patients.