Trials

Question 1

Which trial concluded the following?

‘ICD therapy incurs a 30% reduction in mortality vs’ Amiodarone alone’.

Answer 1

The AVID trial

Question 2

What did AVID, CASH and CIDS investigate?

Answer 2

ICD therapy as a way to reduce mortality.

Question 3

What percentage of AVID, CASH and CIDS patients had CAD?

Answer 3

73-83%.

Question 4

ICD is preferred treatment therapy for what 6 secondary prevention disease states?

Answer 4

1. CAD / MI
2. Non ischaemic DCM
3. HCM
4. ARVC
5. Genetic arrhythmia (brugada, CPVT)
6. Syncope with inducible VF in lab

Question 5

MADIT I found what % relative risk reduction with ICD therapy?

Answer 5

Relative risk reduction of 54%.

Question 6

List the 4 MADIT I inclusion criteria.

Answer 6

1. Prior MI
2. NSVT
3. Inducible VT
4. EF <35%

Question 7

True / False

MUSTT highlighted AAD was as effective as ICD therapy

Answer 7

False - ICD pts had a 75% relative risk reduction compared to AAD therapy

Question 8

List the 4 MUSTT inclusion criteria.

Answer 8

1. Prior MI
2. NSVT
3. Inducible VT
4. EF <40%

Question 9

What % relative risk reduction for the ICD group did MADIT II conclude?

Answer 9

31% relative risk reduction in ICD group.

Mortality = 20% in medical control group vs. 14.2% in ICD group.

Question 10

SCD-HeFT concluded what, with respect to relative risk reduction and Amiodarone?

Answer 10

1. Mortality relative risk reduction of 23% for ICD group
2. Amiodarone has no effect on survival

Question 11

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

Answer 11

20-30%.

Question 12

Which two trials failed to show improved survival with ICD therapy?

Answer 12

1. CABG-Patch
2. DINAMIT

Question 13

Which study found the following with respect to mortality?

‘6.2% absolute & 35% relative risk reduction with ICD implantation for DCM’.

Answer 13

The DEFINITE study.

Question 14

List the 4 inclusion criteria for the DEFINITE study.

Answer 14

1. Non ischemic cardiomyopathy
2. NYHA 1, 2 or 3
3. LVEF <35%
4. >10 PVCs/hr

Question 15

List the 3 inclusion criteria for the COMPANION study.

Answer 15

1. NYHA 3 or 4
2. DCM
3. QRS >120ms

Question 16

COMPANION concluded CRT-D reduced all cause mortality by ____% vs. drugs alone.

Answer 16

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

Question 17

What percentage of children with non compacted LV demonstrate arrhythmia?

Answer 17

40%.

Question 18

Yes / No

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

Answer 18

Yes.

Question 19

True / False

ICD therapy is indicated in patients with life expectancy <12m and class IV symptoms.

Answer 19

False.

Question 20

True / False

QRS duration and Dyssynchrony are strong predictors of worsening HF.

Answer 20

True.

Question 21

True / False

CRT therapy is shown to reduce hospitalizations by 50%.

Answer 21

False - Hospitalizations = 30% decrease.

Question 22

True / False

The COMPANION study highlighted significant differences between CRT-D vs. CRT-P with respect to mortality outcome.

Answer 22

False - The study data was inconclusive.

Question 23

What % reduction of mortality did the CARE-HF study find?

Answer 23

36% death rate reduction vs. medication alone.

Question 24

Most CRT studies highlight response is best in patients with QRS duration > ____ms.

Answer 24

150ms.

Question 25

# True / False Most studies highlight QRS \<150ms is a risk factor for failure to respond to CRT.

Answer 25

True.

Question 26

According to MADIT CRT, is an apical RV lead position preferable or to be avoided?

Answer 26

Avoided - RV Apical lead position worsened HF symptoms.

Question 27

The DAVID trial found \>\_\_\_\_% RV pacing worsened HF symptoms.

Answer 27

\>40% RV pacing worsened HF symptoms.

Question 28

The MADIT II found \>\_\_\_\_\_% RV pacing worsened HF symptoms.

Answer 28

>50% RV pacing worsened HF symptoms.

Question 29

Which gender shows greater success with CRT-D?

Answer 29

Women.

Question 30

# True / False The RAFT study found ICD therapy was preferable to CRT therapy.

Answer 30

False - Mortality was 33% in CRT group vs. 40% in ICD group.

Question 31

What are the 3 inclusion criteria for RAFT?

Answer 31

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

Question 32

What are the 3 inclusion criteria for REVERSE?

Answer 32

1. NYHA 1 or 2 2. LVEF \<40% 3. QRS \>120ms

Question 33

Across CRT trials, what is the average % reduction in mortality offered by CRT therapy?

Answer 33

36% reduction in mortality.

Question 34

# True / False CRT improves mortality only for those at NYHA 2 and above.

Answer 34

True - No improvement observed in NYHA I patients.

Question 35

What is the waiting period for implantation of an ICD post myocardial infarction?

Answer 35

3 months with optimal therapy or 40 days if no PCI performed.

Question 36

Which study concluded pacing therapy should not be considered 1st line for patients with neurosyncope?

Answer 36

VPS-II.

Question 37

Which study concluded the following? 'RV pacing (vs BiV) resulted in reduced EF and larger systolic volumes'.

Answer 37

BLOCK HF.

Question 38

List the 3 inclusion criteria of BLOCK HF.

Answer 38

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

Question 39

# True / False There is an absence of data to show DDDR \> DDD.

Answer 39

True - Never program rate response unless strong clinical need. ## Footnote *Rate response promotes RV pacing = worsening HF.*

Question 40

# True / False Shocked VT associated with 32% increased risk of mortality vs. ATP alone.

Answer 40

True.

Question 41

Which study found the following? 'Prolonged detection 30/40 beats = lower 1yr risk of shocks (17% to 9%), lower morbidity and doesn't increase adverse sequelae'.

Answer 41

The PREPARE study.

Question 42

Building on PREPARE findings, which study found long detection equates to 81% reduction of ICD interventions?

Answer 42

RELEVANT. ## Footnote *Long detection = Less ICD intervention = Less hospitalizations.*

Question 43

MADIT RIT concluded prolonged detection results in a \_\_\_\_\_% risk reduction of first occurrence of inappropriate therapy.

Answer 43

76%.

Question 44

What were the 3 arms of MADIT RIT?

Answer 44

1. Conventional - VF 1sec // VT 2.5sec 2. High rate cut off VF\>200 3. Delayed therapy 170-199=60sec // 200-249=12sec // \>250=2.5sec

Question 45

Which 5 landmark trials investigated prolonged ICD detection?

Answer 45

1. PREPARE 2. RELEVANT 3. MADIT-RIT 4. PROVIDE 5. ADVANCE III

Question 46

PROVIDE found that extended beat detection resulted in a \_\_\_\_% reduction in 2yr shock rate.

Answer 46

36%.

Question 47

# True / False Extended detection (30/40) doesn't negatively impact the rate of syncopal events.

Answer 47

True. ## Footnote *Evidenced by REPARE // RELEVANT // MADIT RIT // ADVANCE III.*

Question 48

What did ADVANCE III include that PREPARE, RELEVANT, MADIT RIT & PROVIDE did not?

Answer 48

ADVANCE III = Primary and Secondary prevention. ## Footnote *All others investigated Primary Prevention only.*

Question 49

Meta-analysis of all delayed detection ICD studies found that inappropriate shocks were reduced by \_\_\_\_%.

Answer 49

50% reduction in inappropriate shocks.

Question 50

# True / False The PAINFREE RX II trial found a 40% relative risk shock reduction.

Answer 50

False. ## Footnote *PAINFREE RX II found a 71% relative risk shock reduction.*

Question 51

# True or False: According to EMPIRIC, physician tailored therapies are more successful than standardized therapies.

Answer 51

False ## Footnote *Standardized VT, VF & ATP therapies \> Physician Tailored.*

Question 52

# True or False: The ADVANCE-D trial found 8 ATP pulses are optimal.

Answer 52

True ## Footnote *8 pulse ATP train is just as effective as 15 pulses.*

Question 53

Which study concluded the following? '88% coupling BURST is more effective than 91% coupling RAMP'.

Answer 53

PITAGORA ICD

Question 54

Which study concluded the following? 'HF hospitalisation increase by 20% for every 10% increase in RV pacing up to 40%'.

Answer 54

MOST. ## Footnote *HF hospitalisation increased 20% for every 10% increase in RV pacing. Beyond 40% RV pacing there is no statistically significant increase.*

Question 55

Which study concluded the following? 'DFT testing doesn't improve shock efficacy or reduce incidence of arrhythmic death'.

Answer 55

SIMPLE. ## Footnote *(8% vs 7% primary outcome).*

Question 56

What was the patient LVEF % range across AVID, CASH and CIDS trials?

Answer 56

LVEF = 32-45%

Question 57

# True or False: CRT Therapy demonstrates a mortality rate benefit of 24-36% in suitable patients.

Answer 57

True

Question 58

Which study concluded the following? 'BiVp = 26% reduction in combined endpoint mortality'.

Answer 58

BLOCK HF.

Question 59

Meta-analysis of all delayed detection ICD studies found that risk of death and all cause mortality were reduced by \_\_\_\_%

Answer 59

30% reduction in risk of death and all cause mortality.

Question 60

Which study concluded the following? 'RV pacing \>40% = 2.5x greater risk of hospitalisation vs. RV pacing \<40%'.

Answer 60

MOST.

Question 61

Which study proved the 'Bear Dropping Theory'?

Answer 61

CAST.

Question 62

Antiarrhythmic suppression of frequent PVCs \>10/hr was dangerous and is called what theory?

Answer 62

Bear Dropping Theory.