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Clinical trials update from Heart Rhythm 2007 and Heart Failure 2007: CARISMA, PREPARE, DAVID II, SAVE-PACE, PROTECT

John G F Cleland1, Alison P Coletta, Ahmed Tageldien Abdellah

  • 1Department of Cardiology, University of Hull, Castle Hill Hospital, Cottingham, Kingston-upon-Hull, HU16 5JQ, UK.

European Journal of Heart Failure
|July 24, 2007
PubMed

Insights

Non-invasive tests may identify post-myocardial infarction (MI) patients benefiting from implantable cardioverter-defibrillator (ICD) therapy. Conservative ICD programming reduces morbidity but increases syncope risk, while atrial pacing shows promise for heart failure patients.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Heart Failure Management

Background:

  • Heart failure remains a significant clinical challenge, necessitating advancements in pathophysiology understanding, prevention, and treatment strategies.
  • Recent clinical trials presented at major cardiology conferences offer new insights into managing heart failure and related conditions.

Purpose of the Study:

  • To review and comment on key clinical trials presented at Heart Rhythm 2007 and Heart Failure 2007.
  • To discuss the implications of these trials for the pathophysiology, prevention, and treatment of heart failure and related arrhythmias.

Main Methods:

  • Review of preliminary data from multiple clinical studies presented at Heart Rhythm 2007 and Heart Failure 2007.
  • Commentary on the findings related to implantable cardioverter-defibrillator (ICD) therapy, pacing strategies, and pharmacological interventions.

Main Results:

  • CARISMA study: Non-invasive screening may identify post-myocardial infarction (MI) patients suitable for ICD therapy.
  • PREPARE study: Conservative ICD programming reduces morbidity but increases the risk of arrhythmic syncope.
  • DAVID II: Atrial pacing is a potential alternative to ventricular pacing in patients with left ventricular dysfunction and ICD indications.
  • SAVE-PACE: Dual chamber minimal ventricular pacing decreased persistent atrial fibrillation in sinus node disease patients compared to conventional pacing.
  • PROTECT studies (pilot): 30 mg confirmed as the dose for selective A1 adenosine receptor antagonist KW-3902.
  • AREA-IN-CHF: Canrenone did not improve LV volumes but showed some benefit in secondary clinical endpoints.

Conclusions:

  • Emerging data suggest potential improvements in patient selection for ICDs and optimization of pacing strategies.
  • Pharmacological approaches, like selective A1 adenosine receptor antagonists, require further investigation in pivotal trials.
  • Ongoing research continues to refine treatment paradigms for heart failure and associated arrhythmias.

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