Related Experiment Videos
Survival with oral d-sotalol in patients with left ventricular dysfunction after myocardial infarction: rationale,
A L Waldo1, A J Camm, H deRuyter
1Division of Cardiology, University Hospitals of Cleveland, Ohio 44106, USA.
Insights
The Survival With Oral d-Sotalol (SWORD) trial investigated if d-sotalol reduces mortality in high-risk acute myocardial infarction (AMI) survivors. This study aimed to determine if blocking potassium channels with d-sotalol could decrease sudden cardiac death.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Trials
Background:
- Impaired left ventricular function post-acute myocardial infarction (AMI) significantly increases mortality risk.
- Sudden death constitutes up to 50% of mortality in AMI survivors, with limited effective treatments.
- Class III antiarrhythmic agents, like d-sotalol, show potential by prolonging action potential duration via potassium channel blockade.
Purpose of the Study:
- To test the hypothesis that d-sotalol reduces all-cause mortality in high-risk AMI survivors.
- To evaluate the efficacy of oral d-sotalol in patients with left ventricular dysfunction and heart failure post-AMI.
- To assess the impact of d-sotalol on reducing sudden cardiac death in this vulnerable population.
Main Methods:
- The Survival With Oral d-Sotalol (SWORD) trial is a multicenter, multinational randomized controlled study.
- Enrollment of 6,400 high-risk AMI survivors with ejection fraction ≤40% and heart failure (NYHA class II-III).
- Patients randomized to placebo or d-sotalol (200 mg/day) with a minimum 18-month follow-up, powered to detect a 20% mortality reduction.
Main Results:
- Data on main results are not yet available in the provided abstract.
- The study is designed with 90% power to detect a 20% reduction in all-cause mortality.
- Further analysis will reveal the specific impact of d-sotalol on mortality rates.
Conclusions:
- The SWORD trial is designed to provide critical data on the effectiveness of d-sotalol in reducing mortality after AMI.
- Findings will inform treatment strategies for high-risk post-MI patients, potentially offering a new therapeutic option.
- The study aims to clarify the role of potassium channel blockers in managing post-infarction cardiac mortality.
Abstract:
Impaired left ventricular function after acute myocardial infarction (AMI) is associated with an increased risk of death. Despite recent advances in the management of these patients, sudden death accounts for up to 50% of this mortality, and effective treatment strategies have yet to be identified. Preliminary trials with amiodarone have offered promise that drugs that prolong action potential duration by blocking the potassium channel may be useful in reducing this mortality. The Survival With Oral d-Sotalol (SWORD) trial is a multicenter, multinational study which tests the hypothesis that the class III agent d-sotalol will reduce all-cause mortality in high-risk survivors of AMI. The trial will enroll 6,400 patients with left ventricular dysfunction (ejection fraction < or = 40%) and a recent (6 to 42 days) or a remote (> 42 days) AMI with overt heart failure (New York Heart Association class II or III). In approximately 500 centers throughout the world, men and women aged > or = 18 years will be enrolled and randomized to placebo or d-sotalol (200 mg/day). The minimal follow-up will be 18 months. The trial has a 90% power to detect a 20% reduction in all-cause mortality. The rationale, design, and trial methods are described.