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Lack of long-term ventricular arrhythmia reduction by enalapril in heart failure. SOLVD Investigators
Insights
Enalapril did not significantly reduce ventricular arrhythmias in patients with heart failure. This large, 1-year study found no difference in ventricular premature complexes or tachycardia between enalapril and placebo groups.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Previous small studies suggested angiotensin-converting enzyme inhibitors might reduce ventricular arrhythmias in heart failure patients.
- These prior findings were limited by small sample sizes and short study durations.
Purpose of the Study:
- To prospectively evaluate the long-term effects of enalapril versus placebo on ventricular arrhythmia frequency and complexity.
- To assess these effects in patients with symptomatic or asymptomatic heart failure and reduced left ventricular function.
Main Methods:
- Prospective, 1-year, double-blind study of 734 patients in the Studies of Left Ventricular Dysfunction (SOLVD).
- Patients received either placebo or enalapril (2.5-10 mg twice daily).
- Ambulatory electrocardiographic monitoring was performed at baseline, 4 months, and 12 months.
Main Results:
- No significant difference in ventricular premature complexes per hour between placebo and enalapril groups at 12 months (80 +/- 12 vs 90 +/- 14).
- No significant difference in runs of nonsustained ventricular tachycardia per day between groups at 12 months (11 +/- 7.0 vs 6.1 +/- 4.4).
- Intent-to-treat analysis showed no statistically significant effect of enalapril on ventricular arrhythmias.
Conclusions:
- Enalapril therapy did not significantly alter the frequency or complexity of ventricular arrhythmias in patients with heart failure and depressed left ventricular function over 1 year.
- The findings do not support a significant antiarrhythmic role for enalapril in this patient population.
- Larger, longer-term studies are needed to fully elucidate the role of ACE inhibitors in managing ventricular arrhythmias in heart failure.
Abstract:
Previous studies have indicated that angiotensin-converting enzyme inhibitors may reduce the frequency of ventricular arrhythmias in patients with heart failure. These reports were mostly small and of short duration. We prospectively studied 734 patients recruited in 11 universities for 1 year who were enrolled in the Studies of Left Ventricular Dysfunction (SOLVD) to determine the long-term effects of enalapril and placebo on the frequency and complexity of ventricular arrhythmias in patients with symptomatic (treatment trial) or asymptomatic (prevention trial) heart failure and depressed left ventricular function (ejection fraction < or = 35%). Five hundred fifty-three patients from the prevention trial and 181 from the treatment trial of SOLVD underwent ambulatory electrocardiographic monitoring at baseline, and then at 4 and 12 months of double-blind therapy with either placebo or enalapril (2.5 to 10 mg twice daily). The prospectively defined primary analysis was by intent-to-treat and revealed no significant differences in ventricular premature complexes between the placebo and enalapril groups at baseline (87 +/- 13 vs 84 +/- 13/hour), 4 months (100 +/- 15 vs 85 +/- 12/hour), or 12 months (80 +/- 12 vs 90 +/- 14/hour). Likewise, there was no difference between the placebo and enalapril groups in runs of nonsustained ventricular tachycardia: baseline (8.3 +/- 4.1 vs 1.9 +/- 0.4 runs/day), 4 months (16 +/- 12 vs 7.2 +/- 4.1 runs/day), or after 12 months of blinded therapy (11 +/- 7.0 vs 6.1 +/- 4.4 runs/day).(ABSTRACT TRUNCATED AT 250 WORDS)