The Cardiac Arrhythmia Suppression Trial: How Has it Impacted on Contemporary Arrhythmia Management?

Abstract

Implications of the Cardiac Arrhythmia Suppression Trial. A most important issue in cardiology practice has been when and how to treat asymptomatic patients with ventricular arrhythmia. This is a particularly thorny problem, since the presence of complex ventricular ectopy is an independent risk variable in patients with a variety of forms of heart disease. The Cardiac Arrhythmia Suppression Trial (CAST) was designed to answer the question of whether or not abolition of ventricular premature depolarizations, in those who had had a myocardial infarction, would confer any substantial benefit, especially in terms of a mortality reduction. Unfortunately, that question has not yet been answered, but the preliminary results of the CAST has had a major impact on physicians, patients, the scientific community, industry, and regulatory agencies. This article reviews the implications of the CAST and describe how it has affected the contemporary management of patients with cardiac arrhythmia. (J Cardiovasc Electrophysiol, Vol. 1, pp. 457–463, October 1990)