Author + information
- Josep Brugada, MDa
We appreciate Dr. Khairy’s interest in our article recently published in the Journal of the American College of Cardiology.
Dr. Khairy argues that some methodologic aspects of the work are questionable. The objective of our study was not to investigate independent factors predictive of recurrent events during follow-up, but rather to compare several variables between those having or not having recurrent events. In that case, and owing to the limited number of patients, a univariate analysis seems correct.
Our report is an observational study in a very specific patient population with limited information on the literature so far. We never intended to investigate the value of revascularization or antiarrhythmic therapy in such a population. The objective was to report that the combined approach gives excellent results in terms of survival (compared to historical series), and that revascularization alone does not prevent arrhythmic recurrences.
The conclusion that an individualized combined approach gives excellent results and should be used systematically seems reasonable. In patients with a clear indication for revascularization and who have suffered clinically sustained ventricular arrhythmias, a randomized study using different combinations of revascularization yes or no and antiarrhythmic therapy yes or no would probably be methodologically correct but certainly ethically incorrect.
- American College of Cardiology