A randomized clinical trial of the noninvasive and invasive approaches to drug therapy of XXXX .

@entity1 @entity2643 @entity1165 @entity943 @entity591 @entity2224 @entity551
There is controversy over whether therapy to prevent @entity1165 should be selected noninvasively (by trying drugs and monitoring the @entity1 electrocardiographically) or invasively (by selecting a drug that prevents induction of the @entity943 by programmed stimulation). We randomly assigned 57 @entity1 with symptomatic and demonstrable @entity1165 to therapy selected either noninvasively or invasively. The @entity591 involved were sustained @entity1165 (35 @entity1 ), nonsustained @entity1165 with @entity551 (15 @entity1 ), and @entity2224 (7 @entity1 ). The noninvasive approach sought reduction of ventricular premature beats by more than 80 percent and of couplets by more than 90 percent, with elimination of three or more successive ventricular beats on ambulatory monitoring and exercise testing. The invasive approach sought to prevent the induction of five or more repetitive beats by programmed stimulation. The noninvasive approach required fewer drug trials (3.2 +/- 1.8 [mean +/- SD] vs. 5.5 +/- 2.8, P less than 0.001) and fewer hospital days (20 +/- 15 vs. 33 +/- 24, P = 0.01) and identified a therapy predicted to be effective for more @entity1 than did the invasive approach (29 of 29 vs. 15 of 28, P less than 0.001). When a predicted effective therapy was not found, @entity2643 was prescribed despite persisting inducibility of @entity1165 . @entity1 randomly assigned to the noninvasive approach had more symptomatic recurrences of @entity591 than those treated by the invasive approach (two-year actuarial probabilities of 0.50 +/- 0.10 vs. 0.20 +/- 0.08, P = 0.02). Similar differences were observed when @entity2643 recipients were excluded. There were only three deaths from recurrent @entity1165 --two in the group whose treatment was selected noninvasively and one in the group whose treatment was selected invasively (not significant). We conclude that therapy selected by the invasive approach prevents recurrences of @entity1165 better than that selected by the noninvasive approach.
