Classification of death in antiarrhythmi trials

Objectives. We sought to develop and apply new scheme for the classification of death to be used in trials of antiarryhythmi treatments. Background. Because presently accepted classifications of death do not fully describe or tabulate all significant aspects of terminal events, nor do they consider unique aspects of arrhythmi investigations, new classification scheme that addresses these issues is desirable. Methods. classification scheme of deaths that occur in antiarrhythmi trials was developed using the following categories: 1) primary organ cause (cardiac [arrhythmic, nonarrhythmic or unknown], noncardiac or unknown); 2) temporal course (sudden, nonsudden or unknown); 3) documentation (witnessed, monitored [yes, no or unknown]); 4) operative relation (preoperative, perioperative or postoperative); and 5) system relation (procedure related, pulse generator related and lead related [yes, no or unknown]). Results. The classification scheme was used in clinical trial of new implantable cardioverter-defibrillator (1,250 patients, of whom 79 died) and used in an application for device market approval. Application of the classification to dat reported using an older classification scheme is demonstrated. Conclusions. We propose descriptive classification scheme that 1) fully describes and tabulates all significant aspects of terminal events; 2) incorporates previously used categorizations of death and new categorizations that address unique aspects of arrhythmi investigations; and 3) tabulates sufficient dat to allow comparison with other studies. Events in clinical trial of implantable defibrillator therapy were classified using the new classification scheme.