The Cardiac Arrhythmia Suppression Trial (CAST) demonstrated that suppression of asymptomatic ventricular premature depolarizations after myocardial infarction with which agents actually increased mortality?

• A Lidocaine and mexiletine
• B Amiodarone and sotalol
• C Quinidine and procainamide
• D Flecainide and encainide ✓

Explanation

CAST tested class IC agents flecainide and encainide (with moricizine in CAST II) for suppressing ventricular ectopy after infarction. Despite effective arrhythmia suppression, mortality was two to three times higher than placebo, attributed to ischemia related conduction slowing and reentrant proarrhythmia. This landmark trial ended the practice of routine ectopy suppression after MI and explains why class IC drugs are avoided in structural heart disease.

Reference: Goodman and Gilman's The Pharmacological Basis of Therapeutics, 14th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.