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The Cardiac Arrhythmia Suppression Trial (CAST) was a randomized, placebo-controlled study that examined the effect of three antiarrhythmic drugs on patients with ventricular ectopy and nonsustained ventricular tachycardia after myocardial infarction. A preliminary report in 1989 announced that two arms of the trial, using flecainide and encainide, were stopped because of excess mortality in treated patients (see Journal Watch accession number 890818001). This report presents the final analysis of the data on the two drugs.
After a mean follow-up of 10 months, 63 of 755 patients receiving flecainide or encainide and 26 of 743 patients receiving placebo had died -- a highly significant difference. Two-thirds of the deaths were caused by arrhy…