Analysis of arrhythmias in the Circadian Anti-ischaemia Program in Europe (CAPE) study

Introduction Controversy has developed in recent years over the potential detrimental effects of some short-acting calcium channel blockers, and especially with regard to their pro-arrhythmic effects. Materials and methods A re-analysis of the Holter data from the Circadian Anti-ischaemia Program in Europe (CAPE) study was undertaken in order to evaluate the occurrence of ventricular arrhythmic events during 48-h Holter monitoring in severe coronary artery disease (CAD) patients randomized to receive either amlodipine (n=167) or placebo (n=83) in addition to standard antianginal therapy (if any) for 8 weeks. Patients were randomized in a double-blind manner to placebo or amlodipine 5 mg . day - 1 for the first 4 weeks with a forced titration to 10 mg . day -1 for the next 4 weeks. Approximately two-thirds of patients in each group received beta-blockers. Results There were no significant differences in arrhythmic events between placebo- and amlodipine-treated patients during the treatment period. This was true for the patient groups as a whole and for those receiving or not receiving beta-blockers. The placebo patients who were not on beta-blockers showed the largest (although not significant) increase in arrhythmias during treatment. Conclusions Amlodipine administered to patients with severe CAD, the majority receiving conventional anti-ischaemic treatment did not demonstrate any proarrhythmic effect in all subgroups analysed.