Electrophysiology and heart failure: Viewpoint
Prophylactic implantable cardioverter-defibrillator therapy in patients with left ventricular systolic dysfunction: A pooled analysis of 10 primary prevention trials

https://doi.org/10.1016/j.jacc.2004.08.054Get rights and content
Under an Elsevier user license
open archive

Strategies to decrease sudden cardiac death in patients with left ventricular systolic dysfunction are evolving. Recent clinical trials have evaluated the role of prophylactic implantable cardioverter-defibrillators (ICDs) in patients with and without additional risk stratifiers. We pooled studies comparing treatment with and without ICDs from published data and presented abstracts, irrespective of QRS duration and etiology of systolic dysfunction. On the basis of the available clinical trials, implantation of an ICD for primary prevention of death provides a 7.9% absolute mortality reduction (p = 0.003) in patients with left ventricular (LV) systolic dysfunction who were receiving optimized medical therapy. This finding was not sensitive to the exclusion of any individual trial. The ICD is an effective primary preventative measure in patients who are at risk for death; however, the application of this therapy needs to be individualized for the patient, similar to drug therapies in LV systolic dysfunction. In health care settings without unlimited resources, optimal use of this therapy will require better risk stratification methods or lowering of the initial device cost.

Abbreviations and acronyms

ACE
angiotensin-converting enzyme
AMIOVIRT
Amiodarone Versus Implantable Cardioverter-Defibrillator Randomized Trial
CABG-Patch
Coronary Artery Bypass Graft Patch trial
CAT
Cardiomyopathy Trial
CI
confidence interval
COMPANION
Comparison of Medical Therapy, Pacing, and Defibrillation in Patients With Left Ventricular Systolic Dysfunction trial
CRT
cardiac resynchronization therapy
DEFINITE
Defibrillators In Non-Ischemic Cardiomyopathy Treatment Evaluation trial
DINAMIT
Defibrillator In Acute Myocardial Infarction Trial
EP
electrophysiology
ICD
implantable cardioverter-defibrillator
LV
left ventricular
MADIT
Multicenter Automatic Defibrillator Implantation Trial
MUSTT
Multicenter Unsustained Tachycardia Trial
RR
relative risk
SCD-HeFT
Sudden Cardiac Death in Heart Failure Trial

Cited by (0)

Dr. Nanthakumar is supported by the clinician scientist program of the Canadian Institute of Health Research. We would like to disclose that there is potential conflict of interest in that all authors of this manuscript except Dr. Lee’s care for patients with these devices. Dr. Epstein chairs events committees for St. Jude Medical and Guidant Corp., and has been a speaker for Biotronik, Guidant Corp., Medtronic Inc., and St Jude Medical. Drs. Kay, Epstein, and Plumb are investigators for Guidant Corp., St. Jude Medical, Medtronic Inc., and Biotronik. Dr. Nanthakumar is an investigator for Medtronic Inc. In addition, Dr. Kay is a consultant for Guidant Corp.