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
Kumaraswamy Nanthakumar, MD*,*,
Andrew E. Epstein, MD ,
G. Neal Kay, MD,
Vance J. Plumb, MD and
Douglas S. Lee, MD
* Division of Cardiology, University Health Network
Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, Ontario, Canada
University of Alabama at Birmingham, Birmingham, Alabama
Manuscript received April 29, 2004;
revised manuscript received August 9, 2004,
accepted August 16, 2004.
* Reprint requests and correspondence: Dr. Kumaraswamy Nanthakumar, Division of Cardiology, University Health Network, Toronto General Hospital, 150 Gerrard Street West, PMCC 3-558, Toronto, Ontario, Canada M5G 2C4
(Email: nanthaj{at}yahoo.com).
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 |
|
This article has been cited by other articles:
|
|
|
|
 
R. J. Myerburg, V. Reddy, and A. Castellanos
Indications for implantable cardioverter-defibrillators based on evidence and judgment.
J. Am. Coll. Cardiol.,
August 25, 2009;
54(9):
747 - 763.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Kobe and L. Eckardt
Early mortality in implantable cardioverter defibrillator patients: from randomized controlled trials to real life
Europace,
June 1, 2009;
11(6):
694 - 696.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Meine, T. Smith, and R. N.W. Hauer
The economical challenge in the treatment of chronic heart failure: is primary prophylactic ICD therapy cost-effective in Europe?
Europace,
June 1, 2009;
11(6):
689 - 691.
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. Boriani, M. Biffi, C. Martignani, I. Diemberger, C. Valzania, M. Bertini, and A. Branzi
Expenditure and value for money: the challenge of implantable cardioverter defibrillators
QJM,
May 1, 2009;
102(5):
349 - 356.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. J. Sparrow, N. Merchant, Y. L. Provost, D. J. Doyle, E. T. Nguyen, and N. S. Paul
CT and MR Imaging Findings in Patients with Acquired Heart Disease at Risk for Sudden Cardiac Death1
RadioGraphics,
May 1, 2009;
29(3):
805 - 823.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Dorian
Effective and efficient use of implantable defibrillators: Sometimes it's over when it's over
Can. Med. Assoc. J.,
March 17, 2009;
180(6):
599 - 600.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. J. Silka and Y. Bar-Cohen
Should patients with congenital heart disease and a systemic ventricular ejection fraction less than 30% undergo prophylactic implantation of an ICD?: Patients With Congenital Heart Disease and a Systemic Ventricular Ejection Fraction Less Than 30% Should Undergo Prophylactic Implantation of an Implantable Cardioverter Defibrillator
Circ Arrhythm Electrophysiol,
October 1, 2008;
1(4):
298 - 306.
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. K. Triedman
Should patients with congenital heart disease and a systemic ventricular ejection fraction less than 30% undergo prophylactic implantation of an ICD?: Implantable Cardioverter Defibrillator Implantation Guidelines Based Solely on Left Ventricular Ejection Fraction Do Not Apply to Adults With Congenital Heart Disease
Circ Arrhythm Electrophysiol,
October 1, 2008;
1(4):
307 - 316.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. E. Epstein, J. P. DiMarco, K. A. Ellenbogen, N.A. M. Estes III, R. A. Freedman, L. S. Gettes, A. M. Gillinov, G. Gregoratos, S. C. Hammill, D. L. Hayes, et al.
ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices) Developed in Collaboration With the American Association for Thoracic Surgery and Society of Thoracic Surgeons
J. Am. Coll. Cardiol.,
May 27, 2008;
51(21):
e1 - e62.
[Full Text]
[PDF]
|
|
|
|
|
|
|
Writing Committee Members, A. E. Epstein, J. P. DiMarco, K. A. Ellenbogen, N.A. M. Estes III, R. A. Freedman, L. S. Gettes, A. M. Gillinov, G. Gregoratos, S. C. Hammill, et al.
ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices): Developed in Collaboration With the American Association for Thoracic Surgery and Society of Thoracic Surgeons
Circulation,
May 27, 2008;
117(21):
e350 - e408.
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. K H Lam and A. Owen
Combined resynchronisation and implantable defibrillator therapy in left ventricular dysfunction: Bayesian network meta-analysis of randomised controlled trials
BMJ,
November 3, 2007;
335(7626):
925 - 925.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Camm, H. Klein, and S. Nisam
The cost of implantable defibrillators: perceptions and reality
Eur. Heart J.,
February 2, 2007;
28(4):
392 - 397.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Kirchhof, G. Breithardt, and L. Eckardt
Primary prevention of sudden cardiac death
Heart,
December 1, 2006;
92(12):
1873 - 1878.
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. G. Assomull, S. K. Prasad, J. Lyne, G. Smith, E. D. Burman, M. Khan, M. N. Sheppard, P. A. Poole-Wilson, and D. J. Pennell
Cardiovascular Magnetic Resonance, Fibrosis, and Prognosis in Dilated Cardiomyopathy
J. Am. Coll. Cardiol.,
November 21, 2006;
48(10):
1977 - 1985.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Developed in Collaboration With the European Heart, D. P. Zipes, A. J. Camm, M. Borggrefe, A. E. Buxton, B. Chaitman, M. Fromer, G. Gregoratos, G. Klein, A. J. Moss, et al.
ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death)
J. Am. Coll. Cardiol.,
September 5, 2006;
48(5):
e247 - e346.
[Full Text]
[PDF]
|
|
|
|
|
|
|
Writing Committee Members, D. P. Zipes, A. J. Camm, M. Borggrefe, A. E. Buxton, B. Chaitman, M. Fromer, G. Gregoratos, G. Klein, A. J. Moss, et al.
ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: A report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death) Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society
Europace,
September 1, 2006;
8(9):
746 - 837.
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. Vanoli and P. B. Adamson
What does the future hold for the management of chronic heart failure?
Eur. Heart J. Suppl.,
June 1, 2006;
8(suppl_C):
C51 - C57.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
W. C. Levy, D. Mozaffarian, D. T. Linker, S. C. Sutradhar, S. D. Anker, A. B. Cropp, I. Anand, A. Maggioni, P. Burton, M. D. Sullivan, et al.
The Seattle Heart Failure Model: Prediction of Survival in Heart Failure
Circulation,
March 21, 2006;
113(11):
1424 - 1433.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. A. Ellenbogen, M. A. Wood, and H. U. Klein
Why Should We Care About CARE-HF?
J. Am. Coll. Cardiol.,
December 20, 2005;
46(12):
2199 - 2203.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. G. Manios, E. M. Kallergis, E. M. Kanoupakis, H. E. Mavrakis, D. C. Kambouraki, D. A. Arfanakis, and P. E. Vardas
Amino-Terminal Pro-Brain Natriuretic Peptide Predicts Ventricular Arrhythmogenesis in Patients With Ischemic Cardiomyopathy and Implantable Cardioverter-Defibrillators
Chest,
October 1, 2005;
128(4):
2604 - 2610.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Authors/Task Force Members, K. Swedberg, Writing Committee:, J. Cleland, H. Dargie, H. Drexler, F. Follath, M. Komajda, L. Tavazzi, O. A. Smiseth, et al.
Guidelines for the diagnosis and treatment of chronic heart failure: executive summary (update 2005): The Task Force for the Diagnosis and Treatment of Chronic Heart Failure of the European Society of Cardiology
Eur. Heart J.,
June 1, 2005;
26(11):
1115 - 1140.
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. G. Pauker, N. A. M. Estes, and D. N. Salem
Preventing Sudden Cardiac Death: Can We Afford the Benefit?
Ann Intern Med,
April 19, 2005;
142(8):
664 - 666.
[Full Text]
[PDF]
|
|
|
|
