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Implantable Cardioverter- Defibrillator Therapy in Clinical Practice

David A. Cesario, MD, PhD^_* and G. William Dec, MD^,_*

^_* University of California-Irvine, Irvine, California
Cardiology Division, Massachusetts General Hospital, Heart Failure and Transplantation Unit, Boston, Massachusetts

View larger version (46K): [in a new window]   Figure 1 Ejection fraction (EF) and implantable cardioverter-defibrillator (ICD) indications. It is well established that reduced left ventricular ejection fraction (LVEF) is a predictor of increased sudden cardiac death risk and may be useful as an indication for ICD implantation. A number of clinical trials have shown that ICD therapy confers a significant survival benefit when implanted in certain subpopulations with a reduced LVEF, including survivors of cardiac arrest, ischemic cardiomyopathy patients, and possibly dilated cardiomyopathy patients. The final row in this figure lists the clinical trials that support ICD implantation in each of these groups. *The Defibrillators in Non-Ischemic Cardiomyopathy Treatment Evaluation (DEFINITE) trial showed a trend toward improved overall survival in patients with non-ischemic dilated cardiomyopathy and ejection fraction <36%, but failed to reach statistical significance (p = 0.08). AVID = Antiarrhythmics Versus Implantable Defibrillators; CABG = coronary artery bypass graft surgery; CASH = Cardiac Arrest Study Hamburg; CIDS = Canadian Implantable Defibrillator Study; MADIT = Multicenter Automatic Defibrillator Implantation Trials (MADIT I and II); MI = myocardial infarction; MUSTT = Multicenter Unsustained Tachycardia Trial; SCD-HeFT = Sudden Cardiac Death in Heart Failure Trial.