Prophylactic Defibrillator Implantation in Patients with Nonischemic Dilated Cardiomyopathy

Kadish, Alan H.; Dyer, Alan R.; Daubert, James P.; Quigg, Rebecca; Estes, N.A. Mark; Anderson, Kelley P.; Calkins, Hugh; Hoch, David; Goldberger, Jeffrey J.; Shalaby, Alaa; Sanders, William E.; Schaechter, Andi; Levine, Joseph

doi:10.1056/nejmoa033088

Cited by 1,831 publications

(1,014 citation statements)

References 30 publications

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“…2,14,26 Frequencies of inappropriate device interventions up to 21% were reported in the primary prevention trials. 18,27 The proportion of patients with any inappropriate ICD intervention (ATP or shock) is only 11% in our study, with a cumulative incidence of 14% at 5 years of follow-up. This probably is due to consequent programming.…”

Section: Inappropriate Icd Interventionsmentioning

confidence: 55%

Long‐Term Follow‐Up of Prophylactic Implantable Cardioverter‐Defibrillator–Only Therapy: Comparison of Ischemic and Nonischemic Heart Disease

Smith

Theuns

Çalışkan

et al. 2011

Clinical Cardiology

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Background:The benefits of primary prophylactic implantable cardioverter‐defibrillators (ICDs) are actually debated, as some drawbacks become more apparent and as the natural history of cardiac disease seems to improve. Therefore, contemporary follow‐up data of non‐trial populations treated according to current guidelines remain necessary. The aim of this study was to evaluate mortality and the occurrence of ICD interventions in patients with coronary artery disease (CAD) and dilated cardiomyopathy (DCM) who received in the recent era a primary prophylactic ICD without resynchronization therapy.Hypothesis:Survival and event‐free rates from appropriate ICD therapy are different between ischemic and nonischemic ICD patients.Methods:Prospective cohort study of 427 consecutive primary prevention ICD patients with ischemic or nonischemic heart disease, excluding patients with resynchronization.Results:Ischemic heart disease was present in 290 patients (68%), nonischemic heart disease in 137 patients (32%). During a median follow‐up of 31 months (interquartile range [IQR] 15–45 months), 30 patients (7%) died. Mortality was not different in both disease categories. The incidence of appropriate ICD interventions was similar in CAD and DCM (23% vs 21%). Appropriate ICD intervention occurred more frequently in patients with atrial fibrillation (29% vs 19%). Inappropriate ICD intervention occurred in 11% of patients.Conclusions:The clinical course of ischemic and nonischemic heart disease patients treated with a primary prophylactic ICD is similar with respect to mortality and to appropriate and inappropriate ICD interventions, in spite of a younger age at baseline of the DCM patients. © 2011 Wiley Periodicals, Inc.This work was partly funded by “het College Voor Zorgverzekeringen” (OP 0864207). Dr. D.A.M.J. Theuns received research grants from Biotronik, Boston Scientific, and St. Jude Medical, and he is a consultant to Cameron Health (USA). L. Jordaens received research grants and speaker fees from Biotronik, Boston Scientific, Cameron Health, Medtronic, Sorin, and St. Jude Medical. T. Smith and K. Caliskan had no funding, financial relationships, or conflicts of interest to declare.

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Section: Inappropriate Icd Interventionsmentioning

confidence: 55%

Long‐Term Follow‐Up of Prophylactic Implantable Cardioverter‐Defibrillator–Only Therapy: Comparison of Ischemic and Nonischemic Heart Disease

Smith

Theuns

Çalışkan

et al. 2011

Clinical Cardiology

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“…The six primary prevention trials were the Cardiomyopathy Trial (CAT); the Amiodarone vs Implantable Cardioverter‐Defibrillator Randomized Trial (AMIOVIRT); the Defibrillators in Nonischemic Cardiomyopathy Treatment Evaluation (DEFINITE) Trial; the SCD‐HeFT trial; the Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) Trial; and, more recently, the DANISH trial 5, 6, 7, 12, 13, 14. These trials display noticeable qualitative heterogeneities with regard to study design, comorbidity burden, and follow‐up duration.…”

Section: Discussionmentioning

confidence: 99%

Implantable cardioverter defibrillator in nonischemic cardiomyopathy: A systematic review and meta‐analysis

Khan

Ghimire

Talluri

et al. 2017

Journal of Arrhythmia

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The evidence to support implantable cardioverter defibrillator (ICD) in subjects with nonischemic cardiomyopathy (NICM) for primary prevention of sudden cardiac death (SCD) is not robust. This meta‐analysis intends to assess the impact of routine ICD implantation for primary prevention of mortality due to SCD in NICM based on all the published randomized clinical trials (RCTs). Six RCTs were selected using PubMed/Medline, EMBASE, and CENTRAL from inception to December 2016. Outcomes were calculated as random‐effects relative risk (RR) and risk difference (RD) with 95% confidence interval (CI). Patients were randomized to ICD arm and control arm (usual care, medical treatment, and anti‐arrhythmic drugs). ICD significantly reduced all‐cause mortality in NICM patients (RR, 0.74, 95% CI, 0.56‐0.97, P = .03, I2 = 40). Mortality benefit was achieved due to a significant reduction in sudden cardiac death (SCD) (RR, 0.47, 95% CI, 0.30‐0.73, P < .001, I2 = 0). There were no statistical differences between two groups with regard to risk of noncardiac mortality, non‐SCD, cardiac arrest, cardiac transplant, sustained ventricular tachycardia (VT), and VT requiring medical treatment. Our results support efficacy of ICDs at reducing all‐cause mortality due to a reduction in SCD.

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“…Since then, there have been remarkable technical advances. The ICD is now widely used in high‐risk patients based on evidence from RCTs that supports the use of ICDs for both primary and secondary prevention of SCA 30, 31, 32, 33, 34, 35. In particular, 3 randomized controlled trials evaluated the impact of ICD therapy for secondary prevention indications (Table 1).…”

Section: Randomized Controlled Trials Of Icds and Guidelinesmentioning

confidence: 99%

Implantable Cardioverter‐Defibrillators for Secondary Prevention of Sudden Cardiac Death: A Review

Borne

Katz

Betz

et al. 2017

JAHA

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Prophylactic Defibrillator Implantation in Patients with Nonischemic Dilated Cardiomyopathy

Cited by 1,831 publications

References 30 publications

Long‐Term Follow‐Up of Prophylactic Implantable Cardioverter‐Defibrillator–Only Therapy: Comparison of Ischemic and Nonischemic Heart Disease

Long‐Term Follow‐Up of Prophylactic Implantable Cardioverter‐Defibrillator–Only Therapy: Comparison of Ischemic and Nonischemic Heart Disease

Implantable cardioverter defibrillator in nonischemic cardiomyopathy: A systematic review and meta‐analysis

Implantable Cardioverter‐Defibrillators for Secondary Prevention of Sudden Cardiac Death: A Review

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