Prophylactic use of the implantable cardioverter-defibrillator and its effect on the long-term survival, cardiovascular and sudden cardiac death in nonischemic cardiomyopathy patients—a systematic review and meta-analysis

Abstract

Implantable cardioverter-defibrillator (ICD) has shown to reduce sudden cardiac death and overall mortality in patients with dilated cardiomyopathy. The recently published DANISH trial has shown conflicting outcomes on the long-term survival in patients with prophylactic implantation of ICD in Non-Ischemic Cardiomyopathy (NICM). Two independent reviewers searched MEDLINE, PUBMED, Ovid, CINAHL, clinicaltrials.gov , and Cochrane Registry for randomized control trials (RCT's) comparing ICD to medical treatment (MT). Six RCT's enrolling 3389 patients (ICD = 1554 and MT = 1835) were included for final analysis. The primary outcomes were mortality comparing ICD to MT, 231 vs 337 (OR = 0.74, CI = 0.62-0.90, p = 0.002, and I = 0%) favoring ICD. On comparing to amiodarone only, there were 47 deaths in the ICD arm vs 71 deaths in amiodarone arm, (OR = 0.66, CI = 0.44-0.98, p = 0.04, I 0%), to placebo and usual care only (excluding amiodarone); there were 225 deaths in ICD patients compared to 266 in the placebo and usual care arm, (OR = 0.73, CI = 0.59-0.92, p = 0.007, I = 15%). The results of our analysis from these six RCTs clearly support the ongoing benefit of prophylactic ICD implantation and support current recommendations for ICD implantation in NICM patients. More RCT's at a larger scale are needed to further elucidate benefits of both ICD and CRT-D in this post PARADIGM era where MT is at a pinnacle in reducing morbidity and mortality in heart failure patients.

Cost-utility analysis of an implantable cardioverterdefibrillator for the treatment of patients with ischemic or non-ischemic New York Heart Association class II or III heart failure in Colombia

“…However, the study did not address the mortality effects in non-ischemic cardiomyopathy patients who only had ICD. On the other hand, a new meta-analysis including the DANISH trial found a decrease in mortality in this population (22,23). Some of the limitations of this study are related to the probabilities of death, which are the more sensitive variables for cost-effectiveness conclusions.…”

“…However, the study did not address the mortality effects in non-ischemic cardiomyopathy patients who only had ICD. On the other hand, a new meta-analysis including the DANISH trial found a decrease in mortality in this population 22 , 23 .…”

Efficacy, safety, and in-hospital outcomes of subcutaneous versus transvenous implantable defibrillator therapy

“…[4] Lead extraction may be necessary when lead failure occurs; this procedure is highly challenging with high complications rates of about 1% and a mortality risk of 0.3%, even in experienced centers. [31] The S-ICD provides a defibrillation system without lead in or on the heart, thereby eliminating several important complications associated with transvenous leads. In the analysis, we found that the S-ICD could significant reduce the risk of lead-related complications by 87%.…”

Does the heart transplant have a future?

“…An ICD implant to detect and alleviate life-threatening arrhythmias in patients with ischaemic and non-ischaemic cardiomyopathologies [25, 26] and cardiac resynchronization therapy [27] both play a fundamental role in the treatment of heart failure—and thus represent a pivotal recommendation in current heart failure guidelines. Remarkably, publication of the DANISH (Danish Study to Assess the Efficacy of ICDs in Patients with Non-ischaemic Systolic Heart Failure on Mortality) trial subsequent to the last European Society of Cardiology guideline recommendation on the treatment of heart failure raised uncertainty about prophylactic ICD implants: device treatment in patients with symptomatic systolic heart failure not caused by coronary heart disease was not associated with a significantly lower long-term rate of death from any cause than was usual clinical care [28].…”