Abstract
In MADIT-II, prophylactic ICD therapy was effective in improving survival in patients with prior myocardial infarction and an ejection fraction ≤0.30, and a host of prespecified secondary analyses indicate that life-saving effect of ICD therapy is consistent across all studied subgroups. We have not been able to identify any traditional risk factors that will permit selection of patients who will receive a significantly better effect from the ICD within any subgroup. The ICD provides appropriate therapy for life-threatening ventricular arrhythmias on at least one occasion in over a third of the patients during the first 4 years after device implantation. Computations from the MADIT-II database indicate that 9 patients need to be treated with an ICD to save one life during a 4-year period. The findings from MADIT-II have implications for patients, physicians, and society.
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References
Moss AJ, Zareba W, Hall WJ, Klein H, Wilber DJ, Cannom DS, Daubert JP, Higgins SL, BrownMW, Andrews ML. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med 2002;346:877–883.
FDA approves expanded indication for Guidant implantable cardioverter defibrillator for heart attack survivors, July 18, 2002. www.fda.gov.
Gregoratos G, Abrams J, Epstein AE, Freedman RA, Hayes DL, Hlatky MA, Kerber RE, Naccarelli GV, Schoenfled MH, Silka MJ, Winters SL. ACC/AHA/NASPE 2002 guideline update for implantation of cardiac pacemakers and antiarrhythmia devices: Summary article. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/NASPE Committee to Update the 1998 Pacemaker Guidelines). J Cardiovasc Electrophysiol 2002;13:1183–1199.
Centers for Medicare and Medicaid Services. National coverage analysis: Implantable cardioverter defibrillators (#CAG-00157N). Tracking sheet. Available at: http:// www.cms.hhs.gov/ncdr/trackingsheet.asp?id=39. Assessed September 5, 2003
Buxton AE. The clinical use of implantable cardioverter de-fibrillators: Where are we now? Where should we go? Ann Intern Med 2003;138:512–514.
Reynolds MR, Josephson ME. MADIT II (second Multicenter Automated Defibrillator Implantation Trial) debate: Risk stratification, costs, and public policy. Circulation 2003;108:1779–1783.
Hinkle LE, Jr., Thaler HT. Clinical classification of cardiac deaths. Circulation 1982;65:457–464.
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Moss, A.J. MADIT-II: Substudies and Their Implications. Card Electrophysiol Rev 7, 430–433 (2003). https://doi.org/10.1023/B:CEPR.0000023155.60684.91
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DOI: https://doi.org/10.1023/B:CEPR.0000023155.60684.91