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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

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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 I2 = 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, I2 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, I2 = 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.

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Abbreviations

ICD:

Implantable cardioverter-defibrillator

CRT:

Cardiac resynchronization therapy

CRT-D:

Cardiac resynchronization therapy-defibrillator

NICM:

Nonischemic cardiomyopathy

MT:

Medical treatment

ICM:

Ischemic cardiomyopathy

RCT:

Randomized control trial

MACE:

Major adverse cardiovascular events

MeSH:

Medical subject headings

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Acknowledgements

Muhammad Hassan Tahir (M.H.T.) and Varun Mairyala (V.M.) helped to extract the data from the papers and enter into the pre-specified data sheets.

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Authors and Affiliations

  1. Department of Medicine, Drexel University College of Medicine, 245 N. 15th Street, NCB Suite 6144, Philadelphia, PA, 19102, USA

    Waqas Javed Siddiqui, Sandeep Aggarwal, Swaiman Singh, Steven Kutalek & Howard J Eisen

  2. Hahnemann University Hospital, Philadelphia, PA, USA

    Waqas Javed Siddiqui, Sandeep Aggarwal, Swaiman Singh, Steven Kutalek & Howard J Eisen

  3. Department of Medicine, Seton Hall University, St. Francis Medical Center, Trenton, NJ, USA

    Muhammad Rafique

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  1. Waqas Javed Siddiqui
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Contributions

Waqas Javed Siddiqui: concept/design, data collection, data analysis and interpretation, drafting, critical revision, statistics

Sandeep Aggarwal: concept/design, data analysis and interpretation, critical revision

Muhammad Rafique: data collection, drafting

Swaiman Singh: drafting

Steven Kutalek: critical revision, approval of article

Howard J Eisen: critical revision, approval of article

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Correspondence to Waqas Javed Siddiqui.

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Siddiqui, W.J., Aggarwal, S., Rafique, M. et al. 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. Heart Fail Rev 23, 181–190 (2018). https://doi.org/10.1007/s10741-018-9671-6

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