Skip to main content
Log in

Update on implantable cardioverter defibrillator trials

  • Published:
Current Cardiology Reports Aims and scope Submit manuscript

Abstract

Many randomized trials of implantable cardioverter defibrillator (ICD) therapy versus medical treatment for the prevention of death in survivors of cardiac arrest or in patients at high risk of sudden cardiac death (SCD) have been reported. ICD therapy has been consistently efficacious in preventing SCD. ICD therapy has generally favorably impacted total mortality, but this has depended upon the control group's risk for arrhythmic and nonarrhythmic mortality. In these trials, predictors of sudden or total mortality better than ventricular dysfunction have not emerged. This review summarizes the randomized ICDs trials and the impact ICDs have on SCD prevention.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References and Recommended Reading

  1. Zheng ZJ, Croft JB, Giles WH, et al.: Sudden cardiac death in the United States, 1989 to 1999. Circulation 2001, 104:2158–2163.

    PubMed  CAS  Google Scholar 

  2. Zipes DP, Wellens HJJ: Sudden cardiac death. Circulation 1998, 98:2334–2351.

    PubMed  CAS  Google Scholar 

  3. Zipes DP, Wyse DG, Friedman PL, et al.: A comparison of antiarrhythmic-drug therapy with implantable defibrillators in patients resuscitated from near-fatal ventricular arrhythmias. The antiarrhythmics versus Implantable Defibrillators (AVID) Investigators. N Engl J Med 1997, 337:1576–1583. AVID is the first study to show survival benefit with ICD therapy for secondary prevention. AVID criteria are class I indications for ICD implantation.

    Article  Google Scholar 

  4. Connolly SJ, Gent M, Roberts RS, et al.: Canadian implantable defibrillator study (CIDS): a randomized trial of the implantable cardioverter defibrillator against amiodarone. Circulation 2000, 101:1297–1302.

    PubMed  CAS  Google Scholar 

  5. Kuck KH, Cappato R, Siebels J, et al.: Randomized comparison of antiarrhythmic drug therapy with implantable defibrillators in patients resuscitated from cardiac arrest: the Cardiac Arrest Study Hamburg (CASH). Circulation 2000, 102:748–754.

    PubMed  CAS  Google Scholar 

  6. Connolly SJ, Hallstrom AP, Cappato EB, et al.: Meta-analysis of the implantable cardioverter defibrillator secondary prevention trials. Eur Heart J 2000, 21:2071–2078. Meta-analysis and subgroup analysis of secondary prevention trials showed that most of the benefit was driven by the patients with low EF

    Article  PubMed  CAS  Google Scholar 

  7. Domanski MJ, Sakseena S, Epstein AE, et al.: Relative effectiveness of the implantable cardioverter-defibrillator and antiarrhythmic drugs in patients with varying degrees of left ventricular dysfunction who have survived malignant ventricular arrhythmias. J Am Coll Cardiol 1999, 34:1090–1095.

    Article  PubMed  CAS  Google Scholar 

  8. Moss AJ, Hall WJ, Cannom DS, et al.: Improved survival with an implanted defibrillator in patients with coronary artery disease at high risk for ventricular arrhythmia. Multicenter Automatic Defibrillator Implantation Trial Investigators. N Engl J Med 1996, 335:1933–1940. MADIT is the first study in patients with ischemic cardiomyopathy to show survival benefit with ICD therapy. MADIT criteria define a class I indication for ICD implantation

    Article  PubMed  CAS  Google Scholar 

  9. Bigger JT Jr: Prophylactic use of implanted cardiac defibrillators in patients at high risk for ventricular arrhythmias after coronary-artery bypass graft surgery. Coronary Artery Bypass Graft (CABG) Patch Trial Investigators. N Engl J Med 1997, 337:1569–1575.

    Article  PubMed  Google Scholar 

  10. Buxton AE, Lee KL, Fisher JD, et al.: A randomized study of the prevention of sudden death in patients with coronary artery disease. Multicenter Unsustained Tachycardia Trial Investigators. N Engl J Med 1999, 341:1882–1890. MUSTT showed significant survival benefit with ICD therapy in ischemic cardiomyopathy patients who have NSVT and inducible ventricular tachycardia, hence supporting the results of MADIT trial.

    Article  PubMed  CAS  Google Scholar 

  11. Buxton AE, Lee KL, DiCarlo L, et al.: Electrophysiologic testing to identify patients with coronary artery disease who are at risk for sudden death. N Engl J Med 2000, 342:1937–1945.

    Article  PubMed  CAS  Google Scholar 

  12. Moss AJ, Zareba W, Hall WJ, et al.: Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med 2002, 346:877–883. MADIT II is the first study showing the benefit of ICD therapy in patients with ischemic cardiomyopathy for primary prevention without inducible VT. MADIT II criteria are class IIa indications of ICD implantation.

    Article  PubMed  Google Scholar 

  13. Zareba W: Late-breaking clinical trails: noninvasive electrocardiology and outcome in MADIT-II patients. Presented at the North American Society of Pacing and Electrophysiology. San Diego, CA: May 2002.

  14. Daubert JP, Zareba W, Schuger CD, et al.: Does EPS inducibility in MADIT II patients predict subsequent VT and/or VF events [abstract]? Pacing Clin Electrophysiol 2003, 26:960.

    Google Scholar 

  15. Wilber DJ, Zareba W, Hall WJ, et al.: Time dependence of mortality risk and defibrillator benefit after myocardial infarction. Circulation 2004, 109:1082–1084.

    Article  PubMed  Google Scholar 

  16. Dec GW, Fuster V: Medical progress: idiopathic dilated cardiomyopathy. N Engl J Med 1994, 331:1564–1575.

    Article  PubMed  CAS  Google Scholar 

  17. Diaz RA, Obasohan A, Oakley CM: Prediction of outcome in dilated cardiomyopathy. Br Heart J 1987, 58:393–399.

    PubMed  CAS  Google Scholar 

  18. Sugrue DD, Rodeheffer RJ, Codd MB, et al.: The clinical course of idiopathic dilated cardiomyopathy: a population based study. Ann Intern Med 1992, 117:117–123.

    PubMed  CAS  Google Scholar 

  19. Bansch D, Antz M, Boczor S, et al.: Primary prevention of sudden cardiac death in idiopathic dilated cardiomyopathy: the Cardiomyopathy Trail (CAT). Circulation 2002, 105:1453–1458.

    Article  PubMed  Google Scholar 

  20. Strickberger SA, Hummel JD, Bartlett TG, et al.: Amiodarone versus implantable cardioverter-defibrillator: randomized trial in patients with nonischemic dilated cardiomyopathy and asymptomatic nonsustained ventricular tachycardia. AMIOVIRT. J Am Coll Cardiol 2003, 41:1707–1712.

    Article  PubMed  Google Scholar 

  21. Kadish A, Dyer A, Daubert JP, et al.: Prophylactic defibrillator implantation in patients with nonischemic dilated cardiomyopathy. N Engl J Med 2004, 350:2151–2158. DEFINITE is the first large-scale clinical trial to evaluate the efficacy of ICD in nonischemic cardiomyopathy. It showed a strong trend toward a reduction in mortality that did not reach statistical significance.

    Article  PubMed  CAS  Google Scholar 

  22. Bristow MR, Saxon LA, Boehmer J, et al.: Cardiacresynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med 2004, 350:2193–2195. The COMPANION trial showed that in patients with ischemic and nonischemic cardiomyopathy with wide QRS and class III-IV heart failure, ICD implantation is associated with significant decrease in mortality.

    Article  Google Scholar 

  23. Maron BJ, Shen W-K, Link MS, et al.: Efficacy of implantable cardioverter-defibrillators for the prevention of sudden death in patients with hypertrophic cardiomyopathy. N Engl J Med 2000, 342:365–373.

    Article  PubMed  CAS  Google Scholar 

  24. Nademanee K, Veerakul G, Mower M, et al.: Defibrillator versus b-blocker for unexplained death in Thailand (DEBUT): a randomized clinical trial. Circulation 2003, 107:2221–2226.

    Article  PubMed  Google Scholar 

  25. Priori SG, Napolitano C, Gasparini M, et al.: Natural history of Brugada syndrome: insights for risk stratification and management. Circulation 2002, 105:1342–1347.

    Article  PubMed  Google Scholar 

  26. Groh WJ, Silka MJ, Oliver RP, et al.: Use of implantable cardioverter-defibrillators in the congenital long QT syndrome. Am J Cardiol 1996, 78:703–706.

    Article  PubMed  CAS  Google Scholar 

  27. Zareba W, Moss AJ, Daubert JP, et al.: Implantable cardioverter defibrillator in high-risk long QT syndrome patients. J Cardiovasc Electrophysiol 2003, 14:337–341.

    Article  PubMed  Google Scholar 

  28. Corrado D, Leoni L, Link MS, et al.: Implantable cardioverterdefibrillator therapy for prevention of sudden death in patients with arrhythmogenic right ventricular cardiomyopathy/dysplasia. Circulation 2003, 08:3084–3091.

    Article  Google Scholar 

  29. Tavernier R, Gevaert S, De Sutter J, et al.: Long term results of cardioverter-defibrillator implantation in patients with right ventricular dysplasia and malignant ventricular tachyarrhythmias. Heart 2001, 85:53–56.

    Article  PubMed  CAS  Google Scholar 

  30. Wilkoff BL, Cook JR, Epstein AE, et al.: Dual-chamber pacing or ventricular backup pacing in patients with an implantable defibrillator: the Dual Chamber and VVI Implantable Defibrillator (DAVID) Trial. JAMA 2002, 288:3115–3123.

    Article  PubMed  Google Scholar 

  31. Larsen G, Hallstrom A, McAnulty J, et al.: AVID Investigators. Costeffectiveness of the implantable cardioverter-defibrillator versus antiarrhythmic drugs in survivors of serious ventricular tachyarrhythmias: results of the Antiarrhythmics Versus Implantable Defibrillators (AVID) economic analysis substudy. Circulation 2002, 105:2049–2057.

    Article  PubMed  Google Scholar 

  32. Mushlin AI, Hall WJ, Zwanziger J, et al.: The cost-effectiveness of automatic implantable cardiac defibrillators: results from MADIT. Circulation 1998, 97:2129–2135.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Shah, A.H., Huang, D.T., Rosero, S.Z. et al. Update on implantable cardioverter defibrillator trials. Curr Cardiol Rep 6, 327–332 (2004). https://doi.org/10.1007/s11886-004-0034-7

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11886-004-0034-7

Keywords

Navigation