Skip to main content

Advertisement

SpringerLink
Log in

Role of implantable cardioverter defibrillator in non-ischemic cardiomyopathy: a systematic review and meta-analysis of prospective randomized clinical trials

  • REVIEWS
  • Published:
Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Introduction

A mortality benefit in patients with implantable cardioverter defibrillator (ICD) in ischemic cardiomyopathy is well established. However, the benefit of ICD implantation in non-ischemic cardiomyopathy (NICM) on total mortality remains uncertain. We performed a systematic review and meta-analysis of randomized controlled trials (RCT) evaluating the role of primary prevention ICD in NICM patients.

Methods

We performed a systematic review on PubMed, The Cochrane Library, EMBASE, EBSCO, Web of Science, and CINAHL databases from the inception through February 2017 to identify RCT evaluating the role of ICD in NICM patients. Mantel-Haenszel risk ratio (RR) fixed effects model was used to summarize data across treatment arms. If heterogeneity (I 2) ≥25, random effects model was used instead.

Results

We analyzed a total of 2573 patients from five RCTs comparing ICD with medical therapy in patients with NICM. The mean follow up for the trials was 48 ± 22 months. There was a significant reduction in (a) all-cause mortality (RR 0.84, 95% CI 0.71–0.99, p = 0.03) and (b) sudden cardiac death (RR 0.47, 95% CI 0.30–0.73, p < 0.001) in ICD group versus medical therapy.

Conclusion

Our analysis demonstrates that the use of ICD for primary prevention is associated with a reduction in all-cause mortality and SCD in patients with NICM.

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Abbreviations

ICD:

Implantable cardioverter defibrillator

NICM:

Non-ischemic cardiomyopathy

CI:

Confidence interval

SCD:

Sudden cardiac death

LVEF:

Left ventricular ejection fraction

RCTs:

Randomized controlled trials

SMD:

Standard mean difference

References

  1. Moss AJ, Zareba W, Hall WJ, Klein H, Wilber DJ, Cannom DS, et al. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med. 2002;346(12):877–83.

    Article  PubMed  Google Scholar 

  2. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, et al. 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016;37(27):2129–200.

    Article  PubMed  Google Scholar 

  3. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Drazner MH, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. J Am Coll Cardiol. 2013;62(16):e147–239.

    Article  PubMed  Google Scholar 

  4. Desai AS, Fang JC, Maisel WH, Baughman KL. Implantable defibrillators for the prevention of mortality in patients with nonischemic cardiomyopathy: a meta-analysis of randomized controlled trials. JAMA. 2004;292(23):2874–9.

    Article  CAS  PubMed  Google Scholar 

  5. Goldberger JJ, Buxton AE, Cain M, Costantini O, Exner DV, Knight BP, et al. Risk stratification for arrhythmic sudden cardiac death: identifying the roadblocks. Circulation. 2011;123(21):2423–30.

    Article  PubMed  Google Scholar 

  6. Stecker EC, Chugh SS. Prediction of sudden cardiac death: next steps in pursuit of effective methodology. J Interv Card Electrophysiol. 2011;31(2):101–7.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Ghanbari H, Dalloul G, Hasan R, Daccarett M, Saba S, David S, et al. Effectiveness of implantable cardioverter-defibrillators for the primary prevention of sudden cardiac death in women with advanced heart failure: a meta-analysis of randomized controlled trials. Arch Intern Med. 2009;169(16):1500–6.

    Article  PubMed  Google Scholar 

  8. Bardy GH, Lee KL, Mark DB, Poole JE, Packer DL, Boineau R, et al. Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med. 2005;352(3):225–37.

    Article  CAS  PubMed  Google Scholar 

  9. Kadish A, Dyer A, Daubert JP, Quigg R, Estes NA, Anderson KP, et al. Prophylactic defibrillator implantation in patients with nonischemic dilated cardiomyopathy. N Engl J Med. 2004;350(21):2151–8.

    Article  CAS  PubMed  Google Scholar 

  10. Bansch D, Antz M, Boczor S, Volkmer M, Tebbenjohanns J, Seidl K, et al. Primary prevention of sudden cardiac death in idiopathic dilated cardiomyopathy: the cardiomyopathy trial (CAT). Circulation. 2002;105(12):1453–8.

    Article  PubMed  Google Scholar 

  11. Strickberger SA, Hummel JD, Bartlett TG, Frumin HI, Schuger CD, Beau SL, 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(10):1707–12.

    Article  PubMed  Google Scholar 

  12. Kober L, Thune JJ, Nielsen JC, Haarbo J, Videbaek L, Korup E, et al. Defibrillator implantation in patients with nonischemic systolic heart failure. N Engl J Med. 2016;375(13):1221–30.

    Article  PubMed  Google Scholar 

  13. Knobloch K, Yoon U, Vogt PM. Preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement and publication bias. Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery. 2011;39(2):91–2.

    Article  Google Scholar 

  14. Higgins JPT GS, eds.. Cochrane Handbook for Systematic Reviews of Interventions. Version 5.1.0. The Cochrane Collaboration. http://handbook.cochrane.org. Updated March 2011. Accessed October 20, 2016.

  15. DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7(3):177–88.

    Article  CAS  PubMed  Google Scholar 

  16. Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315(7109):629–34.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Sterne JA, Sutton AJ, Ioannidis JP, Terrin N, Jones DR, Lau J, et al. Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials. BMJ. 2011;343:d4002.

    Article  PubMed  Google Scholar 

  18. Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994;50(4):1088–101.

    Article  CAS  PubMed  Google Scholar 

  19. Bristow MR, Saxon LA, Boehmer J, Krueger S, Kass DA, De Marco T, et al. Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med. 2004;350(21):2140–50.

    Article  CAS  PubMed  Google Scholar 

  20. Jefferies JL, Towbin JA. Dilated cardiomyopathy. Lancet. 2010;375(9716):752–62.

    Article  PubMed  Google Scholar 

  21. Maron BJ, Towbin JA, Thiene G, Antzelevitch C, Corrado D, Arnett D, et al. Contemporary definitions and classification of the cardiomyopathies: an American Heart Association scientific statement from the Council on Clinical Cardiology, heart failure and transplantation committee; quality of care and outcomes research and functional genomics and translational biology interdisciplinary working groups; and council on epidemiology and prevention. Circulation. 2006;113(14):1807–16.

    Article  PubMed  Google Scholar 

  22. Felker GM, Thompson RE, Hare JM, Hruban RH, Clemetson DE, Howard DL, et al. Underlying causes and long-term survival in patients with initially unexplained cardiomyopathy. N Engl J Med. 2000;342(15):1077–84.

    Article  CAS  PubMed  Google Scholar 

  23. Russo AM, Daugherty SL, Masoudi FA, Wang Y, Curtis J, Lampert R. Gender and outcomes after primary prevention implantable cardioverter-defibrillator implantation: findings from the National Cardiovascular Data Registry (NCDR). Am Heart J. 2015;170(2):330–8.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Drazner MH, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2013;128(16):e240–327.

    Article  PubMed  Google Scholar 

  25. Lam SK, Owen A. Combined resynchronisation and implantable defibrillator therapy in left ventricular dysfunction: Bayesian network meta-analysis of randomised controlled trials. BMJ. 2007;335(7626):925.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Colquitt JL, Mendes D, Clegg AJ, Harris P, Cooper K, Picot J, et al. Implantable cardioverter defibrillators for the treatment of arrhythmias and cardiac resynchronisation therapy for the treatment of heart failure: systematic review and economic evaluation. Health Technol Assess. 2014;18(56):1–560.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Kuhne M, Abrams G, Sarrazin JF, Crawford T, Good E, Chugh A, et al. Isolated potentials and pace-mapping as guides for ablation of ventricular tachycardia in various types of nonischemic cardiomyopathy. J Cardiovasc Electrophysiol. 2010;21(9):1017–23.

    Article  PubMed  Google Scholar 

  28. Tereshchenko LG, Faddis MN, Fetics BJ, Zelik KE, Efimov IR, Berger RD. Transient local injury current in right ventricular electrogram after implantable cardioverter-defibrillator shock predicts heart failure progression. J Am Coll Cardiol. 2009;54(9):822–8.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Xie J, Weil MH, Sun S, Tang W, Sato Y, Jin X, et al. High-energy defibrillation increases the severity of postresuscitation myocardial dysfunction. Circulation. 1997;96(2):683–8.

    Article  CAS  PubMed  Google Scholar 

  30. Harada M, Tsuji Y, Ishiguro YS, Takanari H, Okuno Y, Inden Y, et al. Rate-dependent shortening of action potential duration increases ventricular vulnerability in failing rabbit heart. Am J Physiol Heart Circ Physiol. 2011;300(2):H565–73.

    Article  CAS  PubMed  Google Scholar 

  31. Moss AJ, Schuger C, Beck CA, Brown MW, Cannom DS, Daubert JP, et al. Reduction in inappropriate therapy and mortality through ICD programming. N Engl J Med. 2012;367(24):2275–83.

    Article  CAS  PubMed  Google Scholar 

  32. Frankel DS, Mountantonakis SE, Robinson MR, Zado ES, Callans DJ, Marchlinski FE. Ventricular tachycardia ablation remains treatment of last resort in structural heart disease: argument for earlier intervention. J Cardiovasc Electrophysiol. 2011;22(10):1123–8.

    Article  PubMed  Google Scholar 

  33. Dinov B, Arya A, Bertagnolli L, Schirripa V, Schoene K, Sommer P, et al. Early referral for ablation of scar-related ventricular tachycardia is associated with improved acute and long-term outcomes: results from the Heart Center of Leipzig ventricular tachycardia registry. Circ Arrhythm Electrophysiol. 2014;7(6):1144–51.

    Article  PubMed  Google Scholar 

  34. Dinov B, Arya A, Schratter A, Schirripa V, Fiedler L, Sommer P, et al. Catheter ablation of ventricular tachycardia and mortality in patients with nonischemic dilated cardiomyopathy: can noninducibility after ablation be a predictor for reduced mortality? Circ Arrhythm Electrophysiol. 2015;8(3):598–605.

    Article  PubMed  Google Scholar 

  35. Piers SR, Leong DP, van Huls van Taxis CF, Tayyebi M, Trines SA, Pijnappels DA, et al. Outcome of ventricular tachycardia ablation in patients with nonischemic cardiomyopathy: the impact of noninducibility. Circ Arrhythm Electrophysiol. 2013;6(3):513–21.

    Article  CAS  PubMed  Google Scholar 

  36. Hu J, Zeng S, Zhou Q, Zhu W, Xu Z, Yu J, et al. Can ventricular tachycardia non-inducibility after ablation predict reduced ventricular tachycardia recurrence and mortality in patients with non-ischemic cardiomyopathy? A meta-analysis of twenty-four observational studies. Int J Cardiol. 2016;222:689–95.

    Article  PubMed  Google Scholar 

  37. Vest RN 3rd, Gold MR. Risk stratification of ventricular arrhythmias in patients with systolic heart failure. Curr Opin Cardiol. 2010;25(3):268–75.

    Article  PubMed  Google Scholar 

  38. Knight BP, Goyal R, Pelosi F, Flemming M, Horwood L, Morady F, et al. Outcome of patients with nonischemic dilated cardiomyopathy and unexplained syncope treated with an implantable defibrillator. J Am Coll Cardiol. 1999;33(7):1964–70.

    Article  CAS  PubMed  Google Scholar 

  39. Fonarow GC, Feliciano Z, Boyle NG, Knight L, Woo MA, Moriguchi JD, et al. Improved survival in patients with nonischemic advanced heart failure and syncope treated with an implantable cardioverter-defibrillator. Am J Cardiol. 2000;85(8):981–5.

    Article  CAS  PubMed  Google Scholar 

  40. Fauchier L, Babuty D, Cosnay P, Poret P, Rouesnel P, Fauchier JP. Long-term prognostic value of time domain analysis of signal-averaged electrocardiography in idiopathic dilated cardiomyopathy. Am J Cardiol. 2000;85(5):618–23.

    Article  CAS  PubMed  Google Scholar 

  41. Goldberger JJ, Subacius H, Patel T, Cunnane R, Kadish AH. Sudden cardiac death risk stratification in patients with nonischemic dilated cardiomyopathy. J Am Coll Cardiol. 2014;63(18):1879–89.

    Article  PubMed  Google Scholar 

  42. Salerno-Uriarte JA, De Ferrari GM, Klersy C, Pedretti RF, Tritto M, Sallusti L, et al. Prognostic value of T-wave alternans in patients with heart failure due to nonischemic cardiomyopathy: results of the ALPHA study. J Am Coll Cardiol. 2007;50(19):1896–904.

    Article  PubMed  Google Scholar 

  43. Kelesidis I, Travin MI. Use of cardiac radionuclide imaging to identify patients at risk for arrhythmic sudden cardiac death. J Nucl Cardiol. 2012;19(1):142–52.

  44. Neilan TG, Coelho-Filho OR, Danik SB, Shah RV, Dodson JA, Verdini DJ, et al. CMR quantification of myocardial scar provides additive prognostic information in nonischemic cardiomyopathy. JACC Cardiovasc Imaging. 2013;6(9):944–54.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Gulati A, Jabbour A, Ismail TF, Guha K, Khwaja J, Raza S, et al. Association of fibrosis with mortality and sudden cardiac death in patients with nonischemic dilated cardiomyopathy. JAMA. 2013;309(9):896–908.

    Article  CAS  PubMed  Google Scholar 

  46. Perazzolo Marra M, De Lazzari M, Zorzi A, Migliore F, Zilio F, Calore C, et al. Impact of the presence and amount of myocardial fibrosis by cardiac magnetic resonance on arrhythmic outcome and sudden cardiac death in nonischemic dilated cardiomyopathy. Heart Rhythm. 2014;11(5):856–63.

    Article  PubMed  Google Scholar 

  47. Memon S, Ganga HV, Kluger J. Late gadolinium enhancement in patients with nonischemic dilated cardiomyopathy. Pacing Clin Electrophysiol. 2016;39(7):731–47.

    Article  PubMed  Google Scholar 

  48. Agostoni P, Corra U, Cattadori G, Veglia F, La Gioia R, Scardovi AB, et al. Metabolic exercise test data combined with cardiac and kidney indexes, the MECKI score: a multiparametric approach to heart failure prognosis. Int J Cardiol. 2013;167(6):2710–8.

    Article  PubMed  Google Scholar 

  49. Tung R, Zimetbaum P, Josephson ME. A critical appraisal of implantable cardioverter-defibrillator therapy for the prevention of sudden cardiac death. J Am Coll Cardiol. 2008;52(14):1111–21.

    Article  PubMed  Google Scholar 

  50. Poole JE, Johnson GW, Hellkamp AS, Anderson J, Callans DJ, Raitt MH, et al. Prognostic importance of defibrillator shocks in patients with heart failure. N Engl J Med. 2008;359(10):1009–17.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Author notes

  1. Jorge Romero, Rahul Chaudhary, and Jalaj Garg have contributed equally for the paper

Authors and Affiliations

  1. Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY, 10467, USA

    Jorge Romero, Florentino Lupercio, Andrea Natale & Luigi Di Biase

  2. Department of Medicine, Sinai Hospital of Baltimore, Johns Hopkins University, Baltimore, MD, USA

    Rahul Chaudhary

  3. Division of Cardiology, Lehigh Valley Health Network, 1250 S Cedar Crest Blvd, Allentown, PA, 18103, USA

    Jalaj Garg, Neeraj Shah, Talha Nazir & Babak Bozorgnia

  4. Queens Cardiac Care, Queens Village, New York, NY, USA

    Rahul Gupta

  5. Texas Cardiac Arrhythmia Institute at St. David’s Medical Center, Austin, TX, USA

    Andrea Natale & Luigi Di Biase

Authors
  1. Jorge Romero
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rahul Chaudhary
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jalaj Garg
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Florentino Lupercio
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Neeraj Shah
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Rahul Gupta
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Talha Nazir
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Babak Bozorgnia
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Andrea Natale
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Luigi Di Biase
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Jalaj Garg or Luigi Di Biase.

Ethics declarations

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Conflict of interest

The authors declare that they have no conflicts of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Romero, J., Chaudhary, R., Garg, J. et al. Role of implantable cardioverter defibrillator in non-ischemic cardiomyopathy: a systematic review and meta-analysis of prospective randomized clinical trials. J Interv Card Electrophysiol 49, 263–270 (2017). https://doi.org/10.1007/s10840-017-0260-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10840-017-0260-8

Keywords

Search

Navigation