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Published online: 2021-04-09
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An implantable cardioverter-defibrillator for primary prevention in non-ischemic cardiomyopathy: A systematic review and meta-analysis

Michał Wasiak, Mateusz Tajstra, Dariusz Kosior, Mariusz Gąsior
DOI: 10.5603/CJ.a2021.0041
·
Pubmed: 33843044

open access

Ahead of print
Original articles
Published online: 2021-04-09

Abstract

Background: Recent data regarding the comparison of implantable cardioverter-defibrillator (ICD) therapy and optimal medical treatment in patients with non-ischemic cardiomyopathy has indicated no mortality benefit as a result of ICD therapy. Although the recommendations for ICD implantation did not change, it is worth noting that these findings significantly affected the daily practice of ICD implantation in Europe. Methods: To assess the effect of ICD implantation in comparison to pharmacotherapy in the non-ischemic cardiomyopathy heart failure population through a systematic review and meta-analysis of the available carefully designed prospective randomized controlled trials. Only prospective randomized controlled trials comparing ICD implantation in primary prevention vs. optimal pharmacological therapy or placebo and reporting mortality results were included in the meta-analysis. The authors have chosen to include the following trials: CAT, AMIOVIRT, DEFINITE, and DANISH. Results: A meta-analysis of pooled hazard ratios (HR) from all trials conducted on a total of 1789 patients found that ICD therapy decreased all-cause mortality in comparison to optimal pharmacological treatment, with a HR of 0.48 (95% confidence interval [CI] 0.67–1.01); p = 0.06. The data from the AMIOVIRT, DANISH, and DEFINITE trials, with a total of 1677 participants, showed a significant reduction of sudden cardiac deaths as a result of ICD implantation, with a HR of 0.48 (95% CI 0.31–0.67); p < 0.001. Conclusions: In comparison with optimal medical treatment, ICD implantation in patients with heart failure improves the long-term prognosis in terms of sudden cardiac death, with a strong tendency towards all-cause mortality reduction.

Abstract

Background: Recent data regarding the comparison of implantable cardioverter-defibrillator (ICD) therapy and optimal medical treatment in patients with non-ischemic cardiomyopathy has indicated no mortality benefit as a result of ICD therapy. Although the recommendations for ICD implantation did not change, it is worth noting that these findings significantly affected the daily practice of ICD implantation in Europe. Methods: To assess the effect of ICD implantation in comparison to pharmacotherapy in the non-ischemic cardiomyopathy heart failure population through a systematic review and meta-analysis of the available carefully designed prospective randomized controlled trials. Only prospective randomized controlled trials comparing ICD implantation in primary prevention vs. optimal pharmacological therapy or placebo and reporting mortality results were included in the meta-analysis. The authors have chosen to include the following trials: CAT, AMIOVIRT, DEFINITE, and DANISH. Results: A meta-analysis of pooled hazard ratios (HR) from all trials conducted on a total of 1789 patients found that ICD therapy decreased all-cause mortality in comparison to optimal pharmacological treatment, with a HR of 0.48 (95% confidence interval [CI] 0.67–1.01); p = 0.06. The data from the AMIOVIRT, DANISH, and DEFINITE trials, with a total of 1677 participants, showed a significant reduction of sudden cardiac deaths as a result of ICD implantation, with a HR of 0.48 (95% CI 0.31–0.67); p < 0.001. Conclusions: In comparison with optimal medical treatment, ICD implantation in patients with heart failure improves the long-term prognosis in terms of sudden cardiac death, with a strong tendency towards all-cause mortality reduction.

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Keywords

implantable cardioverter-defibrillator, meta-analysis, non-ischaemic cardiomyopathy, systematic review

About this article
Title

An implantable cardioverter-defibrillator for primary prevention in non-ischemic cardiomyopathy: A systematic review and meta-analysis

Journal

Cardiology Journal

Issue

Ahead of print

Article type

Original Article

Published online

2021-04-09

DOI

10.5603/CJ.a2021.0041

Pubmed

33843044

Keywords

implantable cardioverter-defibrillator
meta-analysis
non-ischaemic cardiomyopathy
systematic review

Authors

Michał Wasiak
Mateusz Tajstra
Dariusz Kosior
Mariusz Gąsior

References (17)
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