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. 2010 May 20;33(5):254–260. doi: 10.1002/clc.20757

Prophylactic Implantation of Cardioverter Defibrillators in Idiopathic Nonischemic Cardiomyopathy for the Primary Prevention of Death: A Narrative Review

Cihan Cevik 1,✉, Kenneth Nugent 1, Alejandro Perez‐Verdia 2, R David Fish 1,3
PMCID: PMC6653039  PMID: 20513063

Abstract

Implantable cardioverter defibrillator (ICD) therapy reduces sudden cardiac death rates and reduces mortality in patients with ischemic heart disease and low ejection fractions. One‐third of the deaths in patients with nonischemic cardiomyopathy are sudden. However, the efficacy of ICDs in the primary prevention of death in these patients is less clear. The most common cause of mortality in patients treated with ICDs is heart failure progression. ICD shocks can cause direct myocardial injury, fibrosis, inflammation, and adverse psychological outcomes, and these changes may contribute to the ventricular dysfunction in patients who already have a significantly depressed ejection fraction. We have reviewed the published randomized controlled trials and meta‐analysis of prophylactic ICD therapy in the primary prevention of death in patients with nonischemic cardiomyopathy. The individual randomized controlled trials do not report a statistically significant reduction of mortality unless the ICD treatment is added to cardiac resynchronization therapy, but the meta‐analysis did show a significant mortality reduction and favored ICD therapy in these patients. Medical management of many study participants was suboptimal, at least based on current guidelines. The patients with non‐ischemic cardiomyopathy have good outcomes with medical therapy, and ICD therapy in this relatively low‐risk population needs better selection criteria. Copyright © 2010 Wiley Periodicals, Inc.

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References

  • 1. Dec GW, Fuster V. Idiopathic dilated cardiomyopathy. N Engl J Med 1994; 331: 1564–1575. [DOI] [PubMed] [Google Scholar]
  • 2. Zipes DP, Camm AJ, Borggrefe M, et al. ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death—executive summary: A report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death). Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Eur Heart J 2006; 27: 2099–2140. [DOI] [PubMed] [Google Scholar]
  • 3. Connolly SJ, Hallstrom AP, Cappato R, et al. Meta‐analysis of the implantable cardioverter defibrillator secondary prevention trials. AVID, CASH and CIDS studies. Antiarrhythmics vs Implantable Defibrillator study. Cardiac Arrest Study Hamburg. Canadian Implantable Defibrillator Study. Eur Heart J 2000; 21: 2071–2078. [DOI] [PubMed] [Google Scholar]
  • 4. Curtis JP, Luebbert JJ, Wang Y, et al. Association of physician certification and outcomes among patients receiving an implantable cardioverter‐defibrillator. JAMA 2009; 301: 1661–1670. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 5. Bn̈sch D, Antz M, Boczor S, et al. Primary prevention of sudden cardiac death in idiopathic dilated cardiomyopathy: the Cardiomyopathy Trial (CAT). Circulation 2002; 105: 1453–1458. [DOI] [PubMed] [Google Scholar]
  • 6. Cevik C, Perez‐Verdia A, Nugent K. Implantable cardioverter defibrillators and their role in heart failure progression. Europace 2009; 11: 710–715. [DOI] [PubMed] [Google Scholar]
  • 7. Strickberger SA, Hummel JD, Bartlett TG, et al; for AMIOVIRT Investigators . 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. [DOI] [PubMed] [Google Scholar]
  • 8. Singh SN, Fletcher RD, Fisher SG, et al. Amiodarone in patients with congestive heart failure and asymptomatic ventricular arrhythmia. Survival Trial of Antiarrhythmic Therapy in Congestive Heart Failure. N Engl J Med 1995; 333: 77–82. [DOI] [PubMed] [Google Scholar]
  • 9. Kadish A, Dyer A, Daubert JP, et al; Defibrillators in Non‐Ischemic Cardiomyopathy Treatment Evaluation (DEFINITE) Investigators. Prophylactic defibrillator implantation in patients with nonischemic dilated cardiomyopathy. N Engl J Med 2004; 350: 2151–2158. [DOI] [PubMed] [Google Scholar]
  • 10. Bardy GH, Lee KL, Mark DB, et al; Sudden Cardiac Death in Heart Failure Trial (SCD‐HeFT) Investigators. Amiodarone or an implantable cardioverter‐defibrillator for congestive heart failure [published correction appears in N Engl J Med. 2005;352:2146]. N Engl J Med 2005; 352: 225–237. [DOI] [PubMed] [Google Scholar]
  • 11. Russo AM, Poole JE, Mark DB, et al. Primary prevention with defibrillator therapy in women: results from the Sudden Cardiac Death in Heart Failure Trial. J Cardiovasc Electrophysiol 2008; 19: 720–724. [DOI] [PubMed] [Google Scholar]
  • 12. Bristow MR, Saxon LA, Boehmer J, et al; Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) Investigators. Cardiac‐resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med 2004; 350: 2140–2150. [DOI] [PubMed] [Google Scholar]
  • 13. 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: 2874–2879. [DOI] [PubMed] [Google Scholar]
  • 14. Epstein AE, DiMarco JP, Ellenbogen KA, et al. ACC/AHA/HRS 2008 Guidelines for Device‐Based Therapy of Cardiac Rhythm Abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices) developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons [published corrections appear in J Am Coll Cardiol 2009;53:147 and 2009;53:1473]. J Am Coll Cardiol 2008; 51: e1–e62. [DOI] [PubMed] [Google Scholar]
  • 15. Mark DB, Nelson CL, Anstrom KJ, et al; SCD‐HeFT Investigators. Cost‐effectiveness of defibrillator therapy or amiodarone in chronic stable heart failure: results from the Sudden Cardiac Death in Heart Failure Trial (SCD‐HeFT). Circulation 2006; 114: 135–142. [DOI] [PubMed] [Google Scholar]
  • 16. Sanders GD, Hlatky MA, Owens DK. Cost‐effectiveness of implantable cardioverter‐defibrillators. N Engl J Med 2005; 353: 1471–1480. [DOI] [PubMed] [Google Scholar]
  • 17. Grimm W, Christ M, Bach J, et al. Noninvasive arrhythmia risk stratification in idiopathic dilated cardiomyopathy: results of the Marburg Cardiomyopathy Study. Circulation 2003; 108: 2883–2891. [DOI] [PubMed] [Google Scholar]
  • 18. Bogun FM, Desjardins B, Good E, et al. Delayed‐enhanced magnetic resonance imaging in nonischemic cardiomyopathy: utility for identifying the ventricular arrhythmia substrate. J Am Coll Cardiol 2009; 53: 1138–1145. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 19. Jessup M, Abraham WT, Casey DE, et al. 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation. Circulation 2009; 119: 1977–2016. [DOI] [PubMed] [Google Scholar]
  • 20. Poole JE, Johnson GW, Hellkamp AS, et al. Prognostic importance of defibrillator shocks in patients with heart failure. N Engl J Med 2008; 359: 1009–1017. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 21. Saxon LA, Bristow MR, Boehmer J, et al. Predictors of sudden cardiac death and appropriate shock in the Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) Trial. Circulation 2006; 114: 2766–2772. [DOI] [PubMed] [Google Scholar]
  • 22. 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: 1111–1121. [DOI] [PubMed] [Google Scholar]
  • 23. Goldenberg I, Moss AJ, Hall WJ, et al; Multicenter Automatic Defibrillator Implantation Trial (MADIT) II Investigators. Causes and consequences of heart failure after prophylactic implantation of a defibrillator in the multicenter automatic defibrillator implantation trial II. Circulation 2006; 113: 2810–2817. [DOI] [PubMed] [Google Scholar]

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