Author + information
- Rahman Shah,
- Mark Heckle,
- Abdul Rashid,
- David Flatt,
- Teresa Slomka,
- Beatrix Ramos Bondy and
- Mohamed Morsy
Background: Current guidelines recommend prophylactic implantation of an implantable cardioverter-defibrillator (ICD) for patients with heart failure and reduced left ventricular ejection fraction. However, the evidence for a benefit of prophylactic ICD in patients with non-ischemic cardiomyopathy is less robust. Indeed, a recently reported clinical trial (DANIHS) has challenged these recommendations by suggesting that ICD therapy does not improve survival in patients with non-ischemic heart failure who receive evidence-based optimal medical therapy (OMT). Therefore, we conducted an updated comprehensive meta-analysis of available randomized controlled trials (RCTs), with the largest sample size ever reported in this subject.
Methods: Relevant studies were included in random-effects models to determine pooled risk ratios (RRs). As CRT alone has benefit on survival, so we excluded trials with CRT-D (i.e. COMPANION) to avoid potential bias on survival (favoring the ICD arm) from CRT. The primary endpoint was all-cause mortality
Results: We included data from 5 trials involving 2573 patients. Prophylactic ICDs decreased all-cause mortality (RR 0.83; 95% CI, 0.71–0.97; P = 0.021 compared to OMT alone. No statistical evidence of heterogeneity was found (I2 = 0%; P = 0.727).
Conclusions: This updated meta-analysis of RCTs (including DANISH trial) showed that in patients with non-ischemic cardiomyopathy, prophylactic ICD therapy seem to decreases all-cause mortality compared to OMT alone.
Moderated Poster Contributions
Arrhythmias and Clinical EP Moderated Poster Theater, Poster Hall, Hall C
Friday, March 17, 2017, 4:15 p.m.-4:25 p.m.
Session Title: Ventricular Arrhythmias and Sudden Death Prevention
Abstract Category: 5. Arrhythmias and Clinical EP: Devices
Presentation Number: 1174M-07
- 2017 American College of Cardiology Foundation