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Background: The recently published DANISH trial calls into question the efficacy of prophylactic Implantable Cardioverter Defibrillator (ICD) implantation in patients with reduced Ejection Fraction (EF) due to Nonischemic Cardiomyopathy (NICMP).
Methods: We conducted meta-analysis to put all available evidence in perspective on efficacy and safety of ICDs in patients with reduced EF due to NICMP. PubMed, EMBASE, and Cochrane Central Register of Controlled Trials were searched for randomized controlled trials of prophylactic ICD vs. conventional therapy in patients with reduced EF due to NICMP. Pooled estimates were calculated using Der-Simonian and Laird random-effects models. All-cause mortality was the primary end point.
Results: Six primary prevention trials comprising of 2, 410 patients were included. Prophylactic ICD implantation in patients with reduced EF due to NICMP resulted in 21% relative risk reduction of All-cause mortality [RR (Relative Risk) 0.79; 95% confidence intervals (CI): 0.68-0.91] (Fig. 1). Prior to publication of the DANISH trial, 31% RR reduction had been reported. No single trial had disproportionate influence on pooled effect size. Overall heterogeneity was low (I2=23.4%).
Conclusions: Available evidence from randomized data would still support ICD implantation in patients with reduced EF due to NICMP. However, the recent trial data suggests the benefit of ICD may have lessened with contemporary heart failure therapy in NICMP population.
Poster Hall, Hall C
Friday, March 17, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Atrial Fibrillation and VT: Unique Populations and Solutions
Abstract Category: 8. Arrhythmias and Clinical EP: Supraventricular/Ventricular Arrhythmias
Presentation Number: 1151-104
- 2017 American College of Cardiology Foundation