title: Prophylactic defibrillator implantation in patients with nonischemic dilated cardiomyopathy.
abstract: BACKGROUND
  Patients with nonischemic dilated cardiomyopathy are at substantial risk for sudden death from cardiac causes. However, the value of prophylactic implantation of an implantable cardioverter-defibrillator (ICD) to prevent sudden death in such patients is unknown.
  
  
  METHODS
  We enrolled 458 patients with nonischemic dilated cardiomyopathy, a left ventricular ejection fraction of less than 36 percent, and premature ventricular complexes or nonsustained ventricular tachycardia. A total of 229 patients were randomly assigned to receive standard medical therapy, and 229 to receive standard medical therapy plus a single-chamber ICD.
  
  
  RESULTS
  Patients were followed for a mean (+/-SD) of 29.0+/-14.4 months. The mean left ventricular ejection fraction was 21 percent. The vast majority of patients were treated with angiotensin-converting-enzyme (ACE) inhibitors (86 percent) and beta-blockers (85 percent). There were 68 deaths: 28 in the ICD group, as compared with 40 in the standard-therapy group (hazard ratio, 0.65; 95 percent confidence interval, 0.40 to 1.06; P=0.08). The mortality rate at two years was 14.1 percent in the standard-therapy group (annual mortality rate, 7 percent) and 7.9 percent in the ICD group. There were 17 sudden deaths from arrhythmia: 3 in the ICD group, as compared with 14 in the standard-therapy group (hazard ratio, 0.20; 95 percent confidence interval, 0.06 to 0.71; P=0.006).
  
  
  CONCLUSIONS
  In patients with severe, nonischemic dilated cardiomyopathy who were treated with ACE inhibitors and beta-blockers, the implantation of a cardioverter-defibrillator significantly reduced the risk of sudden death from arrhythmia and was associated with a nonsignificant reduction in the risk of death from any cause.
authors.affiliation: Clinical Cardiology Trials Office, Division of Cardiology, Department of Medicine, Northwestern University Medical School, Chicago, USA. a-kadish@northwestern.edu
authors.forename: Alan
authors.initials: A
authors.lastname: Kadish
authors.forename: Alan
authors.initials: A
authors.lastname: Dyer
authors.forename: James P
authors.initials: JP
authors.lastname: Daubert
authors.forename: Rebecca
authors.initials: R
authors.lastname: Quigg
authors.forename: N A Mark
authors.initials: NA
authors.lastname: Estes
authors.forename: Kelley P
authors.initials: KP
authors.lastname: Anderson
authors.forename: Hugh
authors.initials: H
authors.lastname: Calkins
authors.forename: David
authors.initials: D
authors.lastname: Hoch
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Goldberger
authors.forename: Alaa
authors.initials: A
authors.lastname: Shalaby
authors.forename: William E
authors.initials: WE
authors.lastname: Sanders
authors.forename: Andi
authors.initials: A
authors.lastname: Schaechter
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Levine
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D001145:Arrhythmias, Cardiac / Q000150:complications / Q000401:mortality; D002311:Cardiomyopathy, Dilated / Q000150:complications / Q000188:drug therapy / Q000401:mortality / Q000628:therapy*; D003131:Combined Modality Therapy; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000517:prevention & control; D017147:Defibrillators, Implantable; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000628:therapy
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors