title: The prediction of ICD therapy in multicenter automatic defibrillator implantation trial (MADIT) II like patients: a retrospective analysis.
abstract: OBJECTIVE
  MADIT II like patients have not been compared to patients without an electrophysiological study, patients in whom ventricular tachycardia or fibrillation were induced in an electrophysiological study (EPS) and patients without an inducibility in EPS in one study.
  
  
  BACKGROUND
  The multicenter automatic defibrillator implantation trial (MADIT) II showed a benefit of ICD implantation in patients with ischemic heart disease.
  
  
  METHODS
  We performed a retrospective analysis in 93 patients with an ischemic heart disease and an ejection fraction </=30% who had an ICD implanted with a follow-up at least an 18 months. Patients were divided into 3 groups according to the primary indication for ICD implantation: without EPS (group I), patients in whom ventricular tachycardia or fibrillation were inducible in EPS (group II) or patients without an inducibility in EPS (group III).
  
  
  RESULTS
  During the mean follow-up of 32.9 +/- 16.1 months 289 appropriate ICD therapies and 10 deaths occurred. The incidence of appropriate ICD therapies did not differ significantly between the groups (group I 40%, group II 54% and group III 48% of patients). We found in group II a higher risk of appropriate ICD therapies with occurrence of a specific constellation of EPS values. These patients showed a 15-fold risk (P = 0.005) of an appropriate ICD therapy. Furthermore a brain natriuretic peptide value of 265 pg/ml also predicted an appropriate ICD therapy with a 3.5-fold risk (P = 0.017).
  
  
  CONCLUSIONS
  In the present retrospective study the results of MADIT II were affirmed in the case of incidence of ventricular arrhythmias in patients with an EF < 30% and coronary heart disease. The prediction of an appropriate ICD therapy with EPS was only achieved in patients with inducibility in the EPS.
authors: Department of Cardiology, West-German Heart Centre, University of Duisburg-Essen, Germany. marco.budeus@uk-essen.de
authors: Marco
authors: M
authors: Budeus
authors: Nico
authors: N
authors: Reinsch
authors: Heinrich
authors: H
authors: Wieneke
authors: Stefan
authors: S
authors: Sack
authors: Raimund
authors: R
authors: Erbel