Effectiveness of prophylactic implantation of cardioverter-defibrillators without cardiac resynchronization therapy in patients with ischaemic or non-ischaemic heart disease: a systematic review and meta-analysis.
OBJECTIVE
Much controversy exists concerning the efficacy of primary prophylactic implantable cardioverter-defibrillators (ICDs) in patients with low ejection fraction due to coronary artery disease (CAD) or dilated cardiomyopathy (DCM). This is also related to the bias created by function improving interventions added to ICD therapy, e.g. resynchronization therapy. The aim was to investigate the efficacy of ICD-only therapy in primary prevention in patients with CAD or DCM.


RESULTS
Public domain databases, MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials, were searched from 1980 to 2009 for randomized clinical trials of ICD vs. conventional therapy. Two investigators independently abstracted the data. Pooled estimates were calculated using both fixed-effects and random-effects models. Eight trials were included in the final analysis (5343 patients). Implantable cardioverter-defibrillators significantly reduced the arrhythmic mortality [relative risk (RR): 0.40; 95% confidence interval (CI): 0.27-0.67] and all-cause mortality (RR: 0.73; 95% CI: 0.64-0.82). Regardless of aetiology of heart disease, ICD benefit was similar for CAD (RR: 0.67; 95% CI: 0.51-0.88) vs. DCM (RR: 0.74; 95% CI: 0.59-0.93).


CONCLUSIONS
The results of this meta-analysis provide strong evidence for the beneficial effect of ICD-only therapy on the survival of patients with ischaemic or non-ischaemic heart disease, with a left ventricular ejection fraction ≤ 35%, if they are 40 days from myocardial infarction and ≥ 3 months from a coronary revascularization procedure.
Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands.
Dominic A M J
DA
Theuns
Tim
T
Smith
Myriam G M
MG
Hunink
Gust H
GH
Bardy
Luc
L
Jordaens
D000368:Aged; D001145:Arrhythmias, Cardiac / Q000401:mortality / Q000517:prevention & control; D058406:Cardiac Resynchronization Therapy; D002311:Cardiomyopathy, Dilated / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D003324:Coronary Artery Disease / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D016757:Death, Sudden, Cardiac / Q000517:prevention & control; D017147:Defibrillators, Implantable; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000517:prevention & control; D009204:Myocardial Revascularization; D011322:Primary Prevention; D019919:Prosthesis Implantation; D016032:Randomized Controlled Trials as Topic; D013318:Stroke Volume