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(Circulation. 2000;102:748.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
From St Georg Hospital, Hamburg, Germany.
Correspondence to Karl-Heinz Kuck, MD, AK St Georg, Lohmühlenstrasse 5, 20099 Hamburg, Germany. E-mail kuck{at}uke.uni-hamburg.de
| Abstract |
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Methods and ResultsFrom 1987, eligible patients were randomized to an ICD, amiodarone, propafenone, or metoprolol (ICD versus antiarrhythmic agents randomization ratio 1:3). Assignment to propafenone was discontinued in March 1992, after an interim analysis conducted in 58 patients showed a 61% higher all-cause mortality rate than in 61 ICD patients during a follow-up of 11.3 months. The study continued to recruit 288 patients in the remaining 3 study groups; of these, 99 were assigned to ICDs, 92 to amiodarone, and 97 to metoprolol. The primary end point was all-cause mortality. The study was terminated in March 1998, when all patients had concluded a minimum 2-year follow-up. Over a mean follow-up of 57±34 months, the crude death rates were 36.4% (95% CI 26.9% to 46.6%) in the ICD and 44.4% (95% CI 37.2% to 51.8%) in the amiodarone/metoprolol arm. Overall survival was higher, though not significantly, in patients assigned to ICD than in those assigned to drug therapy (1-sided P=0.081, hazard ratio 0.766, [97.5% CI upper bound 1.112]). In ICD patients, the percent reductions in all-cause mortality were 41.9%, 39.3%, 28.4%, 27.7%, 22.8%, 11.4%, 9.1%, 10.6%, and 24.7% at years 1 to 9 of follow-up.
ConclusionsDuring long-term follow-up of cardiac arrest survivors, therapy with an ICD is associated with a 23% (nonsignificant) reduction of all-cause mortality rates when compared with treatment with amiodarone/metoprolol. The benefit of ICD therapy is more evident during the first 5 years after the index event.
Key Words: heart arrest defibrillation cardioversion antiarrhythmia agents resuscitation
| Introduction |
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75% of cases, death is the result of
recurrent cardiac arrest, with a 2-year incidence between 20% and
45%1 2 3 4 ; nonarrhythmic deaths account for the remaining
fatalities. Several recent studies have provided evidence that class I antiarrhythmic drugs are less effective than class III drugs in patients with ventricular arrhythmias,5 6 most likely because of proarrhythmic effects.7 8 Since their introduction in 1980,9 numerous reports have shown that implantable cardioverter-defibrillators (ICDs) reduce sudden cardiac death10 11 12 13 14 15 16 17 ; more recently, randomized trials have shown that ICDs reduce all-cause mortality rates compared with amiodarone or no antiarrhythmic drugs in the therapeutic18 or prophylactic treatment19 of high-risk patients, respectively.
In 1987, when ICDs were still considered investigational tools by most clinicians and 3 years before other randomized ICD trials began, the Cardiac Arrest Study Hamburg (CASH) was initiated, with the aim of investigating, in patients resuscitated from cardiac arrest, the impact on overall survival of initial therapy with an ICD as compared with that with 3 antiarrhythmic drugs: amiodarone, metoprolol, or propafenone. Assignment to propafenone was discontinued on the request of the Safety Monitoring Board in March 1992, after an interim analysis conducted on 58 patients showed a 61% higher all-cause mortality rate than in 61 ICD patients during a follow-up of 11.3 months.20 The study continued to enroll and assign patients to amiodarone, metoprolol, and ICD. This article reports the final results of CASH.
| Methods |
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Eligible patients were randomized to ICD or drug treatment. In the drug arm, 3 antiarrhythmic agents were tested: amiodarone, metoprolol, and propafenone. The ratio of randomization assignment between the ICD and the drug arm was 1:3 (ie, ICD/amiodarone/metoprolol/propafenone=1:1:1:1)
The primary end point was all-cause mortality. Secondary end points were sudden death and recurrence of cardiac arrest at 2-year follow-up. Sudden death was defined as death within 1 hour after the onset of symptoms or an unwitnessed death; cardiac arrest was defined as sudden circulatory collapse requiring resuscitation.
Diagnosis
The patients history was assessed and a physical examination
performed. If all diagnostic tests-including exercise
testing, thallium scintigraphy, coronary
angiography, ergonovine test, right ventriculography, right
ventricular biopsy and MRI-were negative, the diagnosis of
no organic heart disease was made. Programmed electrical stimulation
(PES) was performed with up to 3 extrastimuli from 2 right
ventricular sites during sinus rhythm and basic drive
pacing (8 beats) at cycle lengths of 640, 510, and 440 ms.
Therapy
Amiodarone was administered orally at a loading dose of
1000 mg/d for 7 days, followed by a maintenance dose of 200 to
600 mg/d. Metoprolol was initiated at a dose of 12.5 to 25.0 mg/d and
increased within 7 to 14 days to a maximum of 200 mg/d, if tolerated.
All patients assigned to the antiarrhythmic drug arm underwent repeat
predischarge 24-hour Holter monitoring, PES, and exercise testing:
Response to serial drug testing did not affect the therapy assignment
obtained by randomization.
Cardiac Pacemakers, Inc, devices were used throughout the study (Ventak AID, Ventak AICD, Ventak P, Ventak PRx, Ventak Mini) in patients assigned to ICDs. All patients assigned to ICD therapy were given an epicardial device until June 1991 and an endocardial device from July 1991. In patients requiring surgical revascularization, implantation of epicardial and endocardial devices was performed at the time of or 7 to 15 (mean 10±3) days after coronary artery bypass grafting, respectively. Predischarge defibrillation testing was performed to verify appropriate sensing and defibrillation functions. Rate was the only criterion selected for detection of a sustained ventricular arrhythmia.
Recruitment and Follow-Up
The investigational review board of each institution approved
the study. Recruitment of patients began in March 1987. Patients were
evaluated at months 2, 4, 6, 12, 18, and 24 and every 12 months
thereafter until termination of the study, as well as at time of
events. The last patient was enrolled in March 1996. The study was
terminated in March 1998, when all patients had concluded a minimum
follow-up of 2 years.
Statistical Analysis
We hypothesized that therapy with ICDs would in the worst case
be as effective as with antiarrhythmic drugs.2 3 4 21 22 23
Accordingly, the
-level for comparison of survival distributions
between the ICD and the antiarrhythmic drug arms was based on a 1-sided
test, and the significance test was set at a 0.025 level.
Analysis was performed according to the intention-to-treat
principle. The design had a power of 80% to detect a difference of 19
percentage points in 2-year mortality rates between the 2 arms (50%
expected mortality rate in patients assigned to the drug arm, 31% in
the ICD arm). A sample size of 390 patients, with a 1:3 ratio of
randomization between ICD and drug arms, was estimated to be
sufficient.
At the time of planning of the study, no precautions were stated concerning multiple group comparisons and multiple looks into the data. Because of the unexpectedly long recruitment time and subsequent data in the literature showing life-threatening proarrhythmic effects by class Ic antiarrhythmic agents,5 7 8 in March 1992 the Safety Monitoring Board required to perform an interim analysis to prevent further patients being assigned to a possibly harmful treatment. Consequently, the overall significance level for comparisons of the ICD group with each of the 3 drug groups (ie, ICD versus propafenone, ICD versus amiodarone, and ICD versus metoprolol) was adjusted according to Bonferroni inequality.20
Time to occurrence of clinical events (ie, total mortality, sudden death, and cardiac arrest recurrence) in the 2 arms (ICD versus antiarrhythmic drugs) was analyzed by means of the Kaplan-Meier method.24 The cumulative survival functions had been compared by means of the log-rank (Mantel-Cox) test.25 For calculation of hazard ratios, the Cox proportional regression model was used with the patients grouped as randomized (intention-to-treat).26
| Results |
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The mean (±1 SD) left ventricular ejection fraction was 0.46±0.19 in the ICD arm and 0.46±0.17 in the drug arm (amiodarone, 0.44±0.17; metoprolol, 0.47±0.17). The majority of patients were in New York Heart Association functional class II: 59% in the ICD arm and 56% in the drug arm (57% in the amiodarone group and 55% in the metoprolol group). During hospitalization after the index event, 19% of patients in the ICD arm and 21% in the drug arm underwent coronary revascularization.
Therapy
All patients randomized to ICD received the assigned therapy. An
epicardial system was used in 55 patients and an endocardial system in
44 patients. Two patients assigned to amiodarone refused to
start drug therapy. The daily maintenance doses of
amiodarone and metoprolol throughout the study were 225±75 mg
and 85±73 mg, respectively. Table 2
lists the concurrent therapies at discharge.
|
Primary Analysis
Over a mean follow-up of 57±34 months, the crude death rates were
36.4% (CI 26.9% to 46.6%) in the ICD and 44.4% (CI 37.2% to
51.8%) in the antiarrhythmic arm. Figure 1
illustrates survival (life-table)
distributions in the 2 study arms. Overall survival was higher, though
not significantly, in patients assigned to ICD than in those assigned
to drug therapy (1-sided P [unadjusted for multiple looks]
=0.081, hazard ratio 0.766 [97.5% CI upper bound 1.112]). These
survival figures represent a decrease in death rates
(Kaplan-Maier estimates) of 41.9%, 39.3%, 28.4%, 27.7%, 22.8%,
11.4%, 9.1%, 10.6%, and 24.7% at years 1 to 9 of follow-up,
respectively. Figure 2
illustrates
survival (life-table) distributions in the 2 drug groups. The crude
death rates in the amiodarone group were at 43.5% (CI 33.2%
to 54.2%), similar to those at 45.4% (CI 35.2% to 55.8%) in the
metoprolol group (P=0.845).
|
|
Secondary Analyses
The crude sudden death rates were 13.0% (CI 7.9% to 19.6%) in
the ICD arm and 33.0% (CI 27.2% to 41.8%) in the antiarrhythmic arm.
Figure 3
illustrates long-term survival
distributions in the 2 study arms. Survival free of sudden death was
significantly higher in patients assigned to ICD than in those assigned
to drug therapy (1-sided P=0.005, hazard ratio 0.423
[97.5% CI upper bound 0.721]). These survival figures
represent a decrease in sudden death rates of 81.8%, 86.7%,
76.2%, 78.3%, 80.8%, 73.1%, 64.3%, 56.7%, and 60.6% at years 1
to 9 of follow-up, respectively. Figure 4
illustrates the survival distributions free of sudden death in the 2
drug groups. The crude sudden death rates in the amiodarone
group were at 29.5% (CI 19.4% to 40.8%), similar to those at 35.1%
(CI 25.2% to 48.8%) in the metoprolol group (P=0.467).
|
|
The crude rates of nonfatal cardiac arrest were 11.1% (CI 6.9% to 16.5%) in the ICD and 19.5% (CI 12.2% to 25.6%) in the antiarrhythmic arm. Survival free of cardiac arrest was higher, though not significantly, in patients assigned to ICD than in those assigned to drug therapy (1-sided P=0.072, hazard ratio 0.481 [97.5% CI upper bound 1.338]). The decrease in cardiac arrest rates of patients assigned to ICD therapy was 61.8%, 65.5%, 59.2%, 53.8%, 50.4%, 58.6%, 49.2%, 52.8%, and 42.1% at years 1 to 9 of follow-up, respectively.
Among patients with inducible sustained ventricular arrhythmia at baseline PES, death rates were 49.4% (CI 42.9% to 57.2%) in 46 assigned to ICD and 52.6% (CI 47.9% to 59.4%) in 88 assigned to drug treatment (P=0.290). Of patients noninducible at baseline PES, death rates were 35.7% (CI 26.4% to 45.7%) in 51 assigned to ICD and 49.3% (CI 42.9% to 56.2%) in 100 assigned to drug treatment (P=0.170).
Over a mean follow-up of 37±26 months, a similar outcome was observed in 55 patients receiving an epicardial ICD and in 44 receiving an endocardial ICD (P=0.189).
Six (6.1%) patients in the ICD arm and 11 (5.8%) in the drug arm crossed over or added the other therapy by 24 months. Three (3.0%) patients assigned to ICD and none of those assigned to amiodarone received ß-blockers during follow-up.
There were no significant differences concerning the hazard ratios for
death from any cause in subgroups defined according to left
ventricular ejection fraction, NYHA class, and presence of
organic heart disease (Table 3
).
However, a trend toward a higher benefit from ICD therapy was observed
for subgroups with lower ejection fraction and higher NYHA functional
class.
|
Complications of Therapy
Among patients assigned to the amiodarone limb, no
evidence of drug-related pulmonary toxicity was found, whereas
hyperthyroidism was observed during follow-up in 3 (3.3%) of the
patients. Drug discontinuation was required in 9 (9.8%) patients
assigned to amiodarone and 10 (10.3%) to metoprolol.
Five (5.1%) patients, of whom 3 (5.4%) having received an epicardial and 2 (4.5%) an endocardial ICD, died perioperatively. Within the same time frame, 2 (1.1%) patients in the antiarrhythmic drug arm (amiodarone, 2 patients; metoprolol, 0 patients) died (P versus ICD arm=0.029). Other complications included infection in 3 patients (requiring explantation in 2), hematoma or seroma in 6 patients, pericardial effusion in 1 patient, pleural effusion in 3 patients, and pneumothorax in 1 patient. Dislodgment or migration of system leads occurred in 3 patients and device dysfunction in 5 patients. Overall, the complication rate in this arm during follow-up was 23.0%, including an explantation rate of 2.1%.
| Discussion |
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Although ICDs have undisputedly proven effective to reduce sudden death,10 11 12 13 14 15 16 17 the debate has continued about whether this effect would translate into a reduction of total mortality rates and if so, to what extent.27 28 29 To appropriately address this issue, randomized controlled trials have been demanded that prospectively compare ICD with the best antiarrhythmic drug therapy in categories of patients at risk.27 28 29 30 31 Recent trials conducted with the use of these methods have produced conflicting results. The benefit of ICD therapy, either used prophylactically or in response to ventricular arrhythmias, could be demonstrated in the Multicenter Automatic Defibrillator Implantation Trial (MADIT)19 and the Antiarrhythmic Versus Implantable Defibrillators (AVID) trial.18 In the former study, ICDs were compared with "conventional" therapy (mostly amiodarone) in patients after myocardial infarction with low left ventricular ejection fraction, spontaneous nonsustained ventricular tachycardia, and inducible nonsuppressible sustained ventricular arrhythmias. In AVID, they were compared with empiric amiodarone (97%) or sotalol (3%) in patients with near-fatal ventricular fibrillation (45%) or syncopal or hemodynamically nontolerated ventricular tachycardia (55%). Therapy with an ICD resulted in a 54% 2-year reduction of all-cause mortality in MADIT and 27% 2-year reduction of all-cause mortality in AVID. In another study, the CABG Patch trial,32 no benefit was shown if prophylactic ICDs were implanted at the time of surgical revascularization in patients with low left ventricular ejection fraction and an abnormal signal-averaged ECG. The different results obtained with these randomized controlled trials outline the necessity to identify patient categories at higher risk of sudden death that might most benefit from an ICD.
In CASH, the ICD and drug arms were well balanced with respect to
patient baseline clinical characteristics and initial treatment of
ischemia. The mean left ventricular ejection
fraction did not differ in the 2 arms, nor did the distribution of NYHA
functional class, with
50% of patients being in class II. Compared
with AVID,18 the higher mean value of ejection fraction
observed in this study probably reflects a larger population of
patients without organic heart disease in CASH.
In patients assigned to ICDs, the reduction of all-cause mortality was evident throughout the study duration. Reduction of all-cause mortality in ICD patients was related to the large effect of this therapy in the prevention of sudden death. When analyzed during a long-term follow-up, response to baseline PES did not appear to discriminate between patients at higher and patients at lower benefit from ICD.
In CASH, the 4% perioperative mortality rate observed in the first 15 patients receiving an endocardial device does not reflect current trends33 and might have contributed to an underestimation of ICD benefit in this trial.
Mortality rates in the amiodarone and metoprolol groups contributed in a similar number to the overall mortality in the drug arm. This finding is not completely unexpected. In fact, previous studies in patients after myocardial infarction have shown that among all antiarrhythmic agents (including amiodarone), ß-blockers are the most effective treatment to reduce all-cause mortality rates during follow-up and that part of their effectiveness is related to a reduction in sudden cardiac death.34 Sudden death accounted for a similar proportion of all deaths in both groups. These findings reflect a substantially similar impact of the 2 drugs in the clinical outcome of cardiac arrest survivors.
Rates of crossover in the ICD (6%) and in the drug arm (6%) were low. Most crossovers occurred because of arrhythmia recurrence rather than because of intolerance to the drug or device. In patients assigned to ICD therapy, antiarrhythmic drugs were added to eliminate inappropriate discharges associated with supraventricular arrhythmias triggering defibrillation. The discontinuation rate of randomly assigned treatments during follow-up was low (ICD arm, 2.1%; drug arm, 10.0%).
Limitations of the Study
In CASH, the long recruitment time exposed the study to
complexities driven by rapid changes in ICD and conventional therapy
and by accumulation of new knowledge. Among responsible causes were the
small number of participating centers and their reluctance to enroll
patients for potential ICD therapy in the early phase and to deny such
therapy in the late phase of the study. Also, the 0.46 mean ejection
fraction reported in the whole cohort suggests a disproportional
representation of relatively healthy patients in CASH, as
compared with AVID.18 On the basis of these observations,
we cannot exclude a selection bias that if present, might have
influenced the outcome of CASH and possibly led to underestimation of
the benefit of ICD therapy. In fact, although collected in more
heterogeneous patient categories over a markedly shorter
follow-up than in CASH, data from AVID suggest that patients who appear
to most benefit from ICD treatment are those with a low (ie, <35%)
rather than those with a relatively well-preserved left
ventricular ejection fraction.18
The 19.6% 2-year all-cause mortality rate observed in the amiodarone and metoprolol groups was less than half the mortality rate used to calculate the trial sample size, thus rendering CASH underpowered to test the working hypothesis.
Conclusions
In the present study, a 23% (nonsignificant) reduction in
all-cause mortality rate was found in patients receiving ICD therapy
compared with amiodarone/metoprolol over a long-term follow-up.
The reduction was much larger, 61%, for sudden cardiac death. No
differences were found in all-cause mortality and sudden death rates
between patients assigned to amiodarone and those assigned to
metoprolol.
| Acknowledgments |
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| Appendix 1 |
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Received November 1, 1999; revision received March 4, 2000; accepted March 10, 2000.
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M. M. Gulizia, L. Piraino, M. Scherillo, C. Puntrello, C. Vasco, M. C. Scianaro, F. Mascia, O. Pensabene, S. Giglia, G. Chiaranda, et al. A Randomized Study to Compare Ramp Versus Burst Antitachycardia Pacing Therapies to Treat Fast Ventricular Tachyarrhythmias in Patients With Implantable Cardioverter Defibrillators: The PITAGORA ICD Trial Circ Arrhythm Electrophysiol, April 1, 2009; 2(2): 146 - 153. [Abstract] [Full Text] [PDF] |
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A. Proclemer, M. Ghidina, D. Gregori, D. Facchin, L. Rebellato, P. Fioretti, and M. Brignole Impact of the main implantable cardioverter-defibrillator trials in clinical practice: data from the Italian ICD Registry for the years 2005-07 Europace, April 1, 2009; 11(4): 465 - 475. [Abstract] [Full Text] [PDF] |
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B. A. Koplan and W. G. Stevenson Ventricular Tachycardia and Sudden Cardiac Death Mayo Clin. Proc., March 1, 2009; 84(3): 289 - 297. [Abstract] [Full Text] [PDF] |
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C. A. Muratore, L. A. Batista Sa, P. A. Chiale, R. Eloy, M. C. Tentori, J. Escudero, A. M. C. Lima, L. E. Medina, R. Garillo, and J. Maloney Implantable cardioverter defibrillators and Chagas' disease: results of the ICD Registry Latin America Europace, February 1, 2009; 11(2): 164 - 168. [Abstract] [Full Text] [PDF] |
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R J Lewin, S Coulton, D J Frizelle, G Kaye, and H Cox A brief cognitive behavioural preimplantation and rehabilitation programme for patients receiving an implantable cardioverter-defibrillator improves physical health and reduces psychological morbidity and unplanned readmissions Heart, January 1, 2009; 95(1): 63 - 69. [Abstract] [Full Text] [PDF] |
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L. Eckardt, G.;n. Breithardt, and S. Hohnloser CHAPTER 30 Ventricular Tachycardia and Sudden Cardiac Death ESC Textbook of Cardiovascular Medicine, January 1, 2009; 2(1): med-9780199566990-chapter - med-9780199566990-chapter. [Abstract] [Full Text] [PDF] |
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R. W. Neumar, J. P. Nolan, C. Adrie, M. Aibiki, R. A. Berg, B. W. Bottiger, C. Callaway, R. S.B. Clark, R. G. Geocadin, E. C. Jauch, et al. Post-Cardiac Arrest Syndrome: Epidemiology, Pathophysiology, Treatment, and Prognostication A Consensus Statement From the International Liaison Committee on Resuscitation (American Heart Association, Australian and New Zealand Council on Resuscitation, European Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Asia, and the Resuscitation Council of Southern Africa); the American Heart Association Emergency Cardiovascular Care Committee; the Council on Cardiovascular Surgery and Anesthesia; the Council on Cardiopulmonary, Perioperative, and Critical Care; the Council on Clinical Cardiology; and the Stroke Council Circulation, December 2, 2008; 118(23): 2452 - 2483. [Full Text] [PDF] |
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R. J. Myerburg Implantable Cardioverter-Defibrillators after Myocardial Infarction N. Engl. J. Med., November 20, 2008; 359(21): 2245 - 2253. [Full Text] [PDF] |
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C. N. Pellegrini, K. Lee, J. E. Olgin, M. P. Turakhia, Z. H. Tseng, R. Lee, N. Badhwar, B. Lee, and P. D. Varosy Impact of advanced age on survival in patients with implantable cardioverter defibrillators Europace, November 1, 2008; 10(11): 1296 - 1301. [Abstract] [Full Text] [PDF] |
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S. Sherazi, J. P. Daubert, R. C. Block, V. Jeevanantham, K. Abdel-Gadir, M. R. DiSalle, J. M. Haley, and A. H. Shah Physicians' Preferences and Attitudes About End-of-Life Care in Patients With an Implantable Cardioverter-Defibrillator Mayo Clin. Proc., October 1, 2008; 83(10): 1139 - 1141. [Abstract] [Full Text] [PDF] |
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R. Tung, P. Zimetbaum, and M. E. Josephson A Critical Appraisal of Implantable Cardioverter-Defibrillator Therapy for the Prevention of Sudden Cardiac Death J. Am. Coll. Cardiol., September 30, 2008; 52(14): 1111 - 1121. [Abstract] [Full Text] [PDF] |
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A. E. Epstein Benefits of the Implantable Cardioverter-Defibrillator J. Am. Coll. Cardiol., September 30, 2008; 52(14): 1122 - 1127. [Abstract] [Full Text] [PDF] |
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L. Ding, W. Hua, H. Niu, K. Chen, and S. Zhang Primary prevention of sudden cardiac death using implantable cardioverter defibrillators Europace, September 1, 2008; 10(9): 1034 - 1041. [Abstract] [Full Text] [PDF] |
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A. E. Epstein, J. P. DiMarco, K. A. Ellenbogen, N.A. M. Estes III, R. A. Freedman, L. S. Gettes, A. M. Gillinov, G. Gregoratos, S. C. Hammill, D. L. Hayes, et al. ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices) Developed in Collaboration With the American Association for Thoracic Surgery and Society of Thoracic Surgeons J. Am. Coll. Cardiol., May 27, 2008; 51(21): e1 - e62. [Full Text] [PDF] |
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A. E. Epstein, J. P. DiMarco, K. A. Ellenbogen, N.A. Mark Estes III, R. A. Freedman, L. S. Gettes, A. M. Gillinov, G. Gregoratos, S. C. Hammill, D. L. Hayes, et al. ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices) Developed in Collaboration With the American Association for Thoracic Surgery and Society of Thoracic Surgeons J. Am. Coll. Cardiol., May 27, 2008; 51(21): 2085 - 2105. [Full Text] [PDF] |
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Writing Committee Members, A. E. Epstein, J. P. DiMarco, K. A. Ellenbogen, N.A. M. Estes III, R. A. Freedman, L. S. Gettes, A. M. Gillinov, G. Gregoratos, S. C. Hammill, et al. ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices): Developed in Collaboration With the American Association for Thoracic Surgery and Society of Thoracic Surgeons Circulation, May 27, 2008; 117(21): 2820 - 2840. [Full Text] [PDF] |
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Writing Committee Members, A. E. Epstein, J. P. DiMarco, K. A. Ellenbogen, N.A. M. Estes III, R. A. Freedman, L. S. Gettes, A. M. Gillinov, G. Gregoratos, S. C. Hammill, et al. ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices): Developed in Collaboration With the American Association for Thoracic Surgery and Society of Thoracic Surgeons Circulation, May 27, 2008; 117(21): e350 - e408. [Full Text] [PDF] |
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H. J. Wellens Forty Years of Invasive Clinical Electrophysiology: 1967-2007 Circ Arrhythm Electrophysiol, April 1, 2008; 1(1): 49 - 53. [Full Text] [PDF] |
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R. Sutton, J. D. Fisher, C. Linde, and D. G. Benditt History of electrical therapy for the heart Eur. Heart J. Suppl., December 1, 2007; 9(suppl_I): I3 - I10. [Abstract] [Full Text] [PDF] |
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T. Rossenbacker, S. G. Priori, and D. P. Zipes The fight against sudden cardiac death: consensus guidelines as a reference Eur. Heart J. Suppl., December 1, 2007; 9(suppl_I): I50 - I58. [Abstract] [Full Text] [PDF] |
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W. Jung and B. Schumacher What is the role of risk stratification for sudden death in the defibrillator era? Eur. Heart J. Suppl., December 1, 2007; 9(suppl_I): I59 - I65. [Abstract] [Full Text] [PDF] |
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M. Santini, C. Lavalle, and R. P. Ricci Primary and secondary prevention of sudden cardiac death: who should get an ICD? Heart, November 1, 2007; 93(11): 1478 - 1483. [Full Text] [PDF] |
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P. Vassallo and R. G. Trohman Prescribing Amiodarone: An Evidence-Based Review of Clinical Indications JAMA, September 19, 2007; 298(11): 1312 - 1322. [Abstract] [Full Text] [PDF] |
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D. J. Callans Patients With Hemodynamically Tolerated Ventricular Tachycardia Require Implantable Cardioverter-Defibrillators Circulation, September 4, 2007; 116(10): 1196 - 1203. [Full Text] [PDF] |
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J. Almendral and M. E. Josephson All Patients With Hemodynamically Tolerated Postinfarction Ventricular Tachycardia Do Not Require an Implantable Cardioverter-Defibrillator Circulation, September 4, 2007; 116(10): 1204 - 1212. [Full Text] [PDF] |
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S. Singh and M. M. Murawski Implantable Cardioverter Defibrillator Therapy and the Need for Concomitant Antiarrhythmic Drugs Journal of Cardiovascular Pharmacology and Therapeutics, September 1, 2007; 12(3): 175 - 180. [Abstract] [PDF] |
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J. A. Ezekowitz, B. H. Rowe, D. M. Dryden, N. Hooton, B. Vandermeer, C. Spooner, and F. A. McAlister Systematic Review: Implantable Cardioverter Defibrillators for Adults with Left Ventricular Systolic Dysfunction Ann Intern Med, August 21, 2007; 147(4): 251 - 262. [Abstract] [Full Text] [PDF] |
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R. Passman and A. Kadish Sudden Death Prevention With Implantable Devices Circulation, July 31, 2007; 116(5): 561 - 571. [Full Text] [PDF] |
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D. H. Birnie MB ChB MD, C. Sambell BSc, H. Johansen PhD, K. Williams MS, R. Lemery MD, M. S. Green MD, M. H. Gollob MD, D. S. Lee MD PhD, and A. S.L. Tang MD Use of implantable cardioverter defibrillators in Canadian and US survivors of out-of-hospital cardiac arrest Can. Med. Assoc. J., July 3, 2007; 177(1): 41 - 46. [Abstract] [Full Text] [PDF] |
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C. S. Simpson MD Implantable cardioverter defibrillators work so why aren't we using them? Can. Med. Assoc. J., July 3, 2007; 177(1): 49 - 51. [Full Text] [PDF] |
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J. S. Healey, A. P. Hallstrom, K.-H. Kuck, G. Nair, E. P. Schron, R. S. Roberts, C. A. Morillo, and S. J. Connolly Role of the implantable defibrillator among elderly patients with a history of life-threatening ventricular arrhythmias Eur. Heart J., July 2, 2007; 28(14): 1746 - 1749. [Abstract] [Full Text] [PDF] |
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A. Jahangir, D. J. Bradley, and W. K. Shen ICDs for secondary prevention of sudden death in the older-elderly Eur. Heart J., July 2, 2007; 28(14): 1665 - 1667. [Full Text] [PDF] |
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S. S. Chugh, K. Reinier, and E. C. Stecker Learning From a Real-World Analysis of Implantable Cardioverter-Defibrillator Recipients: Comorbidities Matter J. Am. Coll. Cardiol., June 26, 2007; 49(25): 2416 - 2418. [Full Text] [PDF] |
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J. Patel and J. T. Heywood Mode of Death in Patients With Systolic Heart Failure Journal of Cardiovascular Pharmacology and Therapeutics, June 1, 2007; 12(2): 127 - 136. [Abstract] [PDF] |
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A. E. Epstein, C. A. Baessler, A. B. Curtis, N.A. M. Estes III, B. J. Gersh, B. Grubb, and L. B. Mitchell Addendum to "Personal and Public Safety Issues Related to Arrhythmias That May Affect Consciousness: Implications for Regulation and Physician Recommendations: A Medical/ Scientific Statement From the American Heart Association and the North American Society of Pacing and Electrophysiology" Public Safety Issues in Patients With Implantable Defibrillators A Scientific Statement From the American Heart Association and the Heart Rhythm Society Circulation, March 6, 2007; 115(9): 1170 - 1176. [Abstract] [Full Text] [PDF] |
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A. K. Gehi, D. Mehta, and J. A. Gomes Evaluation and Management of Patients After Implantable Cardioverter-Defibrillator Shock JAMA, December 20, 2006; 296(23): 2839 - 2847. [Abstract] [Full Text] [PDF] |
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V. J. Dzau, E. M. Antman, H. R. Black, D. L. Hayes, J. E. Manson, J. Plutzky, J. J. Popma, and W. Stevenson The Cardiovascular Disease Continuum Validated: Clinical Evidence of Improved Patient Outcomes: Part II: Clinical Trial Evidence (Acute Coronary Syndromes Through Renal Disease) and Future Directions Circulation, December 19, 2006; 114(25): 2871 - 2891. [Full Text] [PDF] |
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M. A Hlatky, D. K Owens, and G. D Sanders Cost-effectiveness as an outcome in randomized clinical trials Clinical Trials, December 1, 2006; 3(6): 543 - 551. [Abstract] [PDF] |
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Developed in Collaboration With the European Heart, D. P. Zipes, A. J. Camm, M. Borggrefe, A. E. Buxton, B. Chaitman, M. Fromer, G. Gregoratos, G. Klein, A. J. Moss, et al. ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death--Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death) J. Am. Coll. Cardiol., September 5, 2006; 48(5): 1064 - 1108. [Full Text] [PDF] |
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Developed in Collaboration With the European Heart, D. P. Zipes, A. J. Camm, M. Borggrefe, A. E. Buxton, B. Chaitman, M. Fromer, G. Gregoratos, G. Klein, A. J. Moss, et al. ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death) J. Am. Coll. Cardiol., September 5, 2006; 48(5): e247 - e346. [Full Text] [PDF] |
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D. P. Zipes, D. P. Zipes, A. J. Camm, M. Borggrefe, A. E. Buxton, B. Chaitman, M. Fromer, G. Gregoratos, G. Klein, A. J. Moss, et al. ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death--executive summary: A report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death) Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Eur. Heart J., September 1, 2006; 27(17): 2099 - 2140. [Full Text] [PDF] |
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Writing Committee Members, D. P. Zipes, A. J. Camm, M. Borggrefe, A. E. Buxton, B. Chaitman, M. Fromer, G. Gregoratos, G. Klein, A. J. Moss, et al. ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: A report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death) Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society Europace, September 1, 2006; 8(9): 746 - 837. [Full Text] [PDF] |
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K.-H. Kuck and S. Nisam ICD therapy: 'the sickest benefit the most...': what about the less sick? Europace, July 1, 2006; 8(7): 508 - 511. [Abstract] [Full Text] [PDF] |
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S. Nisam and G. Breithardt Lessons learned from neutral ICD trials Europace, June 1, 2006; 8(6): 393 - 397. [Abstract] [Full Text] [PDF] |
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Z. Goldberger and R. Lampert Implantable Cardioverter-Defibrillators: Expanding Indications and Technologies JAMA, February 15, 2006; 295(7): 809 - 818. [Abstract] [Full Text] [PDF] |
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J. R. Paisey, A. M. Yue, F. Bessoule, P. R. Roberts, and J. M. Morgan Passive electrode effect reduces defibrillation threshold in bi-filament middle cardiac vein defibrillation. Europace, February 1, 2006; 8(2): 113 - 117. [Abstract] [Full Text] [PDF] |
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M C S Hall and D M Todd Modern management of arrhythmias Postgrad. Med. J., February 1, 2006; 82(964): 117 - 125. [Abstract] [Full Text] [PDF] |
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M. Abello, J. L. Merino, R. Peinado, M. Gnoatto, M. A. Arias, M. Gonzalez-Vasserot, and J. A. Sobrino Syncope following cardioverter defibrillator implantation in patients with spontaneous syncopal monomorphic ventricular tachycardia Eur. Heart J., January 1, 2006; 27(1): 89 - 95. [Abstract] [Full Text] [PDF] |
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Part 4: Advanced Life Support Circulation, November 29, 2005; 112(22_suppl): III-25 - III-54. [Full Text] [PDF] |
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A. Elhendy, S. Chapman, T. R. Porter, and J. Windle Association of Myocardial Ischemia With Mortality and Implantable Cardioverter-Defibrillator Therapy in Patients With Coronary Artery Disease at Risk of Arrhythmic Death J. Am. Coll. Cardiol., November 1, 2005; 46(9): 1721 - 1726. [Abstract] [Full Text] [PDF] |
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S. M. Al-Khatib, F. L. Lucas, J. G. Jollis, D. J. Malenka, and D. E. Wennberg The Relation Between Patients' Outcomes and the Volume of Cardioverter-Defibrillator Implantation Procedures Performed by Physicians Treating Medicare Beneficiaries J. Am. Coll. Cardiol., October 18, 2005; 46(8): 1536 - 1540. [Abstract] [Full Text] [PDF] |
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E. G. Manios, E. M. Kallergis, E. M. Kanoupakis, H. E. Mavrakis, D. C. Kambouraki, D. A. Arfanakis, and P. E. Vardas Amino-Terminal Pro-Brain Natriuretic Peptide Predicts Ventricular Arrhythmogenesis in Patients With Ischemic Cardiomyopathy and Implantable Cardioverter-Defibrillators Chest, October 1, 2005; 128(4): 2604 - 2610. [Abstract] [Full Text] [PDF] |
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D. A.M.J. Theuns, A. S. Thornton, A. P. J. Klootwijk, M. F. Scholten, P. J.M.J. Vantrimpont, A. H.M.M. Balk, and L. J. Jordaens Outcome in patients with an ICD incorporating cardiac resynchronisation therapy: Differences between primary and secondary prophylaxis Eur J Heart Fail, October 1, 2005; 7(6): 1027 - 1032. [Abstract] [Full Text] [PDF] |
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A. Gehi, D. Haas, and V. Fuster Primary Prophylaxis With the Implantable Cardioverter-Defibrillator: The Need for Improved Risk Stratification JAMA, August 24, 2005; 294(8): 958 - 960. [Full Text] [PDF] |
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A. Kadish and M. Mehra Heart Failure Devices: Implantable Cardioverter-Defibrillators and Biventricular Pacing Therapy Circulation, June 21, 2005; 111(24): 3327 - 3335. [Full Text] [PDF] |
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M. O. Sweeney, M. S. Wathen, K. Volosin, I. Abdalla, P. J. DeGroot, M. F. Otterness, and A. J. Stark Appropriate and Inappropriate Ventricular Therapies, Quality of Life, and Mortality Among Primary and Secondary Prevention Implantable Cardioverter Defibrillator Patients: Results From the Pacing Fast VT REduces Shock ThErapies (PainFREE Rx II) Trial Circulation, June 7, 2005; 111(22): 2898 - 2905. [Abstract] [Full Text] [PDF] |
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T. J. Bunch, S. C. Hammill, and R. D. White Outcomes After Ventricular Fibrillation Out-of-Hospital Cardiac Arrest: Expanding the Chain of Survival Mayo Clin. Proc., June 1, 2005; 80(6): 774 - 782. [Abstract] [PDF] |
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A. E. Buxton, A. J. Moss, A. E. Buxton, and A. J. Moss Should everyone with an ejection fraction less than or equal to 30% receive an implantable cardioverter-defibrillator? Circulation, May 17, 2005; 111(19): 2537 - 2549. [Full Text] [PDF] |
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P. S. Chan and R. A. Hayward Mortality Reduction by Implantable Cardioverter-Defibrillators in High-Risk Patients With Heart Failure, Ischemic Heart Disease, and New-Onset Ventricular Arrhythmia: An Effectiveness Study J. Am. Coll. Cardiol., May 3, 2005; 45(9): 1474 - 1481. [Abstract] [Full Text] [PDF] |
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R. Sukhija, W. S. Aronow, C. Sorbera, K. Yalamanchili, and M. Cohen Patients, Mean Age 70 Years, With Automatic Implantable Cardioverter-Defibrillators Treated With Dual-Chamber Rate Responsive Pacing (DDDR-70) Have a Higher Mortality Than Patients With Backup Ventricular Pacing (VVI-40) at 3.7-Year Follow-Up J. Gerontol. A Biol. Sci. Med. Sci., May 1, 2005; 60(5): 603 - 604. [Abstract] [Full Text] [PDF] |
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A Y Patwala and D J Wright Device based treatment of heart failure Postgrad. Med. J., May 1, 2005; 81(955): 286 - 291. [Abstract] [Full Text] [PDF] |
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P. S Spector Diagnosis and management of sudden cardiac death Heart, March 1, 2005; 91(3): 408 - 413. [Full Text] [PDF] |
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P. W. Groeneveld, P. A. Heidenreich, and A. M. Garber Trends in implantable cardioverter-defibrillator racial disparity: The importance of geography J. Am. Coll. Cardiol., January 4, 2005; 45(1): 72 - 78. [Abstract] [Full Text] [PDF] |
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C. J. Plummer, R. J. Irving, and J. M. McComb The incidence of implantable cardioverter defibrillator indications in patients admitted to all coronary care units in a single district Europace, January 1, 2005; 7(3): 266 - 272. [Abstract] [Full Text] [PDF] |
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M. A. Hlatky, G. D. Sanders, and D. K. Owens Evidence-Based Medicine And Policy: The Case Of The Implantable Cardioverter Defibrillator Health Aff., January 1, 2005; 24(1): 42 - 51. [Abstract] [Full Text] [PDF] |
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A. S. Desai, J. C. Fang, W. H. Maisel, and K. L. Baughman Implantable Defibrillators for the Prevention of Mortality in Patients With Nonischemic Cardiomyopathy: A Meta-analysis of Randomized Controlled Trials JAMA, December 15, 2004; 292(23): 2874 - 2879. [Abstract] [Full Text] [PDF] |
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R. Parkash, A. Tang, G. Wells, J. Blackburn, I. Stiell, C. Simpson, P. Dorian, R. Yee, D. Cameron, S. Connolly, et al. Use of implantable cardioverter defibrillators after out-of-hospital cardiac arrest: a prospective follow-up study Can. Med. Assoc. J., October 26, 2004; 171(9): 1053 - 1056. [Abstract] [Full Text] [PDF] |
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H. J.J. Wellens Cardiac arrhythmias: The quest for a cure: A historical perspective J. Am. Coll. Cardiol., September 15, 2004; 44(6): 1155 - 1163. [Abstract] [Full Text] [PDF] |
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A. Voigt, R. Ezzeddine, W. Barrington, O. Obiaha-Ngwu, L. I. Ganz, B. London, and S. Saba Utilization of implantable cardioverter-defibrillators in survivors of cardiac arrest in the United States from 1996 to 2001 J. Am. Coll. Cardiol., August 18, 2004; 44(4): 855 - 858. [Abstract] [Full Text] [PDF] |
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H. J. Wellens Randomized Clinical Trials: How Long Should They Last? Circulation, July 13, 2004; 110(2): 107 - 108. [Full Text] [PDF] |
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