(Circulation. 2000;101:1297.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Canadian Implantable Defibrillator Study (CIDS)
A Randomized Trial of the Implantable Cardioverter Defibrillator Against Amiodarone
From the Departments of Medicine (S.J.C.) and Clinical Epidemiology and Biostatistics (M.G., R.S.R., B.O.), McMaster University, Hamilton, Ontario, and the Departments of Medicine at the University of Toronto (P.D.), University of Montreal (D.R.), University of Calgary (R.S.S., L.B.M.), University of Ottawa (M.S.G.), and the University of Western Ontario (G.J.K.), Canada.
Background—Patients surviving ventricular fibrillation (VF) or sustained ventricular tachycardia (VT) are at a high risk of death due to a recurrence of arrhythmia. The implantable cardioverter defibrillator (ICD) terminates VT or VF, but it is not known whether this device prolongs life in these patients compared with medical therapy with amiodarone.
Methods and Results—A total of 659 patients with resuscitated VF or VT or with unmonitored syncope were randomly assigned to treatment with the ICD or with amiodarone. The primary outcome measure was all-cause mortality, and the secondary outcome was arrhythmic death. A total of 328 patients were randomized to receive an ICD. A thoracotomy was done in 33, no ICD was implanted in 18, and the rest had a nonthoracotomy ICD. All 331 patients randomized to amiodarone received it initially. At 5 years, 85.4% of patients assigned to amiodarone were still receiving it at a mean dose of 255 mg/day, 28.1% of ICD patients were also receiving amiodarone, and 21.4% of amiodarone patients had received an ICD. A nonsignificant reduction in the risk of death was observed with the ICD, from 10.2% per year to 8.3% per year (19.7% relative risk reduction; 95% confidence interval, -7.7% to 40%; P=0.142). A nonsignificant reduction in the risk of arrhythmic death was observed, from 4.5% per year to 3.0% per year (32.8% relative risk reduction; 95% confidence interval, -7.2% to 57.8%; P=0.094).
Conclusions—A 20% relative risk reduction occurred in all-cause mortality and a 33% reduction occurred in arrhythmic mortality with ICD therapy compared with amiodarone; this reduction did not reach statistical significance.
Key Words: heart arrest • tachycardia • amiodarone • defibrillators, implantable
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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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J. Zwanziger, W. J. Hall, A. W. Dick, H. Zhao, A. I. Mushlin, R. M. Hahn, H. Wang, M. L. Andrews, C. Mooney, H. Wang, et al. The Cost Effectiveness of Implantable Cardioverter-Defibrillators: Results From the Multicenter Automatic Defibrillator Implantation Trial (MADIT)-II J. Am. Coll. Cardiol., June 6, 2006; 47(11): 2310 - 2318. [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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P. A. Gould, A. D. Krahn, and for the Canadian Heart Rhythm Society Working Grou Complications associated with implantable cardioverter-defibrillator replacement in response to device advisories. JAMA, April 26, 2006; 295(16): 1907 - 1911. [Abstract] [Full Text] [PDF]
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D. A. Cesario and G. W. Dec Implantable Cardioverter- Defibrillator Therapy in Clinical Practice J. Am. Coll. Cardiol., April 18, 2006; 47(8): 1507 - 1517. [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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D. M. Bloomfield, J. T. Bigger, R. C. Steinman, P. B. Namerow, M. K. Parides, A. B. Curtis, E. S. Kaufman, J. M. Davidenko, T. S. Shinn, and J. M. Fontaine Microvolt T-Wave Alternans and the Risk of Death or Sustained Ventricular Arrhythmias in Patients With Left Ventricular Dysfunction J. Am. Coll. Cardiol., January 17, 2006; 47(2): 456 - 463. [Abstract] [Full Text] [PDF]
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S. J. Connolly, P. Dorian, R. S. Roberts, M. Gent, S. Bailin, E. S. Fain, K. Thorpe, J. Champagne, M. Talajic, B. Coutu, et al. Comparison of {beta}-Blockers, Amiodarone Plus {beta}-Blockers, or Sotalol for Prevention of Shocks From Implantable Cardioverter Defibrillators: The OPTIC Study: A Randomized Trial JAMA, January 11, 2006; 295(2): 165 - 171. [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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