Implantable Cardioverter-Defibrillator for Nonischemic Cardiomyopathy
An Updated Meta-Analysis
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The use of implantable cardioverter-defibrillators (ICDs) has been a major advancement in patients with ischemic cardiomyopathy with reduced ejection fraction <35%.1 Although the data supporting the use of ICDs are robust in patients with ischemic cardiomyopathy, limited randomized controlled clinical trial (RCT) data exist for similar benefit in patients with nonischemic cardiomyopathy (NICM).2 A prior meta-analysis that included both primary and secondary prevention ICD trials in 2004 by Desai et al2 demonstrated a 31% reduction in all-cause mortality with ICD use in patients with NICM. The data became the back bone of the current American College of Cardiology/American Heart Association guidelines for ICD implantation in patients with NICM.3 However, recently, the DANISH trial (Defibrillator Implantation in Patients with Nonischemic Systolic Heart Failure), which randomly assigned >1100 patients with NICM on optimal medical therapy (OMT) and cardiac resynchronization therapy (CRT) to ICD versus no ICD for primary prevention of sudden cardiac death, revealed no difference in all-cause mortality between the 2 groups at 5-year follow-up.4 Although the primary results of DANISH were neutral, the ICD group showed reduction in incidence of sudden cardiac death by half, and there was an interaction …