Implantable Cardioverter-Defibrillator for Non Ischemic Cardiomyopathy: An Updated Meta-Analysis
Use of Implantable cardioverter-defibrillators (ICD) have been a major advancement in patients with ischemic cardiomyopathy (ICM) with reduced ejection fraction <35%.1 While the data supporting the use of ICDs are robust in patients with ICM, limited randomized controlled clinical trial (RCT) data exist for similar benefit in patients with non-ischemic cardiomyopathy (NICM).2 A prior meta-analysis that included both primary and secondary prevention ICD trials in 2004 by Desai et al. demonstrated a 31% reduction in all-cause mortality with ICD use in patients with NICM.2 The data became the back bone of the current American College of Cardiology/American Heart Association (ACC/AHA) guidelines for ICD implantation in patients with NICM.3 However, recently, the DANISH trial which randomized more than 1,100 patients with NICM on optimal medical therapy (OMT) and/or cardiac resynchronization therapy (CRT) to ICD vs. no ICD for primary prevention of sudden cardiac death (SCD) revealed no difference in all-cause mortality between the two 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 of survival benefit with ICD use in younger patients with NICM. In light of the recent data, we sought to update the meta-analysis of RCTs assessing the utility of ICD for primary prevention in patients with NICM.
- Received October 20, 2016.
- Accepted December 1, 2016.