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Meta-Analysis
. 2023;30(1):117-124.
doi: 10.5603/CJ.a2021.0041. Epub 2021 Apr 12.

An implantable cardioverter-defibrillator for primary prevention in non-ischemic cardiomyopathy: A systematic review and meta-analysis

Michał Wasiak  1   2 , Mateusz Tajstra  3 , Dariusz Kosior  4 , Mariusz Gąsior  3
Affiliations
Meta-Analysis

An implantable cardioverter-defibrillator for primary prevention in non-ischemic cardiomyopathy: A systematic review and meta-analysis

Michał Wasiak et al. Cardiol J. 2023.

Abstract

Background: Recent data regarding the comparison of implantable cardioverter-defibrillator (ICD) therapy and optimal medical treatment in patients with non-ischemic cardiomyopathy has indicated no mortality benefit as a result of ICD therapy. Although the recommendations for ICD implantation did not change, it is worth noting that these findings significantly affected the daily practice of ICD implantation in Europe.

Methods: To assess the effect of ICD implantation in comparison to pharmacotherapy in the non- -ischemic cardiomyopathy heart failure population through a systematic review and meta-analysis of the available carefully designed prospective randomized controlled trials. Only prospective randomized controlled trials comparing ICD implantation in primary prevention vs. optimal pharmacological therapy or placebo and reporting mortality results were included in the meta-analysis. The authors have chosen to include the following trials: CAT, AMIOVIRT, DEFINITE, and DANISH.

Results: A meta-analysis of pooled hazard ratios (HR) from all trials conducted on a total of 1789 patients found that ICD therapy decreased all-cause mortality in comparison to optimal pharmacological treatment, with a HR of 0.48 (95% confidence interval [CI] 0.67-1.01); p = 0.06. The data from the AMIOVIRT, DANISH, and DEFINITE trials, with a total of 1677 participants, showed a significant reduction of sudden cardiac deaths as a result of ICD implantation, with a HR of 0.48 (95% CI 0.31-0.67); p < 0.001.

Conclusions: In comparison with optimal medical treatment, ICD implantation in patients with heart failure improves the long-term prognosis in terms of sudden cardiac death, with a strong tendency towards all-cause mortality reduction.

Keywords: implantable cardioverter-defibrillator; meta-analysis; non-ischemic cardiomyopathy; systematic review.

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Conflict of interest statement

Conflict of interest: None declared

Figures

Figure 1
Figure 1
Study flow diagram; EF — ejection fraction; RCT — randomized controlled trials.
Figure 2
Figure 2
Hazard ratios for all-cause death: implantable cardioverter-defibrillator (ICD) therapy versus conventional care; AMIOVIRT — Amiodarone Versus Implantable Cardioverter-Defibrillator: Randomized Trial in Patients with Non-ischemic Dilated Cardiomyopathy and Asymptomatic Non-sustained Ventricular Tachycardia; CAT — Cardiomyopathy Trial; Cl — confidence interval; DANISH — Danish Study to Assess the Efficacy of ICDs in Patients with Non-ischemic Systolic Heart Failure on Mortality; DEFINITE — Defibrillators in Non-Ischemic Cardiomyopathy Treatment Evaluation; ICD — implantable cardioverter-defibrillator.
Figure 3
Figure 3
Hazard ratios for sudden death: implantable cardioverter-defibrillator therapy versus conventional care; AMIOVIRT — Amiodarone Versus Implantable Cardioverter-Defibrillator: Randomized Trial in Patients with Non-ischemic Dilated Cardiomyopathy and Asymptomatic Non-sustained Ventricular Tachycardia; Cl — confidence interval; DANISH — Danish Study to Assess the Efficacy of ICDs in Patients with Non-ischemic Systolic Heart Failure on Mortality; DEFINITE — Defibrillators in Non-Ischemic Cardiomyopathy Treatment Evaluation; ICD — implantable cardioverter-defibrillator.
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References

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