The ICD in Heart Failure - Time for a Rethink?

In a number of primary-prevention trials, implantable cardioverter–defibrillators (ICDs) have been shown to reduce the risk of premature death among patients with left ventricular systolic dysfunction after myocardial infarction and among patients with heart failure and reduced ejection fraction.1 The evidence of a benefit is less robust for patients with heart failure who do not have coronary artery disease; the single largest trial, involving 458 such patients, did not show a significant reduction in mortality in association with ICD therapy.2 As a result, the current guideline recommendations are based on a meta-analysis of small trials involving patients with nonischemic cardiomyopathy, . . .

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[6]  P. Kudenchuk,et al.  Survival Benefit of the Primary Prevention Implantable Cardioverter-Defibrillator Among Older Patients: Does Age Matter? An Analysis of Pooled Data From 5 Clinical Trials , 2015, Circulation. Cardiovascular quality and outcomes.

[7]  Andrea Mazzanti,et al.  [2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death]. , 2015, Kardiologia polska.

[8]  P. Kudenchuk,et al.  Outcomes of implantable cardioverter-defibrillator use in patients with comorbidities: results from a combined analysis of 4 randomized clinical trials. , 2014, JACC. Heart failure.

[9]  Akshay S. Desai,et al.  Angiotensin-neprilysin inhibition versus enalapril in heart failure. , 2014, The New England journal of medicine.

[10]  Akshay S. Desai,et al.  Implantable Defibrillators for the Prevention of Mortality in Patients With Nonischemic Cardiomyopathy: A Meta-analysis of Randomized Controlled Trials , 2004 .

[11]  Hugh Calkins,et al.  Prophylactic defibrillator implantation in patients with nonischemic dilated cardiomyopathy. , 2004, The New England journal of medicine.