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Prophylactic defibrillator implantation in patients with nonischemic dilated cardiomyopathy.
N Engl J Med. 2004 May 20; 350(21):2151-8.NEJM

Abstract

BACKGROUND

Patients with nonischemic dilated cardiomyopathy are at substantial risk for sudden death from cardiac causes. However, the value of prophylactic implantation of an implantable cardioverter-defibrillator (ICD) to prevent sudden death in such patients is unknown.

METHODS

We enrolled 458 patients with nonischemic dilated cardiomyopathy, a left ventricular ejection fraction of less than 36 percent, and premature ventricular complexes or nonsustained ventricular tachycardia. A total of 229 patients were randomly assigned to receive standard medical therapy, and 229 to receive standard medical therapy plus a single-chamber ICD.

RESULTS

Patients were followed for a mean (+/-SD) of 29.0+/-14.4 months. The mean left ventricular ejection fraction was 21 percent. The vast majority of patients were treated with angiotensin-converting-enzyme (ACE) inhibitors (86 percent) and beta-blockers (85 percent). There were 68 deaths: 28 in the ICD group, as compared with 40 in the standard-therapy group (hazard ratio, 0.65; 95 percent confidence interval, 0.40 to 1.06; P=0.08). The mortality rate at two years was 14.1 percent in the standard-therapy group (annual mortality rate, 7 percent) and 7.9 percent in the ICD group. There were 17 sudden deaths from arrhythmia: 3 in the ICD group, as compared with 14 in the standard-therapy group (hazard ratio, 0.20; 95 percent confidence interval, 0.06 to 0.71; P=0.006).

CONCLUSIONS

In patients with severe, nonischemic dilated cardiomyopathy who were treated with ACE inhibitors and beta-blockers, the implantation of a cardioverter-defibrillator significantly reduced the risk of sudden death from arrhythmia and was associated with a nonsignificant reduction in the risk of death from any cause.

Authors+Show Affiliations

Clinical Cardiology Trials Office, Division of Cardiology, Department of Medicine, Northwestern University Medical School, Chicago, USA. a-kadish@northwestern.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15152060

Citation

Kadish, Alan, et al. "Prophylactic Defibrillator Implantation in Patients With Nonischemic Dilated Cardiomyopathy." The New England Journal of Medicine, vol. 350, no. 21, 2004, pp. 2151-8.
Kadish A, Dyer A, Daubert JP, et al. Prophylactic defibrillator implantation in patients with nonischemic dilated cardiomyopathy. N Engl J Med. 2004;350(21):2151-8.
Kadish, A., Dyer, A., Daubert, J. P., Quigg, R., Estes, N. A., Anderson, K. P., Calkins, H., Hoch, D., Goldberger, J., Shalaby, A., Sanders, W. E., Schaechter, A., & Levine, J. H. (2004). Prophylactic defibrillator implantation in patients with nonischemic dilated cardiomyopathy. The New England Journal of Medicine, 350(21), 2151-8.
Kadish A, et al. Prophylactic Defibrillator Implantation in Patients With Nonischemic Dilated Cardiomyopathy. N Engl J Med. 2004 May 20;350(21):2151-8. PubMed PMID: 15152060.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prophylactic defibrillator implantation in patients with nonischemic dilated cardiomyopathy. AU - Kadish,Alan, AU - Dyer,Alan, AU - Daubert,James P, AU - Quigg,Rebecca, AU - Estes,N A Mark, AU - Anderson,Kelley P, AU - Calkins,Hugh, AU - Hoch,David, AU - Goldberger,Jeffrey, AU - Shalaby,Alaa, AU - Sanders,William E, AU - Schaechter,Andi, AU - Levine,Joseph H, AU - ,, PY - 2004/5/21/pubmed PY - 2004/5/27/medline PY - 2004/5/21/entrez SP - 2151 EP - 8 JF - The New England journal of medicine JO - N Engl J Med VL - 350 IS - 21 N2 - BACKGROUND: Patients with nonischemic dilated cardiomyopathy are at substantial risk for sudden death from cardiac causes. However, the value of prophylactic implantation of an implantable cardioverter-defibrillator (ICD) to prevent sudden death in such patients is unknown. METHODS: We enrolled 458 patients with nonischemic dilated cardiomyopathy, a left ventricular ejection fraction of less than 36 percent, and premature ventricular complexes or nonsustained ventricular tachycardia. A total of 229 patients were randomly assigned to receive standard medical therapy, and 229 to receive standard medical therapy plus a single-chamber ICD. RESULTS: Patients were followed for a mean (+/-SD) of 29.0+/-14.4 months. The mean left ventricular ejection fraction was 21 percent. The vast majority of patients were treated with angiotensin-converting-enzyme (ACE) inhibitors (86 percent) and beta-blockers (85 percent). There were 68 deaths: 28 in the ICD group, as compared with 40 in the standard-therapy group (hazard ratio, 0.65; 95 percent confidence interval, 0.40 to 1.06; P=0.08). The mortality rate at two years was 14.1 percent in the standard-therapy group (annual mortality rate, 7 percent) and 7.9 percent in the ICD group. There were 17 sudden deaths from arrhythmia: 3 in the ICD group, as compared with 14 in the standard-therapy group (hazard ratio, 0.20; 95 percent confidence interval, 0.06 to 0.71; P=0.006). CONCLUSIONS: In patients with severe, nonischemic dilated cardiomyopathy who were treated with ACE inhibitors and beta-blockers, the implantation of a cardioverter-defibrillator significantly reduced the risk of sudden death from arrhythmia and was associated with a nonsignificant reduction in the risk of death from any cause. SN - 1533-4406 UR - https://www.unboundmedicine.com/medline/citation/15152060/Prophylactic_defibrillator_implantation_in_patients_with_nonischemic_dilated_cardiomyopathy_ L2 - https://www.nejm.org/doi/10.1056/NEJMoa033088?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -