Justin A. Ezekowitz, MB, BCh; Paul W. Armstrong, MD, FRCPC; Finlay A. McAlister, MD, MSc, FRCPC
Ezekowitz JA, Armstrong PW, McAlister FA. Implantable Cardioverter Defibrillators in Primary and Secondary Prevention: A Systematic Review of Randomized, Controlled Trials. Ann Intern Med. 2003;138:445-452. doi: 10.7326/0003-4819-138-6-200303180-00007
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Published: Ann Intern Med. 2003;138(6):445-452.
Implantable cardioverter defibrillators (ICDs) clearly prevent death from cardiac arrhythmias, but in which patients?
This meta-analysis summarizes findings from eight randomized trials that compared ICDs with usual care or antiarrhythmic drugs. Implantable cardioverter defibrillators reduced sudden death and total mortality in many patients, including patients with previous ventricular arrest or symptomatic sustained ventricular arrhythmias; patients with left ventricular dysfunction due to coronary artery disease who had asymptomatic nonsustained ventricular tachycardia and sustained tachycardia that could be induced electrophysiologically; and some patients with severe left ventricular dysfunction (ejection fraction ≤ 0.3) after myocardial infarction.
RCT = randomized, controlled trial.
Relative risk ( ) is shown with box size proportional to sample size; lines indicate 95% CIs. For each stratum, the diamond represents the pooled analysis. AVID = Antiarrhythmic versus Implantable Defibrillator; CABG Patch = Coronary Artery Bypass Graft Patch Trial; CASH = Cardiac Arrest Study Hamburg; CAT = Cardiomyopathy Trial; CIDS = Canadian Implantable Defibrillator Study; ICD = implantable cardioverter defibrillator; MADIT = Multicenter Automatic Defibrillator Implantation Trial; MADIT II = Multicenter Automatic Defibrillator Implantation Trial II; MUSTT = Multicenter Unsustained Tachycardia Trial.
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Cardiology, Prevention/Screening, Rhythm Disorders and Devices.
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