Prophylactic use of the implantable cardioverter-defibrillator and its effect on the long-term survival, cardiovascular and sudden cardiac death in nonischemic cardiomyopathy patients—a systematic review and meta-analysis

  • Waqas Javed Siddiqui
  • Sandeep Aggarwal
  • Muhammad Rafique
  • Swaiman Singh
  • Steven Kutalek
  • Howard J Eisen


Implantable cardioverter-defibrillator (ICD) has shown to reduce sudden cardiac death and overall mortality in patients with dilated cardiomyopathy. The recently published DANISH trial has shown conflicting outcomes on the long-term survival in patients with prophylactic implantation of ICD in Non-Ischemic Cardiomyopathy (NICM). Two independent reviewers searched MEDLINE, PUBMED, Ovid, CINAHL,, and Cochrane Registry for randomized control trials (RCT’s) comparing ICD to medical treatment (MT). Six RCT’s enrolling 3389 patients (ICD = 1554 and MT = 1835) were included for final analysis. The primary outcomes were mortality comparing ICD to MT, 231 vs 337 (OR = 0.74, CI = 0.62–0.90, p = 0.002, and I2 = 0%) favoring ICD. On comparing to amiodarone only, there were 47 deaths in the ICD arm vs 71 deaths in amiodarone arm, (OR = 0.66, CI = 0.44–0.98, p = 0.04, I2 0%), to placebo and usual care only (excluding amiodarone); there were 225 deaths in ICD patients compared to 266 in the placebo and usual care arm, (OR = 0.73, CI = 0.59–0.92, p = 0.007, I2 = 15%). The results of our analysis from these six RCTs clearly support the ongoing benefit of prophylactic ICD implantation and support current recommendations for ICD implantation in NICM patients. More RCT’s at a larger scale are needed to further elucidate benefits of both ICD and CRT-D in this post PARADIGM era where MT is at a pinnacle in reducing morbidity and mortality in heart failure patients.


Nonischemic cardiomyopathy Sudden cardiac death Implantable cardioverter-defibrillator Meta-analysis Mortality Survival 



Implantable cardioverter-defibrillator


Cardiac resynchronization therapy


Cardiac resynchronization therapy-defibrillator


Nonischemic cardiomyopathy


Medical treatment


Ischemic cardiomyopathy


Randomized control trial


Major adverse cardiovascular events


Medical subject headings



Muhammad Hassan Tahir (M.H.T.) and Varun Mairyala (V.M.) helped to extract the data from the papers and enter into the pre-specified data sheets.

Author contributions

Waqas Javed Siddiqui: concept/design, data collection, data analysis and interpretation, drafting, critical revision, statistics

Sandeep Aggarwal: concept/design, data analysis and interpretation, critical revision

Muhammad Rafique: data collection, drafting

Swaiman Singh: drafting

Steven Kutalek: critical revision, approval of article

Howard J Eisen: critical revision, approval of article

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standards

The manuscript does not contain clinical studies or patient data.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Waqas Javed Siddiqui
    • 1
    • 2
  • Sandeep Aggarwal
    • 1
    • 2
  • Muhammad Rafique
    • 3
  • Swaiman Singh
    • 1
    • 2
  • Steven Kutalek
    • 1
    • 2
  • Howard J Eisen
    • 1
    • 2
  1. 1.Department of MedicineDrexel University College of MedicinePhiladelphiaUSA
  2. 2.Hahnemann University HospitalPhiladelphiaUSA
  3. 3.Department of MedicineSeton Hall University, St. Francis Medical CenterTrentonUSA

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