Sudden Death Prevention in Heart Failure: What Role for ICD?

  • A. Rossillo
  • A. Raviele
Conference paper


Heart failure is one of the most frequent cardiovascular diseases, with a high cost to health care; in Italy about 1 million people are estimated to suffer from heart failure. The annual mortality due to heart failure ranges from 16% to 30%, increasing to 70% when patients with severe symptoms are considered. The relative rates of sudden death decrease with increase in NYHA class [1]. In 70%-80% of patients sudden death is due to an arrhythmia such as monomorphic ventricular tachycardia, polymorphic ventricular tachycardia, ventricular fibrillation, or in 15%-20%, bradyarrhythmias.


Sudden Death Sudden Cardiac Death Left Ventricular Dysfunction Implantable Defibrillator Antiarrhythmic Versus Implantable Defibrillator 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Uretsky BF, Sheahan RG (1997) Primary prevention of sudden cardiac death in heart failure: will the solution be shocking? J Am Coll Cardiol 30(7):1589–1597PubMedCrossRefGoogle Scholar
  2. 2.
    Domanski MJ, Exner DV, Borkowf CB et al (1999) Effect of angiotensin converting enzyme inhibition on sudden cardiac death in patients following acute myocardial infarction. A meta-analysis of randomized clinical trials. J Am Coll Cardiol 33:598–604CrossRefGoogle Scholar
  3. 3.
    The Digitalis Investigation Group (1997) The effect of digoxin on mortality and morbidity in patients with heart failure. N Engl J Med 336:525–533CrossRefGoogle Scholar
  4. 4.
    Rathore SS, Wang Y, Krumholz HM (2002) Sex based differences in the effect of digoxin for the treatment of heart failure. N Engl J Med 347:1403–1411PubMedCrossRefGoogle Scholar
  5. 5.
    Packer M, O’Connor CM, Ghali JK et al (1996) Effect of amlodipine on morbidity and mortality in severe chronic heart failure. N Engl J Med 335:1107–1114PubMedCrossRefGoogle Scholar
  6. 6.
    The long term intervention with pravastatin in ischaemic disease (LIPID) study group (1998). Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. N Engl J Med 339:1349–1357CrossRefGoogle Scholar
  7. 7.
    GISSI Prevenzione Investigators (1999) Dietary supplementation with n-3 polyunsaturated fatty acids and vitamin E after myocardial infarction: results of the GISSIPrevenzione trial. Lancet 354:447–455Google Scholar
  8. 8.
    CAST I investigators (1989) Preliminary report: effect of encainide and flecainide on mortality in a randomized trial of arrhythmia suppression after myocardial infarction. N Engl J Med 321:406–412CrossRefGoogle Scholar
  9. 9.
    The CAST II investigators (1989) Effect of the antiarrhythmic agent morozine on survival after myocardial infarction. N Engl J Med 321:406–412CrossRefGoogle Scholar
  10. 10.
    Packer M, Bristow MR, Cohn JN et al, for the US Carvedilol Heart Failure Study Group (1996) The effect of carvedilol on morbidity and mortality in patients with chronic heart failure. N Engl J Med 334:1349–1355Google Scholar
  11. 11.
    CIBIS-II Investigators and Committees (1999) The Cardiac Insufficiency Bisoprolol Study II (CIBIS-II): a randomised trial. Lancet 353:9–13CrossRefGoogle Scholar
  12. 12.
    The International Steering Committee on behalf of the MERIT-HF Study Group (1997) Rationale, design, and organization of the metoprolol CR/XL randomized intervention trial in heart failure (MERIT-HF). Am J Cardiol 80:54J–58JCrossRefGoogle Scholar
  13. 13.
    Amiodarone Trials Meta-Anlysis Investigators (1997) Effect of prophylactic amiodarone on mortality after acute myocardial infarction and in congestive heart failure: meta-analysis of individual data from 6500 patients in randomized trials. Lancet 350:1417–1424CrossRefGoogle Scholar
  14. 14.
    Waldo AL, Camm AJ, deRuyter H et al, for the SWORD investigators (1996) Effect of D-sotalol on mortality in patients with left ventricular dysfunction after recent and remote myocardial infarction. 348:7–12Google Scholar
  15. 15.
    Torp-Pedersen C, Moller M, Bloch-Thomsen PE et al, for the Danish Investigations of Arrhythmia and Mortality on Dofetilide Study Group (1999) Dofetilide in patients with congestive heart failure and left ventricular dysfunction. N Engl J Med 341:857–865Google Scholar
  16. 16.
    Kober L, Bloch-Thomsen PE, Moller M et al, on behalf of the Danish Investigations of Arrhythmia and Mortality on Dofetilide (DIAMOND) Study Group (2000) Effect of dofetilide in patients with recent myocardial infarction and left-ventricular dysfunction: a randomised trial. Lancet 356:2052–2058Google Scholar
  17. 17.
    The Antiarrhythmics versus Implantable Defibrillator (AVID) Investigators (1997) A comparison of antiarhythmic-drug therapy with implantable defibrillators in patients resuscitated from near-fatal ventricular arrhythmias. N Engl J Med 337:1761583Google Scholar
  18. 18.
    Connoly SJ, Gent M, Roberts RS et al, for the CIDS investigators (2000) Canadian Implantable Defibrillator Study (CIDS). A randomized trial of the implantable cardioverter defibrillator against amiodarone. Circulation 101:1297–1302Google Scholar
  19. 19.
    Kuck KH, Cappato R, Siebels J, Ruppel R, for the CASH investigators (2000) Randomized comparison of antiarrhythmic drug therapy with implantable defibrillators in patients resuscitated from cardiac arrest. The Cardiac Arrest Study Hamburg (CASH). Circulation 102:748–754PubMedGoogle Scholar
  20. 20.
    Cappato R (1999) Secondary prevention of sudden death: the Dutch Study, the Antiarrhythmics Versus Implantable Defibrillator Trial, the Cardiac Arrest Study Hamburg, and the Canadian Implantable Defibrillator Study. Am J Cardiol 83:68D–73DGoogle Scholar
  21. 21.
    Domanski MJ, Sakseena S, Epstein AE et al, for the AVID investigators (1999) Relative effectiveness of the implantable cardioverter-defibrillator and antiarrhythmic drugs in patients with varying degrees of left ventricular dysfunction who have survived malignant ventricular arrhythmias. J Am Coll Cardiol 34:1090–1095Google Scholar
  22. 22.
    Moss AJ, Hall WJ, Cannom DS et al, for the MADIT investigators (1996) Improved survival with an implanted defibrillator in patients with coronary disease at high risk for ventricular arrhythmia. N Engl J Med 335:1933–1940Google Scholar
  23. 23.
    Buxton AE, Lee KL, Fisher JD et al, for the MUSTT (1999) A randomized study of the prevention of sudden death in patients with coronary artery disease. N Engl J Med 341:1882–1890Google Scholar
  24. 24.
    Bigger JT for the CABG Patch trial investigators (1997) Prophylactic use of implanted cardiac defibrillators in patients at high risk for ventricular arrhythmias after coronary artery bypass graft surgery. N Engl J Med 337:1569–1575CrossRefGoogle Scholar
  25. 25.
    Klein H, Auricchio A, Reek S, Geller C (1999) New primary prevention trials of sudden cardiac death in patients with left ventricular dysfunction: SCD-HEFT and MADIT-II. Am J Cardiol 83:91D–97DCrossRefGoogle Scholar
  26. 26.
    Moss AJ, Zareba W, Hall WJ et al, for the MADIT II Investigators (2001) Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med 346:877–883Google Scholar

Copyright information

© Springer-Verlag Italia 2003

Authors and Affiliations

  • A. Rossillo
    • 1
  • A. Raviele
    • 1
  1. 1.Division of CardiologyUmberto I HospitalMestre-VeniceItaly

Personalised recommendations