Impact of MADIT and MUSTT on Clinical Practice

  • S. Nisam
Conference paper


The very first trial aiming at evaluating the role of the implantable cardioverter defibrillator (ICD) as prophylaxis was the Multicenter Automatic Defibrillator Trial (MADIT), initiated by Moss and co-workers in 1990 [1]. MADIT demonstrated that ICD therapy dramatically reduced all-cause mortality in high-risk chronic coronary artery disease patients without previous sustained ventricular tachyarrhythmias. This trial, now recognized as a landmark study, was met by some skepticism [2, 3], but five further positive ICD trials have reinforced the conclusions from the MADIT trial [4]. The most important of these with respect to establishing the role of ICDs in primary prevention of sudden death was the Multicenter UnSustained Tachycardia Trial (MUSTT) [5]. Some authors have contended that these studies would have little clinical impact [6] (D. Andresen, responsible for German EURID registry, personal communication, 1999), and the purpose of our paper here is to investigate precisely that question: what impact have MADIT and MUSTT had on clinical practice?


Implantable Cardioverter Defibrillator Implantable Cardioverter Defibrillator Therapy Implantable Defibrillator Implantable Cardioverter Defibrillator Implantation Multicenter Automatic Defibrillator Implantation Trial 
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  1. 1.
    MADIT Executive Committee (1991) Multicenter Automatic Defibrillator Implantation Trial (MADIT): design and clinical protocol. Pacing Clin Electrophysiol 14:920–927CrossRefGoogle Scholar
  2. 2.
    Friedman P, Stevenson W (1996) Unsustained ventricular tachycardia — to treat or not to treat (editorial). N Engl J Med 335:1984–1985PubMedCrossRefGoogle Scholar
  3. 3.
    Coumel P (1998) The MADIT trial: what was wrong? In: Vardas PE (ed) Cardiac arrhythmias, pacing and electrophysiology. Kluwer Academic Publishers, Dordrecht, pp 121–124CrossRefGoogle Scholar
  4. 4.
    Prystowsky E, Nisam S (2000) Prophylactic implantable cardioverter defibrillator trials (ICD): MUSTT, MADIT, and beyond. Am J Cardiol 86:1214–1215PubMedCrossRefGoogle Scholar
  5. 5.
    Buxton A, Lee K, Fisher J et al for the Multicenter UnSustained Tachycardia Trial (MUSTT) Investigators (1999) A randomized study of the prevention of sudden death in patients with coronary artery disease. N Engl J Med 341:1882–1890PubMedCrossRefGoogle Scholar
  6. 6.
    Hohnloser S, Andresen D, Block M, et al (2000) Guidelines for implantation of automatic cardioverter/defibrillator. Z Kardiol 89:126–135 (German), 136–143 (English)CrossRefGoogle Scholar
  7. 7.
    Gold M, Nisam S (2000) Primary prevention of sudden cardiac death with implantable cardioverter-defibrillators: lessons learned from MADIT and MUSTT. Pacing Clin Electrophysiol 23:1981–1985PubMedCrossRefGoogle Scholar
  8. 8.
    Gold M, Rottman J, Wood M et al (1999) The effect of clinical factors on the benefit of implantable defibrillators in the MUSTT trial (abstract). Circulation 100:1–642CrossRefGoogle Scholar
  9. 9.
    Wilber D, Nisam S (2000) Survey of prophylactic defibrillator implantation following MADIT. Ann Noninvasive Electrocardiol 248–254Google Scholar
  10. 10.
    Nisam S, Wilber D, Henry S (2001) Evolution of practice patterns related to prophylactic defibrillator implantation: results of an international survey (Abstract). PACEGoogle Scholar
  11. 11.
    FDA Talk Paper T96–33 (1996) FDA speeds approval of wider use of heart attack device. Food and Drug Administration, Rockville, MD, 16 May 1996Google Scholar
  12. 12.
    Gregoratos G, Cheitlin M, Conill A et al (1998) ACC/AHA guidelines for implantation of cardiac pacemakers and antiarrhythmia devices: a report of the ACC/AHA task force on practice guidelines (committee on pacemaker implantation). J Am Coll Cardiol 31:1175–1209PubMedCrossRefGoogle Scholar
  13. 13.
    Camm J, Nisam S (2000) The utilization of the implantable defibrillator — a European Enigma. Eur Heart J 21:1998–2004PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2002

Authors and Affiliations

  • S. Nisam
    • 1
  1. 1.Guidant CorporationDiegemBelgium

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