What Have We Learned from the US Experience on the Prophylactic Use of ICDs Following MADIT?

  • S. L. Higgins
  • L. Voshage-Stahl


Referred to as the “single most important arrhythmia study of the 90’s”, the Multicenter Automatic Defibrillator Implantation Trial (MADIT) has had a profound effect on the worldwide practice of cardiac electrophysiology [1]. While the conclusions of the study recommend a dramatic change in therapy application for selected high-risk asymptomatic patients, the actual implementation of these recommendations has not been previously reported. We will review the MADIT experience in the United States (U.S.), placing it in historical perspective, in the first year since conclusion of the study.


Implantable Cardioverter Defibrillator Implantable Defibrillator Multicenter Automatic Defibrillator Implantation Trial Conventional Therapy Group 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.
    Moss AJ, Hall WJ, Cannom DS, Daubert JP, Higgins SL, Klein H, Levine JH, Saksena S, Waldo AL, Wilber D, Brown MW, Heo M for the Multicenter Automatic Defibrillator Implantation Trial Investigators (1996) Improved survival with an implanted defibrillator in patients with coronary disease at high risk for ventricular arrhythmia. N Engl J Med 335: 1933–1940PubMedCrossRefGoogle Scholar
  2. 2.
    MADIT Executive Committee (1991) Multicenter Automatic Defibrillator Implantation Trial (MADIT): design and clinical protocol. PACE 14 (II): 920–927CrossRefGoogle Scholar
  3. 3.
    Friedman P, Stevenson W (1996) Unsustained ventricular tachycardia: to treat or not to treat. N Engl J Med 335: 1984–1985PubMedCrossRefGoogle Scholar
  4. 4.
    Mushlin AI, Hall WJ, Zwanziger J, Gajary E, Andrews M, Marron R, Zou K, Moss AJ for the Multicenter Automatic Defibrillator Implantation Trial Investigators (1997) The cost effectiveness of an implanted cardiac defibrillator in patients with coronary disease at high risk for ventricular arrhythmia: results from the economic component of the MADIT study (pre-publication draft)Google Scholar
  5. 5.
    Kuppermann M, Luce BR, McGovern B et al (1990) An analysis of the cost-effectiveness of the implantable defibrillator. Circulation 81: 91–100PubMedCrossRefGoogle Scholar
  6. 6.
    Higgins SL (1997) The implantable cardioverter defibrillator: a videotape and Manual. Futura Publishing Co., Inc. Armonk, NY, pp 1–6Google Scholar
  7. 7.
    Moss AJ (1997) Update on MADIT: The Multicenter Automatic Defibrillator Implantation Trial. Am J Cardiol 79 (6A): 16–17PubMedCrossRefGoogle Scholar
  8. 8.
    Julian DG, Camm AJ, Frangin G, Janse MJ, Munoz A, Schwartz PJ, Simon P for the European Myocardial Infarct Amiodarone Trial Investigators (1997) Randomised trial of effect of amiodarone on mortality in patients with left-ventricular dysfunction after recent myocardial infarction: EMIAT. Lancet 349: 667–674Google Scholar
  9. 9.
    Cairns JA, Connolly SJ, Roberts R, Gent M for the Canadian Amiodarone Myocardial Infarction Arrhythmia Trial Investigators (1997) Randomised trial of outcome after myocardial infarction in patients with frequent or repetitive ventricular premature depolarisations: CAMIAT. Lancet 349: 675–682Google Scholar
  10. 10.
    Nisam S (1997) Do MADIT results apply only to “MADIT Patients”? Am J Cardiol 79 (6A): 27–30PubMedCrossRefGoogle Scholar
  11. 11.
    National Heart, Lung and Blood Institute Communications (1997) NHLBI stops arrhythmia study-implantable cardiac defibrillators reduce deaths. NIH press release, April 14Google Scholar
  12. 12.
    Voshage-Stahl L and Capek J (1997) CPI/Guidant Corporation Marketing division (personal correspondence), March 16Google Scholar
  13. 13.
    Echt DS, Liebson Pr, Mitchell LB et al (1991) Mortality and morbidity in patients receiving encainide, flecainide, or placebo: the Cardiac Arrhythmia Suppression Trial. N Engl J Med 324: 781–788PubMedCrossRefGoogle Scholar
  14. 14.
    Parsonnet V, Escher D, Furman S et al (1984) Indications for dual-chamber pacing. PACE 7: 318–319PubMedCrossRefGoogle Scholar
  15. 15.
    Viskins S, Kitzis I, Lev E, Zak Z, Heller K, Villa Y, Zajanas A, Laniado S, Belhassen B (1995) Treatment with beta-adrenergic blocking agents after myocardial infarction: from randomized trials to clinical practice. J Am Coll Cardiol 25: 1327–1332CrossRefGoogle Scholar
  16. 16.
    Garg R, Yusuf S (1995) Collaborative Group on ACE Inhibitor Trials. Overview of randomized trials of angiotensin-converting enzyme inhibitors on mortality and morbidity in patients with heart failure. JAMA 18: 1450–1456CrossRefGoogle Scholar
  17. 17.
    Prystowsky E (1997) Management of atrial fibrillation: simplicity surrounded by controversy. Ann Intern Med 126: 244–246PubMedCrossRefGoogle Scholar
  18. 18.
    Maloney JD (1989) Consequences of the Cardiac Arrhythmia Suppression Trial: calamity or clarity? Cleveland Clin J Med 56: 649–653CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 1998

Authors and Affiliations

  • S. L. Higgins
    • 1
    • 2
  • L. Voshage-Stahl
    • 1
    • 2
  1. 1.Regional Cardiac Arrhythmia CenterScripps Memorial HospitalLa JollaUSA
  2. 2.CPI/GuidantSt. PaulUSA

Personalised recommendations