The ICD Cannot Impact Non-Arrhythmic Mortality. Or Can It?

  • S. Nisam


The implantable cardioverter defibrillator (ICD) has been established as the gold standard in terms of reducing sudden death resulting from lethal ventricular tachyarrhythmias [1, 2]. Many large series have shown that the rate of sudden death in patients with a history of such arrhythmias has been reduced to approximately 1% per year, well below the 20%–25% incidence of sudden death observed in major studies of patients treated with antiarrhythmic drugs [3–6]. Nevertheless, there continues to be considerable debate on whether this protection against sudden death translates to meaningful prolongation of life. Or, is sudden arrhythmic death from ventricular tachycardia or fibrillation simply a manifestation of advanced cardiomyopathy from which the patient succumbs shortly after, even if temporarily saved by the ICD?


Sudden Death Ventricular Tachyarrhythmia Sustained Ventricular Tachycardia Implantable Cardioverter Defibrillator Therapy Arrhythmic Death 
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.
    Kuck K, Akhtar M (1993) New horizons for electrical therapy in managing ventricular and supraventricular tachyarrhythmias. PACE 16: 503–505PubMedCrossRefGoogle Scholar
  2. 2.
    Akhtar M, Jazayeri M, Sra J, Tchou P, Rovang K, Blanck Z, Dhala A, Deshpande S, Axtell K (1993) Implantable cardioverter-defibrillator for prevention of sudden cardiac death in patients with ventricular tachycardia and ventricular fibrillation. PACE 16: 511–518PubMedCrossRefGoogle Scholar
  3. 3.
    Herre J, Sauve M, Scheinman M (1989) Long-term results of amiodarone therapy with recurrent sustained ventricular tachycardia or ventricular fibrillation. J Am Coll Cardiol 13: 442–449PubMedCrossRefGoogle Scholar
  4. 4.
    Olson P, Woelfel A, Simpson R, Foster J (1993) Stratification of sudden death risk in patients receiving long-term amiodarone treatment for sustained ventricular tachycardia or ventricular fibrillation. Am J Cardiol 71: 823–826PubMedCrossRefGoogle Scholar
  5. 5.
    Weinberg B, Miles W, Klein L, Bolander J, Dusman R, Stanton M, Heger J, Langefeld C, Zipes D (1993) Five-year follow-up of 589 patients treated with amiodarone. Am Heart J 125: 109–120PubMedCrossRefGoogle Scholar
  6. 6.
    Mason J on behalf of the ESVEM Investigators (1993) A comparison of seven antiarrhythmic drugs in patients with ventricular tachyarrhythmias. N Engl J Med 329: 452–458CrossRefGoogle Scholar
  7. 7.
    Connolly S,Yusuf S (1992) Evaluation of the implantable cardioverter defibrillator in survivors of cardiac arrest: the need for randomized trials. Am J Cardiol 69: 959–962CrossRefGoogle Scholar
  8. 8.
    Epstein A (1994) Letter to the Editor (re. AVID Trial). PACE 17: 262–266CrossRefGoogle Scholar
  9. 9.
    Estes M (1996) Clinical strategies for use of the implantable cardioverter defibrillator: the impact of current trials. PACE 19: 1011–1015PubMedCrossRefGoogle Scholar
  10. 10.
    Winkle R, Mead H, Ruder M et al (1989) Long-term outcome with the automatic implantable cardiover defibrillator. J Am Coll Cardiol 13: 1353–1361PubMedCrossRefGoogle Scholar
  11. 11.
    Newman D, Sauve J, Herre J et al (1992) Survival after implantation of the cardioverter defibrillator. Am J Cardiol 69: 889–903CrossRefGoogle Scholar
  12. 12.
    Weyer E, Hauer R, Van Capelle F et al (1995) Randomized study of implantable defibrillator as first-choice therapy versus conventional strategy in postinfarct sudden death survivors. Circulation 91: 2195–2203CrossRefGoogle Scholar
  13. 13.
    Moss A, Hall J, Cannom D, Daubert J, Higgins S, Klein H, Levine J, Saksena S, Waldo A, Wilber D, Brown M, Heo M for the MADIT Investigators (1996) Improved survival with an implanted defibrillator in patients with coronary disease at high risk of ventricular arrhythmias. N Engl J Med 335: 1933–1940Google Scholar
  14. 14.
    Josephson M, Nisam S (1996) Prospective trials of implantable cardioverter defibrillators versus drugs: are they addressing the right question? Am J Cardiol 77: 859–863PubMedCrossRefGoogle Scholar
  15. 15.
    Nisam S, Mower M, Thomas A, Hauser R (1993) Patient survival comparison in three generations of automatic implantable cardioverter defibrillators: review of 12 years, 25000 patients. PACE 16 (Ií): 174–178PubMedCrossRefGoogle Scholar
  16. 16.
    Summary of safety and effectiveness data for the CPI Endotak lead system. Premarket Approval ( PMA) application to U.S, Food and Drug Administration, 1993Google Scholar
  17. 17.
    Summary of safety and effectiveness data for the Medtronic Transvene lead system premarket approval (PMA) application to U.S. Food and Drug Administration, 1993Google Scholar
  18. 18.
    Block M and the European P2 Investigators (1993) Combination of endocardial leads with a new ICD capable of biphasic shocks-first results of a multicenter study. PACE 16: 874AGoogle Scholar
  19. 19.
    Bardy G, Hofer B, Johnson G, Kudenchuk P, Poole J, Dolack L, Gleva M, Mitchell R, Kelso D (1993) Implantable transvenous cardioverter defibrillators. Circulation 87: 1152–1168PubMedCrossRefGoogle Scholar
  20. 20.
    Block M, Breithardt G (1995) Long-term follow-up and clinical results of implantable cardioverter-defibrillators. In: Zipes D, Jalife J (eds) Cardiac electrophysiology: from cell to bedside. W Saunders, Philadelphia, pp 1412–1425Google Scholar
  21. 21.
    Bardy G, Raitt M, Jones G (1994) Unipolar defibrillation systems. In: Singer I (ed) Implantable cardioverter defibrillator. Futura Publ., Armonk, NY, pp 365–376Google Scholar
  22. 22.
    Pacifico A, Wheelan K, Nasir N, Wells P, Doyle T, Johnson S, Henry P (1997) Longterm follow-up of cardioverter-defibrillator implanted under conscious sedation in prepectoral subfascial position. Circulation 95: 946–950PubMedCrossRefGoogle Scholar
  23. 23.
    Julian D, Camm J, Frangin G, Janse M, Munoz A, Schwartz P 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
  24. 24.
    Nisam S (1997) Do MADIT Results apply only to `MADIT patients’? Am J Cardiol 79 (6A): 27–30PubMedCrossRefGoogle Scholar
  25. 25.
    Saksena S, Madan N, Lewis C (1996) Implantable cardioverter-defibrillators are preferable to drugs a primary therapy in sustained ventricular tachyarrhythmias. Prog Cardiovasc Dis 38: 445–454PubMedCrossRefGoogle Scholar
  26. 26.
    Greene L, CASCADE Investigators (1991) Cardiac arrest in Seattle: conventional versus amiodarone drug evaluation: the CASCADE Study. Am J Cardiol 67: 578–584CrossRefGoogle Scholar
  27. 27.
    Powell A, Finkelstein D, Garan H et al (1993) Influence of implantable cardioverterdefibrillators on the long-term prognosis of survivors of out-of-hospital cardiac arrest. Circulation 88: 1083–1092PubMedCrossRefGoogle Scholar
  28. 28.
    Böcker D, Block M, Borggrefe M, Breithardt G (1997) Defibrillators are superior to antiarrhythmnic drugs in the treatment of ventricular tachyarrhythmias. Eur Heart J 18: 26–30PubMedCrossRefGoogle Scholar
  29. 29.
    Kim S, Fisher J, Choue C et al (1992) Influence on left ventricular function on outcome of patients treated with implantable defibrillators. Circulation 85: 1304–1310PubMedCrossRefGoogle Scholar
  30. 30.
    Choue C, Kim S, Fisher J et al (1994) Comparison of defibrillator therapy and other therapeutic modalities for sustained ventricular tachycardia or ventricular fibrillation associated with coronary artery disease. Am J Cardiol 73: 1075–1079PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 1998

Authors and Affiliations

  • S. Nisam
    • 1
  1. 1.CPI/GuidantZaventemBelgium

Personalised recommendations