CARDIOVASCULAR MEDICINE

Implantable cardioverter-defibrillators in arrhythmias: a rapid and systematic review of effectiveness

J Parkes, J Bryant, R Milne

University of Southampton, Southampton, UK

Correspondence to:
Correspondence to:
Dr J Parkes, Wessex Institute for Health Research and Development, Mailpoint 727, Boldrewood, University of Southampton, Bassett Crescent East, Southampton SO16 7PX, UK;
jules{at}soton.ac.uk

Objective: To review the effectiveness of implantable cardioverter-defibrillators (ICDs) in the management of risk factors for sudden cardiac death.

Design: Systematic review of randomised controlled trials identified from searching eight electronic databases, bibliographies of relevant studies, and consulting experts.

Main outcome measures: Absolute and relative reduction in mortality.

Results: Seven trials met the inclusion criteria. These showed changes in absolute risk of total mortality ranging from +1.7% to -22.8% (relative risk reductions -7% to +54%). Estimated benefits from ICD treatment compared with conventional drug treatment at three years were 0.23 to 0.80 additional years of life.

Conclusions: Evidence suggests that ICDs reduce total mortality in particular subgroups of patients at high risk of ventricular arrhythmias. The optimal strategy for identifying the patients who could benefit most is not clearly established. Ongoing trials into the treatment of cardiac failure with ICDs may provide further evidence about subgroups in whom ICDs are most cost effective.

Keywords: arrhythmias; implantable cardioverterdefibrillators

Abbreviations: AVID, antiarrhythmics versus implantable defribrillators trial; CABG patch, coronary artery bypass graft patch trial; CASH, cardiac arrest study Hamburg; CIDS, Canadian implantable defibrillator study; ESVEM, electrophysiologic study versus electrocardiographic monitoring trial; ICD, implantable cardioverter-defibrillators; MADIT, multicenter automatic defibrillator implantation trial; MUSTT, multicenter unsustained tachycardia trial

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