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Original research article
Implantable cardiac defibrillator and mortality in non-ischaemic cardiomyopathy: an updated meta-analysis
  1. Ana C Alba1,
  2. Farid Foroutan1,2,
  3. Juan Duero Posada1,
  4. Luciano Battioni1,
  5. Toni Schofield1,
  6. Mosaad Alhussein1,
  7. Thomas Agoritsas2,3,
  8. Frederick A Spencer4,
  9. Gordon Guyatt2
  1. 1 Department of cardiology, Hear Failure and Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
  2. 2 Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
  3. 3 Division of General Internal Medicine & Division of Clinical Epidemiology, University Hospitals of Geneva, Geneva, Switzerland
  4. 4 Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
  1. Correspondence to Dr Ana C Alba, Department of Cardiology, Toronto General Hospital, Toronto M5G 2N2, Canada; carolina.alba{at}


Objectives The benefit of implantable cardiac defibrillator (ICD) in symptomatic patients with systolic dysfunction and non-ischaemic cardiomyopathy remains controversial. We conducted a systematic review and meta-analysis to determine the effect of ICD in patients with non-ischaemic cardiomyopathy on (1) all-cause mortality, (2) cardiovascular mortality and (3) sudden cardiac death.

Methods We searched citations in meta-analyses published until 2012, and in MEDLINE, Embase, PubMed and Cochrane databases from 2012 to October 2016. We included randomised controlled trials (RCTs) evaluating the effect of ICD therapy on all-cause and cardiovascular mortality and sudden cardiac death in patients with non-ischaemic cardiomyopathy. Independent reviewers evaluated study eligibility, abstracted data and assessed risk of bias in duplicate. We used random-effect models to meta-analyse relative risks (RR) and hazard ratios (HR) across studies, the Grades of Recommendation, Assessment, Development, and Evaluation system to quantify absolute effects and quality of evidence, and I2 to evaluate heterogeneity.

Results We identified six RCTs including 1715 patients experiencing 421 deaths. ICD therapy was associated with reduced overall mortality (HR 0.78, 95% CI 0.66 to 0.92, I2 = 0%, risk difference 4.7%, high quality), cardiovascular mortality (RR 0.77, 95% CI 0.60 to 0.98, I2 = 39%, risk difference 3.3%, high quality) and sudden cardiac death (RR 0.45, 95% CI 0.29 to 0.70, I2 = 0%, risk difference 4.1%, high quality). The benefit of ICD was not influenced by the use of amiodarone in the comparison group, the duration of follow-up, by use of β-blockers and ACE inhibitors/angiotensin receptor blocker or cardiac resynchronisation therapy.

Conclusion Primary prevention ICD therapy reduces all-cause and cardiovascular mortality and sudden cardiac death in patients with non-ischaemic cardiomyopathy.

  • implanted cardiac defibrillator
  • heart failure with reduced ejection fraction
  • idiopathic dilated cardiomyopathy
  • meta-analysis and study design

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  • Contributors TA, FAS, GG and AA planned and designed the study. TA, FAS, FF, TS, JDP, MA, LB and AA performed citation screening, study selection and data abstraction. AA performed data analysis. AA and GG critically appraised results. AA prepared draft of manuscript and submitted the study for publication. TA, FAS, FF, TS, JDP, MA, LB, GG and AA reviewed and approved final version of the manuscript.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All data related to this study are published within the main manuscript or as supplemental material. No other unpublished data are available.