Primary prevention of VT/VF (prevent SCD from first incident of VT/VF)
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Moss (1996)7: MADIT (multicenter automatic defibrillator implantation trial) | 196 | MI three weeks or more before entry, with documented asymptomatic unsustained VT unrelated to MI, LVEF 0.35, with inducible VT not suppressed by procainamide, NYHA functional class I, II or III; and no indications for CABG/angioplasty within 3 months | 63 ( 9) | 92 | Prophylactic ICD; 47% transthoracic devices, 53% transvenous devices | Conventional tiered treatment | 27 months |
Buxton (1999)9,31: MUSTT (multicenter unsustained tachycardia trial) | 704 | Coronary heart disease, non-sustained VT; LVEF <40% and EP diagnosed inducible sustained VT | †66.5 (58 to 72 ) | 90 | EP guided treatment (ACE inhibitor and/or β blocker, and sequential antiarrhythmic drug treatment supplemented with ICD if drugs failed to make VT no longer inducible); transvenous devices | Conservative (ACE inhibitor and/or β blocker when tolerated and no antiarrhythmic drug treatment) | 39 months |
Bigger (1997)8: CABG patch (coronary artery bypass patch trial) | 900 | Patients having CABG with LVEF <0.36 and abnormalities of signal averaged ECG | 63.5 (9) | 85.5 | ICD; transvenous devices | Control (usual treatment) | Average 32 (16) months |
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Secondary prevention (prevent recurrence of cardiac arrest caused by VT/VF)
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Zipes (1997)10: AVID (antiarrhythmic versus implantable defibrillator) | 1016 | Cardiac arrest survivors (45%) or sustained VT with syncope, or symptomatic sustained VT (55%) with LVEF ≤40% | 65 (11) | 79.5 | ICD; transvenous devices | Amiodarone or sotalol | 45 months, mean 27 months |
Kuck (2000)11: CASH (cardiac arrest study Hamburg) | 288 | Survivors of cardiac arrest | 58 (11) | 80 | ICD; transthoracic devices pre-1991 (55%); transvenous devices post-1991 (44%) | Amiodarone or metoprolol (propefenone arm deleted in 1992 owing to high mortality) | Mean 57 (34) months; minimum 2 year follow up |
Connolly (2000)14,32 CIDS (Canadian implantable defibrillator study) | 600 | Survivors of cardiac arrest, tachyarrhythmias with symptoms, with LVEF less than 35% | 63.5 (9.0) | 84 | ICD; first 33 transthoracic devices; remaining 277 transvenous | Amiodarone | 36–60 months |
Wever (1995)13 | 60 | Survivors of cardiac arrest | 57 (10) | 90 | ICD, apart from three transvenous devices | Tiered drug treatment | 27 months |