Table 1

Summary of randomised controlled trials of implantable cardioverter-defibrillators versus drug treatment to reduce sudden cardiac death: trial characteristics

Study and year of publicationnPatients; inclusion criteriaAge (years)*Sex (% male)Intervention and type of ICD insertionComparitorDuration of follow up
*Mean (SD); †median.
ACE, angiotensin converting enzyme; CABG, coronary artery bypass graft; EP, electrophysiology; ICD, implantable cardioverter-defibrillator; LVEF, left ventricular ejection fraction; MI, myocardial infarction; NYHA, New York Heart Association; VF, ventricular fibrillation; VT, ventricular tachycardia.
Primary prevention of VT/VF (prevent SCD from first incident of VT/VF)
Moss (1996)7: MADIT (multicenter automatic defibrillator implantation trial)196MI 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 months63 ( 9)92Prophylactic ICD; 47% transthoracic devices, 53% transvenous devicesConventional tiered treatment27 months
Buxton (1999)9,31: MUSTT (multicenter unsustained tachycardia trial)704Coronary heart disease, non-sustained VT; LVEF <40% and EP diagnosed inducible sustained VT†66.5 (58 to 72 )90EP 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 devicesConservative (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)900Patients having CABG with LVEF <0.36 and abnormalities of signal averaged ECG63.5 (9)85.5ICD; transvenous devicesControl (usual treatment)Average 32 (16) months
Secondary prevention (prevent recurrence of cardiac arrest caused by VT/VF)
Zipes (1997)10: AVID (antiarrhythmic versus implantable defibrillator)1016Cardiac arrest survivors (45%) or sustained VT with syncope, or symptomatic sustained VT (55%) with LVEF ≤40%65 (11)79.5ICD; transvenous devicesAmiodarone or sotalol45 months, mean 27 months
Kuck (2000)11: CASH (cardiac arrest study Hamburg)288Survivors of cardiac arrest58 (11)80ICD; 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)600Survivors of cardiac arrest, tachyarrhythmias with symptoms, with LVEF less than 35%63.5 (9.0)84ICD; first 33 transthoracic devices; remaining 277 transvenousAmiodarone36–60 months
Wever (1995)1360Survivors of cardiac arrest57 (10)90ICD, apart from three transvenous devicesTiered drug treatment27 months