The AHA Guidelines and Scientific Statements Handbook

Chapter 17 Ventricular Arrhythmias and Sudden Cardiac Death

CABG-Patch

MUSTT

MADIT I

MADIT II

DINAMIT

SCD-HeFT

DEFINITE

AMIOVIRT

CAT

0 0.5^1 1.5^2 2.5

CAD, MI

NICM

CAD,

NICM

Hazard Ratio

ICD better No ICD better

LVEF

< 25

25

23

0.2 0.4 0.6 0.8 1.0 1.2 1.4

Defibrillator

Better

831

401

1232

MADIT II

15

20

25

40

35

30 30

=

= > 30

0.2 0.4 0.6 0.8 1.0 1.2 1.4

1390

285

1675

SCDHeFT

15

20

25

40

35

30

35

25

30

££

=

LVEF

0.2 0.4 0.60.8 1.0 1.2 1.4

310

458

≥ 20

< 20

35

21

15

20

25

40

35

30

DEFINITE

LVEF

148

Conventional

Better

Fig. 17.3 Plot of hazard ratios and confi dence intervals in the primary prevention ICD trials. CABG-Patch, Coronary Artery Bypass Graft
Patch Trial, MADIT, Multicenter Automatic Defi brillator Implantation Trial, MUSTT, Multicenter UnSustained Tachycardia Trial, DINAMIT,
Defi brillator in Acute Myocardial Infarction Trial, SCD-HeFT, Sudden Cardiac Death in Heart Failure Trial, DEFINITE, Defi brillators in
Nonischemic Cardiomyopathy Treatment Evaluation, AMIOVERT, Amiodarone Versus Implantable Cardioverter-Defi brillator, CAT,
Cardiomyopathy Trial.

Fig. 17.4 Summary of the three main ICD primary prevention trials: MADIT II, Multicenter Automatic Defi brillator Implantation Trial II, SCD-
HeFT, Sudden Cardiac Death in Heart Failure Trial and DEFINITE, Defi brillators in Nonischemic Cardiomyopathy Treatment Evaluation. The
dark bars are the main trial result (hazard ratio and 95% confi dence intervals plotted against the mean left ventricular ejection fraction (LVEF)
in the trial. The dotted horizontal line is the LVEF at or below which patients could be recruited into the trial. The gray bars are results
reported by the trial investigators for subgroups within the specifi ed LVEF ranges.

dysfunction due to prior MI and symptoms due to
VT unresponsive to beta-adrenergic-blocking
agents. (Level of Evidence: B) (Fig. 17.6) [30–33].
3 Sotalol is reasonable therapy to reduce
symptoms resulting from VT for patients with

LV dysfunction due to prior MI unrespon-

sive to beta-blocking agents. (Level of Evidence:

C)

4 Adjunctive therapies to the ICD, including cath-

eter ablation or surgical resection, and pharmaco-