The AHA Guidelines and Scientifi c Statements Handbook
Fig. 17.5 Some trial results and analyses which bear on the restriction of ICD indication to a period later than 40 days after acute
myocardial infarction in patients who have a life expectancy of at least 1 year: (1) MADIT II (Multicenter Automatic Defi brillator Implantation
Trial II) results suggest that benefi t from the ICD is gained only after about 12 months of follow-up (top left) and (2) those who most benefi t
were recruited to the trial more than 18 months following their index myocardial infarction (bottom left); (3) substantially greater life year
gains are seen when patients from MADIT or MUSTT (Multicenter UnSustained Tachycardia Trial) are followed for longer periods after
myocardial infarction (top right); and (4) recruitment of patients shortly after myocardial infarction (within 40 days) is not associated with any
net benefi t according to the DINAMIT (Defi brillator in Acute Myocardial Infarction Trial) because the reduction in arrhythmic mortality is more
than offset by increased nonarrhythmic mortality in the ICD treated group.
Table 17.4 Major ICD Secondary Prevention Trials
Study MADIT II DEFINITE SCD HeFT
Sponsor Guidant St Jude MIH/Wyeth/Medtronic
Reported in NEJM Mar 2002 May 2004 Jan 2005
No of patients 1232 458 2521
Disease MI CM/CHF CHF
NYHA I/II/III/IV 37/34.5/24/4.5 21.6/57.4/21.0/..... ./70/30/...
LVEF, % ≤30 (23) ≤35 (21) ≤35 (25)
IHD/NIHD, % 100/..... ./100 52/48
Device ICD ICD ICD
1° end-point ACM ACM ACM
Study duration Jul 1997–Nov 2001 July 1998–June 2002 Sep 1997–Jul 2001
Follow-up, months 20 29 45.5
logical therapy with agents such as amiodarone or
sotalol are reasonable to improve symptoms due to
frequent episodes of sustained VT or VF in patients
with LV dysfunction due to prior MI. (Level of Evi-
dence: C) [34].
5 Amiodarone is reasonable therapy to reduce
symptoms due to recurrent hemodynamically stable
VT for patients with LV dysfunction due to prior MI
who cannot or refuse to have an ICD implanted.
(Level of Evidence: C)