Implantable cardioverter-defibrillators in arrhythmias: a rapid and systematic review of effectiveness

Area of Science:

• Cardiology
• Medical Devices
• Clinical Trials

Background:

• Sudden cardiac death (SCD) remains a significant cause of mortality.
• Identifying patients at high risk for ventricular arrhythmias is crucial for prevention.
• Implantable cardioverter-defibrillators (ICDs) are a key therapeutic option.

Purpose of the Study:

• To systematically review the effectiveness of ICDs in managing SCD risk factors.
• To evaluate the impact of ICDs on mortality reduction.
• To assess the benefits of ICDs compared to conventional treatments.

Main Methods:

• Systematic review of randomized controlled trials.
• Searched eight electronic databases, bibliographies, and expert consultations.
• Analyzed absolute and relative reductions in total mortality.

Main Results:

• Seven trials met inclusion criteria, demonstrating variable absolute mortality risk changes (-22.8% to +1.7%).
• Relative risk reductions ranged from -7% to +54%.
• ICD treatment provided an estimated 0.23 to 0.80 additional life-years at three years compared to drug therapy.

Conclusions:

• ICDs are effective in reducing total mortality for specific patient subgroups at high risk of ventricular arrhythmias.
• Optimal patient selection criteria for ICD benefit require further clarification.
• Ongoing trials in cardiac failure may elucidate cost-effective ICD use in specific populations.