Related Experiment Video
Updated: Mar 15, 2026
A New Single Chamber Implantable Defibrillator with Atrial Sensing: A Practical Demonstration of Sensing and Ease of Implantation
Published on: February 28, 2012
Defibrillator Implantation in Patients with Nonischemic Systolic Heart Failure
Lars Køber1, Jens J Thune1, Jens C Nielsen1
1From the Department of Cardiology, Rigshospitalet (L.K., J.J.T., F.G., R.V., C.H., J.H.S., D.E.H., S.P.), and the Department of Cardiology, Bispebjerg Hospital (J.J.T.), University of Copenhagen, Copenhagen; the Department of Cardiology, Aarhus University Hospital, Aarhus (J.C.N., H.E.); the Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup (J.H., N.E.B.); the Department of Cardiology, Odense University Hospital, Odense (L.V., A.B.); the Department of Cardiology, Aalborg University Hospital (E.K., A.M.T., C.T.-P.), and the Clinical Institute, Aalborg University (N.E.B.), Aalborg; the Department of Cardiology, Zealand University Hospital, Roskilde (G.J.); Frederiksberg Heart Clinic, Frederiksberg (P.H.); the Department of Cardiology, Lillebaelt Hospital, Vejle (F.H.S.); and the Department of Cardiology, Odense University Hospital, Svendborg (K.E.) - all in Denmark.
Insights
Prophylactic implantable cardioverter-defibrillators (ICDs) did not significantly reduce overall mortality in patients with systolic heart failure unrelated to coronary artery disease. However, ICDs did significantly reduce sudden cardiac death in this patient group.
Area of Science:
- Cardiology
- Medical Devices
Background:
- The benefit of implantable cardioverter-defibrillators (ICDs) is established for systolic heart failure due to coronary artery disease.
- Evidence for ICDs in non-coronary systolic heart failure relies on subgroup analyses, with limited data on contemporary management including cardiac resynchronization therapy (CRT).
Purpose of the Study:
- To evaluate the efficacy of prophylactic ICD implantation in patients with symptomatic systolic heart failure not caused by coronary artery disease.
- To assess the impact of ICDs on all-cause mortality, sudden cardiac death, and cardiovascular death in this specific patient population.
Main Methods:
- A randomized controlled trial involving 1116 patients with symptomatic systolic heart failure (left ventricular ejection fraction ≤35%) not due to coronary artery disease.
- Patients were assigned to either ICD implantation or usual clinical care, with 58% in both groups receiving cardiac resynchronization therapy (CRT).
- Primary outcome was death from any cause; secondary outcomes included sudden cardiac death and cardiovascular death.
Main Results:
- After a median follow-up of 67.6 months, no significant difference in all-cause mortality was observed between the ICD and control groups (21.6% vs. 23.4%, P=0.28).
- A significant reduction in sudden cardiac death was observed in the ICD group compared to the control group (4.3% vs. 8.2%, P=0.005).
- Device infection rates were similar between the groups (4.9% vs. 3.6%, P=0.29).
Conclusions:
- Prophylactic ICD implantation in patients with systolic heart failure not caused by coronary artery disease did not significantly reduce the long-term rate of death from any cause.
- ICDs demonstrated a significant benefit in reducing sudden cardiac death in this patient cohort.
- The findings suggest that while ICDs may not improve overall survival, they play a crucial role in preventing sudden cardiac death in specific heart failure populations.
Background:
The benefit of an implantable cardioverter-defibrillator (ICD) in patients with symptomatic systolic heart failure caused by coronary artery disease has been well documented. However, the evidence for a benefit of prophylactic ICDs in patients with systolic heart failure that is not due to coronary artery disease has been based primarily on subgroup analyses. The management of heart failure has improved since the landmark ICD trials, and many patients now receive cardiac resynchronization therapy (CRT).
Methods:
In a randomized, controlled trial, 556 patients with symptomatic systolic heart failure (left ventricular ejection fraction, ≤35%) not caused by coronary artery disease were assigned to receive an ICD, and 560 patients were assigned to receive usual clinical care (control group). In both groups, 58% of the patients received CRT. The primary outcome of the trial was death from any cause. The secondary outcomes were sudden cardiac death and cardiovascular death.
Results:
After a median follow-up period of 67.6 months, the primary outcome had occurred in 120 patients (21.6%) in the ICD group and in 131 patients (23.4%) in the control group (hazard ratio, 0.87; 95% confidence interval [CI], 0.68 to 1.12; P=0.28). Sudden cardiac death occurred in 24 patients (4.3%) in the ICD group and in 46 patients (8.2%) in the control group (hazard ratio, 0.50; 95% CI, 0.31 to 0.82; P=0.005). Device infection occurred in 27 patients (4.9%) in the ICD group and in 20 patients (3.6%) in the control group (P=0.29).
Conclusions:
In this trial, prophylactic ICD implantation in patients with symptomatic systolic heart failure not caused by coronary artery disease was not associated with a significantly lower long-term rate of death from any cause than was usual clinical care. (Funded by Medtronic and others; DANISH ClinicalTrials.gov number, NCT00542945 .).
Related Concept Videos
01:29Cardiomyopathy V: Interprofessional Care
01:22Heart Failure VI: Adjunct Therapies
01:26Heart Failure Drugs: Inotropic Agents
01:30Cardiomyopathy II: Dilated Cardiomyopathy
01:30Heart Failure V: Medical Management
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System