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Europace Advance Access published online on May 2, 2006
Europace, doi:10.1093/europace/eul040
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© The European Society of Cardiology 2006. All rights reserved
Received August 9, 2005
Accepted March 21, 2006

Article

Lessons learned from neutral ICD trials

Seah Nisam 1 * and Günter Breithardt 2

1 Guidant Corporation, Park Lane, Culliganlaan 2B, 1831 Diegem, Brussels, Belgium
2 Department of Cardiology and Angiology, Hospital of the University of Münster, Münster, Germany

* To whom correspondence should be addressed.
Seah Nisam, E-mail: snisam{at}guidant.com


  Abstract

Multiple prospective randomized trials with implantable cardioverter defibrillators (ICDs) over the past decade have convincingly established the efficacy of ICD therapy in reducing all-cause mortality, by significantly reducing sudden cardiac death. Nevertheless, four trials have failed to show improved survival. Analysing these, in comparison with the positive trials, provides important information concerning the type of patients not likely to receive benefit from ICDs: (i) those with relatively low mortality (≤18% within 2 years of follow-up; (ii) those whose mechanism of death is predominantly non-arrhythmic; (iii) patients early (within 6 weeks) after infarction.

Keywords: Implantable cardioverter defibrillator; Sudden death; ICD trials.
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