***(La Rovere MT, Bigger Jr JT, Marcus FI, Mortara A, Schwartz PJ. Baroreflex sensitivity
and heart-rate variability in prediction of total cardiac mortality after myocardial infarction.
ATRAMI (Autonomic Tone and Reflexes After Myocardial Infarction)
Investigators. Lancet 1998; 351: 478–84)
5% to 10% of hospitalized patients may develop
ventricular tachycardia (VT)/ventricular fibrillation (VF),
usually within 48 hours
Primary Secondary
Prevention Prevention
Trial Year Patient LVEF Additional Study Hazard 95% CI p
s Features Ratio*
(n)
MADIT I 1996 196 < 35% NSVT and EP+ 0.46 (0.26-0.82) p=0.009
MADIT II 2002 1232 < 30% Prior MI 0.69 (0.51-0.93) p=0.016
CABG- 1997 900 < 36% +SAECG and CABG 1.07 (0.81-1.42) p=0.63
Patch
DEFINITE 2004 485 < 35% NICM, PVCs or 0.65 (0.40-1.06) p=0.08
NSVT
DINAMIT 2004 674 < 35% 6-40 days post-MI 1.08 (0.76-1.55) p=0.66
and Impaired HRV
SCD-HeFT 2006 1676 < 35% Prior MI of NICM 0.77 (0.62-0.96) p=0.007
AVID 1997 1016 Prior cardiac NA 0.62 (0.43-0.82) NS
arrest
CASH† 2000 191 Prior cardiac NA 0.766 ‡ 1-sided
arrest p=0.081
CIDS 2000 659 Prior cardiac NA 0.82 (0.60-1.1) NS
arrest,
syncope
* Hazard ratios for death from any cause in the ICD group compared with the non-ICD group. Includes only ICD and amiodarone patients from CASH.
‡CI Upper Bound 1.112 CI indicates Confidence Interval, NS = Not statistically significant, NSVT = nonsustained ventricular tachycardia, SAECG =
signal-averaged electrocardiogram.
Epstein A, et al. ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities. J Am Coll Cardiol 2008; 51:e1–62. Table
ICD therapy is indicated before discharge in patients
who develop sustained VT/VF more than 48 hours after
STEMI, provided the arrhythmia is not due to transient
or reversible ischemia, reinfarction, or metabolic
abnormalities*
All primary SCD prevention ICD recommendations apply only to patients who are receiving optimal medical
therapy and have reasonable expectation of survival with good functional capacity for more than 1 year.
PEDOMAN TERAPI MEMAKAI ALAT ELEKTRONIK KARDIOVASKULAR IMPLAN (ALEKA), PERKI 2014
In patients who are within 90 days of
revascularization and who previously qualified for
the implantation of an ICD for primary prevention
of sudden cardiac death, and who have
undergone revascularization that is unlikely to
result in an improvement in LVEF >0.35, and who
are not within 40 days after an acute MI,
implantation of an ICD can be useful
(n=742) (n=490)
19.8% Hazard
20%
Ratio =
0.65
15% 14.2%
10%
5%
0%
Conventional ICD
Therapy
Non Cardiac Cardiac Arrhythmic Non Arrhythmic
15% 13.7%
10.0%
10% 9.4%
5.5%
5% 4.1% 3.6% 3.7%
3.5%
0%
Conv ICD Conv ICD Conv ICD Conv ICD
Therapy Therapy Therapy Therapy
In a MADIT-II substudy of 951 patients with prior
coronary revascularization, an ICD was of benefit
only in patients enrolled at least 6 months after
revascularization