Pankaj Arora, M.D.A new study from a team of researchers at the University of Alabama at Birmingham published in Circulation has found that there is a 23 percent risk in reduction of all-cause mortality with use of implantable cardioverter-defibrillator therapy in patients with non-ischemic cardiomyopathy, a disease that exhibits inappropriate ventricular hypertrophy or dilatation.
The study provides further support to the current American Heart Association and American College of Cardiology guidelines and challenges the recently published DANISH trial in New England Journal of Medicine.
A team of researchers from UAB identified six clinical trials with 2,970 patients with non-ischemic cardiomyopathy to study the efficacy of ICD for primary prevention. Investigators reported data on all-cause mortality from these clinical trials.
An ICD is a small device that is placed in the chest or abdomen. Doctors use the device to help treat irregular heartbeats, called arrhythmias.
“While the data supporting the use of ICDs is robust in patients with ischemic cardiomyopathy, limited clinical trial data existed for similar benefit in patients with non-ischemic cardiomyopathy,” said senior author Pankaj Arora, M.D., assistant professor in the Division of Cardiovascular Disease.
Researchers found that, despite the neutral results of the recently published DANISH trial, the current analyses demonstrated significant clinical benefit on all-cause mortality in favor of ICD use for primary prevention in patients with non-ischemic cardiomyopathy. Additional UAB co-authors of the circulation manuscript are Navkaranbir Singh Bajaj, M.D., and Garima Arora, M.D., in the Division of Cardiovascular Disease.
“Traditional reliance on ejection fraction — which is the percentage of blood that is ejected out of the ventricles with each contraction — for risk stratification of sudden cardiac death is not an ideal approach,” he said.
Arora noted that, in the future, improvement in risk-prediction models to provide personalized decisions on who should get an ICD hopefully will become standard of care. Until then, authors concluded that clinical judgment should prevail while assessing risk of sudden cardiac in non-ischemic cardiomyopathy patients with reduced ejection fraction.