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Moss, AJ et al. "Improved Survival with an Implanted Defibrillator in Patients with Coronary Disease at High Risk for Ventricular Arrhythmia" New England Journal of Medicine. 335(26), 1933–1940.
Clinical Question
In high-risk patients with ischemic cardiomyopathy does prophylactic ICD placement improve survival?
Bottom Line
In post-MI patients with systolic dysfunction (EF <35%), asymptomatic NSVT, and inducible non-suppressible ventricular tachyarrhythmia on electrophysiology study, prophylactic ICD reduced mortality compared to standard medical therapy.
Major Points
Guidelines
AHA/ACC/HRS Ventricular Arrhythmia and Prevention of Sudden Cardiac Death Guidelines (2017, adapted) [1]
- ICD is recommended in patients with prior MI, NSVT, LVEF of 40% or less, and inducible sustained VT or VF at EP study if meaningful survival of greater than 1 year is expected (Class I: LOE B-R)
Design
Population
Inclusion Criteria
Exclusion Criteria
Baseline Characteristics
Baseline Therapy
Interventions
Outcomes
Primary Outcome
Outcome
Secondary Outcome
Outcome
Subgroup Analysis
Criticisms
Funding
- CPI/Guidant Corporation, St. Paul, Minn.