Prophylactic ICD implantation did not significantly reduce total mortality compared to no antiarrhythmic therapy (HR 1.07, P=0.63), because 71% of deaths were nonarrhythmic.
RCT (n=900)
Effect estimate: HR 1.07
Absolute Event Rate: 22.9% vs 21.1%
p-value: p=0.63
BACKGROUND: The CABG Patch trial compared prophylactic implantable cardiac-defibrillator (ICD) implantation with no antiarrhythmic therapy in coronary bypass surgery patients who had a left ventricular ejection fraction 1 hour from the onset of symptoms, dyspnea within 7 days of death, and overt heart failure within 7 days of death. CONCLUSIONS: In the CABG Patch Trial, ICD therapy reduced arrhythmic death 45% without significant effect on nonarrhythmic deaths. Because 71% of the deaths were nonarrhythmic, total mortality was not significantly reduced.
Bigger et al. (Tue,) conducted a rct in Coronary bypass surgery patients with left ventricular ejection fraction <0.36 and abnormal signal-averaged ECG (n=900). Prophylactic implantable cardiac-defibrillator (ICD) vs. No antiarrhythmic therapy was evaluated on Total mortality (HR 1.07, p=0.63). Prophylactic ICD implantation did not significantly reduce total mortality compared to no antiarrhythmic therapy (HR 1.07, P=0.63), because 71% of deaths were nonarrhythmic.
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