The use of defibrillators for ventricular arrhythmias may significantly reduce mortality when sudden cardiac death is the major contributor
The 2018 guidelines from the National Heart Foundation and the Cardiac Society of Australia and New Zealand provide evidence‐based direction for the management of heart failure in Australia.1 A Perspective article published in the Journal in 20192 challenged the weak recommendation for the implantation of a defibrillator in the primary prevention of mortality in dilated cardiomyopathy (DCM) with a left ventricular ejection fraction (LVEF) of 35% or below.1 The authors of the MJA article2 questioned the differences between this recommendation1 and recent Canadian and American guidelines.3,4 We welcome this opportunity to clarify the basis for the Australian guidelines recommendation.
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- 1. Atherton JJ, Sindone A, De Pasquale CG, et al; NHFA CSANZ Heart Failure Guidelines Working Group. National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: guidelines for the prevention, detection, and management of heart failure in Australia 2018. Heart Lung Circ 2018; 27: 1123–1208.
- 2. Lau DH, Kalman JM, Sanders P. Primary prevention implantable cardioverter defibrillators in non‐ischaemic cardiomyopathy: challenging the Australian heart failure guidelines. Med J Aust 2019; 211: 154–155. https://www.mja.com.au/journal/2019/211/4/primary-prevention-implantable-cardioverter-defibrillators-non-ischaemic
- 3. Bennett M, Parkash R, Nery P, et al. Canadian Cardiovascular Society/Canadian Heart Rhythm Society 2016 implantable cardioverter‐defibrillator guidelines. Can J Cardiol 2017; 33: 174–188.
- 4. Al‐Khatib SM, Stevenson WG, Ackerman MJ, et al. 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Heart Rhythm 2018; 15: e73–e189.
- 5. Moss AJ, Zareba W, Hall WJ, et al. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med 2002; 346: 877–883.
- 6. Bardy GH, Lee KL, Mark DB, et al. Amiodarone or an implantable cardioverter‐defibrillator for congestive heart failure. N Engl J Med 2005; 352: 225–237.
- 7. Køber L, Thune JJ, Nielsen JC, et al. Defibrillator implantation in patients with nonischemic systolic heart failure. N Engl J Med 2016; 375: 1221–1230.
- 8. Stavrakis S, Asad Z, Reynolds D. Implantable cardioverter defibrillators for primary prevention of mortality in patients with nonischemic cardiomyopathy: a meta‐analysis of randomized controlled trials. J Cardiovasc Electrophysiol 2017; 28: 659–665.
- 9. Strickberger SA, Hummel JD, Bartlett TG, et al. Amiodarone versus implantable cardioverter‐defibrillator: randomized trial in patients with nonischemic dilated cardiomyopathy and asymptomatic nonsustained ventricular tachycardia — AMIOVIRT. J Am Coll Cardiol 2003; 41: 1707–1712.
- 10. Ranasinghe I, Labrosciano C, Horton D, et al. Institutional variation in quality of cardiovascular implantable electronic device implantation: a cohort study. Ann Intern Med 2019; 171: 309–317.
- 11. Elming MB, Nielsen JC, Haarbo J, et al. Age and outcomes of primary prevention implantable cardioverter‐defibrillators in patients with nonischemic systolic heart failure. Circulation 2017; 136: 1772–1780.
- 12. Jacobs AK, Anderson JL, Halperin JL, et al. The evolution and future of ACC/AHA clinical practice guidelines: a 30‐year journey: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014; 64: 1373–1384.
Peter Kistler has received consulting fees from St Jude Medical, now known as Abbott.