ICDs for Primary Prevention in High-Risk Patients with Nonischemic DCM?

Despite the survival benefits of ACE inhibitors and beta-blockers, sudden death remains a substantial problem for patients with left-ventricular dysfunction (ischemic or nonischemic) and heart failure. Implantable cardioverter-defibrillators (ICDs) reduce sudden-death risk in cardiac arrest survivors, patients with sustained ventricular tachycardia, and post-MI patients with LV dysfunction (Journal Watch Cardiology May 3 2002).

Now, in the DEFINITE trial, researchers evaluated ICDs for primary prevention in patients with NYHA class I-III nonischemic dilated cardiomyopathy (DCM) and histories of symptomatic heart failure. They randomized 458 patients (71% men; mean LV ejection fraction, 21.4%, maximum LVEF, <36%) to receive standard medical t…