Congestive Heart Failure
Due to Systolic Dysfunction

• Pharmacologic Therapy
• Beta-blockers-in heart failure
• ACE-inhibitors- use maximal dosages in heart failure
• Angiotensin blockers- instead of and as well as ace-inhibitor therapy with beta-blockers
• Spirinolactone in heart failure
• Nitrate and hydralazine combination for African-Americans

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• Prophylactic ICD therapy

The DEFINITE Trial- Use of implantable defibrillators to reduce sudden death risk in cardiomyopathy

The DEFINITE trial included patients with severe non-ischaemia cardiomyopathy (EF less than 35%) and non-sustained ventricular trachycardia or an average of 10 PVCs/hour on Holter monitor.

The patients were randomised to an ICD or medical therapy.

The study found:
• a lower than expected annual mortality of only 6% to 7%, presumably reflecting the benefits of treatment with ACE inhibitors and beta-blockers.
• On drug therapy, arrhythmic sudden cardiac death accounted for only one third of all deaths.
• A reduction with ICD implantation of arrhythmic death and a clear trend towards reduced all-cause mortality.
• The absolute mortality benefit was 5.7% at 2 years.

A number of other studies have examined the benefits of prophylactic use of implantable defibrillators in those with severe impairment of left ventricular systolic function due to ischaemic heart disease or due to a cardiomyopathy.

Hitesh Patel, Cardiologist
6th March, 2005

Reference:

Prophylactic Defibrillator Implantation in Patients with Nonischemic Dilated Cardiomyopathy. N Engl J Med 2004;350:2151-8.