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Peer-reviewedCC BYArquivos brasileiros de cardiologia

Eficácia de Cardiodesfibrilador Implantável na Prevenção Primária em Pacientes com Insuficiência Cardíaca com Fração de Ejeção Reduzida não Isquêmica

  • Luis E Rohde1,2
  • Leandro I Zimerman1,2
  • Lídia Z Moura3
  • Luis C Danzmann4,5
  • Silvia M Martins6
  • Verônica Colpani1,7
  • Kelly Zucatti8
  • José Albuquerque de Figueiredo-Neto9
  • Fabiana G Marcondes-Braga10
  • Ricardo Mourilhe-Rocha11,12
  • Denilson Campos de Albuquerque11,13
  • Mucio T de Oliveira-Júnior10
1 more authors
  • Marcus V Simões14
14 affiliations
  1. 1Hospital de Clínicas de Porto Alegre, Porto Alegre, RS - Brasil.
  2. 2Hospital Moinhos de Vento, Porto Alegre, RS - Brasil.
  3. 3Hospital Universitário do Cajuru, Pontifícia Universidade Católica Paraná (PUCPR), Curitiba, PR - Brasil.
  4. 4Santa Casa de Porto Alegre, Porto Alegre, RS - Brasil.
  5. 5Universidade Luterana do Brasil, Canoas, RS - Brasil.
  6. 6PROCAPE- Universidade de Pernambuco, Recife, PE - Brasil.
  7. 7Hospital Sírio-Libanes, São Paulo, SP - Brasil.
  8. 8Instituto de Cardiologia/ Fundação Universitária de Cardiologia, Porto Alegre, RS - Brasil.
  9. 9Hospital Universitário da Universidade Federal do Maranhão, São Luiz, MA - Brasil.
  10. 10Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil.
  11. 11Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ - Brasil.
  12. 12Complexo Hospitalar Américas - Vitória e Samaritano Barra, Rio de Janeiro, RJ - Brasil.
  13. 13Instituto D'Or de Pesquisa e Ensino-IDOR, Rio de Janeiro, RJ - Brasil.
  14. 14Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, SP - Brasil.
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Abstract

Background

Primary prevention with an implantable cardioverter-defibrillator (ICD) has become an increasingly debated strategy, with its role in patients with nonischemic heart failure with reduced ejection fraction (HFrEF) undergoing continued reassessment.Objective

To summarize the available scientific evidence on the effectiveness of ICD therapy for primary prevention in patients with nonischemic HFrEF.Methods

A rapid systematic review and meta-analysis was conducted in accordance with the recommendations of the Cochrane Rapid Reviews Methods Group and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Statistical significance was defined as a two-sided p-value < 0.05. Searches were performed in the MEDLINE, Embase, and CENTRAL databases. Randomized controlled trials (RCTs) evaluating ICD implantation for primary prevention were included, with sudden cardiac death (SCD), cardiovascular mortality, and all-cause mortality as the primary outcomes.Results

A total of 18 publications reporting daata from six pivotal RCTs were included. ICD therapy was associated with a statistically significant reduction in SCD (relative risk [RR] 0.41; 95%CI 0.26-0.65; high-certainty evidence) and cardiovascular mortality (RR 0.75; 95%CI 0.59-0.95; high-certainty evidence). For all-cause mortality, the primary analysis showed no statistically significant difference between groups (RR 0.88; 95%CI 0.72-1.07; moderate-certainty evidence). In the subgroup analysis, studies with shorter follow-up (< 6.8 years) demonstrated a significant reduction in all-cause mortality (RR 0.69; 95%CI 0.52-0.92).Conclusion

In patients with nonischemic HFrEF, ICD therapy reduced SCD and cardiovascular mortality but did not significantly reduce all-cause mortality in the primary analysis. These findings support the use of ICD therapy when guided by individualized clinical assessment.

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Cite

BibTeXRIS
BibTeX
@article{rohde2026eficácia,
  title = {{Eficácia de Cardiodesfibrilador Implantável na Prevenção Primária em Pacientes com Insuficiência Cardíaca com Fração de Ejeção Reduzida não Isquêmica}},
  author = {Luis E Rohde and Leandro I Zimerman and Lídia Z Moura and Luis C Danzmann and Silvia M Martins and Verônica Colpani and Kelly Zucatti and José Albuquerque de Figueiredo-Neto and Fabiana G Marcondes-Braga and Ricardo Mourilhe-Rocha and Denilson Campos de Albuquerque and Mucio T de Oliveira-Júnior and Marcus V Simões},
  journal = {Arquivos brasileiros de cardiologia},
  year = {2026},
  month = oct,
  doi = {10.36660/abc.20250675},
  url = {https://europepmc.org/article/PMC/PMC13668461},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Eficácia de Cardiodesfibrilador Implantável na Prevenção Primária em Pacientes com Insuficiência Cardíaca com Fração de Ejeção Reduzida não Isquêmica
AU  - Luis E Rohde
AU  - Leandro I Zimerman
AU  - Lídia Z Moura
AU  - Luis C Danzmann
AU  - Silvia M Martins
AU  - Verônica Colpani
AU  - Kelly Zucatti
AU  - José Albuquerque de Figueiredo-Neto
AU  - Fabiana G Marcondes-Braga
AU  - Ricardo Mourilhe-Rocha
AU  - Denilson Campos de Albuquerque
AU  - Mucio T de Oliveira-Júnior
AU  - Marcus V Simões
PY  - 2026
DA  - 2026/10/19
JO  - Arquivos brasileiros de cardiologia
DO  - 10.36660/abc.20250675
UR  - https://europepmc.org/article/PMC/PMC13668461
AB  - Background  Primary prevention with an implantable cardioverter-defibrillator (ICD) has become an increasingly debated strategy, with its role in patients with nonischemic heart failure with reduced ejection fraction (HFrEF) undergoing continued reassessment.Objective  To summarize the available scientific evidence on the effectiveness of ICD therapy for primary prevention in patients with nonischemic HFrEF.Methods  A rapid systematic review and meta-analysis was conducted in accordance with the recommendations of the Cochrane Rapid Reviews Methods Group and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Statistical significance was defined as a two-sided p-value < 0.05. Searches were performed in the MEDLINE, Embase, and CENTRAL databases. Randomized controlled trials (RCTs) evaluating ICD implantation for primary prevention were included, with sudden cardiac death (SCD), cardiovascular mortality, and all-cause mortality as the primary outcomes.Results  A total of 18 publications reporting daata from six pivotal RCTs were included. ICD therapy was associated with a statistically significant reduction in SCD (relative risk [RR] 0.41; 95%CI 0.26-0.65; high-certainty evidence) and cardiovascular mortality (RR 0.75; 95%CI 0.59-0.95; high-certainty evidence). For all-cause mortality, the primary analysis showed no statistically significant difference between groups (RR 0.88; 95%CI 0.72-1.07; moderate-certainty evidence). In the subgroup analysis, studies with shorter follow-up (< 6.8 years) demonstrated a significant reduction in all-cause mortality (RR 0.69; 95%CI 0.52-0.92).Conclusion  In patients with nonischemic HFrEF, ICD therapy reduced SCD and cardiovascular mortality but did not significantly reduce all-cause mortality in the primary analysis. These findings support the use of ICD therapy when guided by individualized clinical assessment.
SN  - 0066-782X
SN  - 1678-4170
ER  -