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MADIT-II and Primary Prevention ICD — EECC MCQ

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ModerateArrhythmia & ElectrophysiologyMADIT-II and Primary Prevention ICDEECC

A 55-year-old man has an ICD implanted for primary prevention (ischaemic CMP, LVEF 28%). Which landmark trial established the mortality benefit of primary prevention ICD in post-MI patients with reduced LVEF?

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Correct answer: E — MADIT-II — demonstrated a 31% relative reduction in all-cause mortality with prophylactic ICD in post-MI patients with LVEF ≤30%

MADIT-II (2002) was the pivotal trial establishing primary prevention ICD therapy in post-MI patients with LVEF ≤30%. It demonstrated a 31% relative reduction in all-cause mortality with ICD compared with conventional medical therapy over 20 months of follow-up. SCD-HeFT (2005) later extended this to both ischaemic and non-ischaemic cardiomyopathy with LVEF ≤35% and NYHA II-III. AVID, CIDS, and CASH established secondary prevention ICD benefit (survivors of VT/VF). COMPANION demonstrated CRT-D benefit. The ESC 2022 VA/SCD Guidelines base primary prevention ICD recommendations on these trials: LVEF ≤35% despite ≥3 months of optimal GDMT (Class I for ischaemic; Class I/IIa for non-ischaemic depending on additional factors).

Reference: ESC (2022): Guidelines on VA and SCD Prevention; MADIT-II Trial