Impact of the Multicenter Automatic Defibrillator Implantation Trial on implantable cardioverter defibrillator indication trends

Since publication of the Multicenter Automatic Defibrillator Implantation T rial (MADIT) in 1996, indications for implantation of implantable cardiover ter defibrillators (ICDs) have expanded. Initial criticisms of the study ha ve been addressed, including the need to await the conclusion of severed ad ditional ICD clinical trial. These other trials have generally shown an imp roved survival with ICD therapy when compared with antiarrhythmic agents. A s a result, ICD implantation volumes have increased worldwide. However, ICD usage has regional variation with 120 implants per million population in t he United States, 45 per million in Germany, but only 7 and 8 per million i n France and the United Kingdom, respectively. Although many factors affect implant decisions, reimbursement issues are particularly important. Other factors may explain the slower growth in Europe when compared with the Unit ed States including greater skepticism regarding MADIT, less industry-spons ored marketing, and lack of unified cardiology society support for the MADI T recommendations. Nevertheless, it is anticipated that >50,000 ICDs have b een implanted worldwide in 1998, with ct growing percentage in the countrie s of Europe. (C) 1999 by Excerpta Medico, Inc.