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The implantable cardioverter-defibrillator
1University of Washington, AVID Clinical Trial Center, Seattle 98105, USA.
Insights
The implantable cardioverter-defibrillator (ICD) is a superior treatment for ventricular arrhythmias, especially for patients with a history of cardiac events. Clinical trials confirm its effectiveness in preventing sudden cardiac death.
Area of Science:
- Cardiology
- Electrophysiology
Background:
- Ventricular arrhythmias are a leading cause of cardiovascular mortality.
- Treatment has shifted from antiarrhythmic drugs to implanted devices like the implantable cardioverter-defibrillator (ICD).
Purpose of the Study:
- To evaluate the efficacy of the implantable cardioverter-defibrillator (ICD) in managing serious ventricular arrhythmias.
- To compare ICD therapy with conventional antiarrhythmic drug therapy.
Main Methods:
- Review of controlled clinical trials and therapeutic outcomes.
- Analysis of patient populations including those with ventricular fibrillation, sustained ventricular tachycardia, and post-myocardial infarction survivors.
Main Results:
- The ICD is the preferred therapy for ventricular fibrillation without reversible causes and for sustained ventricular tachycardia causing syncope.
- In primary prevention, ICDs are superior to antiarrhythmic drugs for specific high-risk post-myocardial infarction patients.
Conclusions:
- The implantable cardioverter-defibrillator (ICD) represents a major advancement in treating life-threatening ventricular arrhythmias.
- Further research is needed to establish the survival benefits of ICDs in other patient groups.
Abstract:
Ventricular arrhythmias remain a major cause of cardiovascular mortality. Therapy for serious ventricular arrhythmias has evolved over the past decade, from treatment primarily with antiarrhythmic drugs to implanted devices. The implantable cardioverter-defibrillator (ICD) is the best therapy for patients who have experienced an episode of ventricular fibrillation not accompanied by an acute myocardial infarction or other transient or reversible cause. It is also superior therapy in patients with sustained ventricular tachycardia (VT) causing syncope or hemodynamic compromise. Controlled clinical trials have confirmed the utility of these devices. As primary prevention, the ICD is superior to conventional antiarrhythmic drug therapy in patients who have survived a myocardial infarction and who have spontaneous, nonsustained ventricular tachycardia, a low ejection fraction, inducible VT at electrophysiologic study, and whose VT is not suppressed by procainamide. The effect of the ICD on survival of other patient populations remains to be proven. The device is costly, but its price is generally accepted to be reasonable. The ICD has been a major advance in the treatment of ventricular arrhythmias.