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Related Experiment Videos

Evidence-based medicine and the implantable defibrillator.

R N Fogoros1

  • 1Electrophysiology Section, Allegheny General Hospital, Pittsburgh, PA 15212, USA.

Current Cardiology Reports
|September 12, 2000
PubMed
Summary

Implantable defibrillators are now recommended for patients with symptomatic ventricular arrhythmias. For primary prevention in high-risk patients, defibrillators show survival benefits, warranting consideration despite screening inconvenience.

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Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Devices

Background:

  • Implantable defibrillators (ICDs) are established treatments for symptomatic ventricular tachyarrhythmias.
  • Primary preventative use of ICDs for at-risk patients without prior events is less defined.
  • Existing evidence supports ICDs in specific high-risk patient groups.

Purpose of the Study:

  • To review the current evidence supporting implantable defibrillator use in clinical practice.
  • To evaluate the role of ICDs in primary prevention of sudden cardiac death.
  • To inform clinical decision-making regarding ICD implantation.

Main Methods:

  • Analysis of recent randomized clinical trials.
  • Evaluation of data from electrophysiologic testing.

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  • Assessment of survival benefits in patient cohorts.

    • Main Results:

    • Strong evidence supports ICDs as first-line therapy for symptomatic sustained ventricular tachyarrhythmias.
    • Two trials show survival benefit for ICDs in patients with ischemic heart disease, low ejection fraction, non-sustained VT, and inducible VT.
    • Screening for primary prevention is recommended despite inconvenience.

    Conclusions:

    • Implantable defibrillators are strongly indicated for patients with symptomatic ventricular tachyarrhythmias.
    • ICDs demonstrate a survival benefit for primary prevention in select high-risk ischemic heart disease patients.
    • Further trials are needed to broaden the application of ICDs for primary prophylaxis.