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Evidence rather than costs must guide use of the implantable cardioverter defibrillator
E Delacretaz1, J Schlaepfer, J Metzger
1Division of Cardiology, University Hospital, Lausanne, Switzerland.
Insights
Implantable cardioverter defibrillators (ICDs) improve survival for cardiac arrest survivors and high-risk heart disease patients. These devices offer advanced pacing and shock therapies, proving cost-effective and expanding future use.
Area of Science:
- Cardiology
- Medical Devices
- Clinical Trials
Background:
- Randomized controlled trials demonstrate improved survival with implantable cardioverter defibrillators (ICDs) versus antiarrhythmic drugs.
- ICDs are indicated for cardiac arrest survivors, life-threatening ventricular tachyarrhythmias, and high-risk ischemic heart disease with inducible ventricular tachycardia (VT).
Purpose of the Study:
- To review the efficacy and cost-effectiveness of implantable cardioverter defibrillators (ICDs).
- To discuss the current and future applications of ICD therapy in managing cardiac arrhythmias.
Main Methods:
- Review of randomized controlled trials and clinical evidence regarding ICD therapy.
- Analysis of device capabilities including high-energy shocks, antitachycardia pacing, and antibradycardia pacing.
Main Results:
- ICDs show superior survival rates compared to antiarrhythmic drugs in specific patient populations.
- Current ICDs are small, implanted similarly to pacemakers, and offer comprehensive arrhythmia management.
- Evidence suggests ICD therapy is cost-effective.
Conclusions:
- ICD therapy is a proven, cost-effective treatment for selected patients with life-threatening ventricular arrhythmias.
- The role of ICDs is expected to expand with ongoing research defining new prophylactic indications and cost-effectiveness.
- Future clinical trials will further clarify the expanding prophylactic indications and cost-effectiveness of ICDs.
Abstract:
Randomized controlled trials have shown superior survival rates with implantable cardioverter defibrillators (ICDs) compared with antiarrhythmic drugs in survivors of cardiac arrest and life-threatening ventricular tachyarrhythmias, as well as in high-risk patients with ischemic heart disease and inducible ventricular tachycardia (VT). Current defibrillators are small and implanted with techniques similar to standard pacemakers. They provide high-energy shocks for ventricular fibrillation (VF) and rapid VT, antitachycardia pacing for monomorphic VT, and antibradycardia pacing. Limited evidence suggests that ICD therapy is cost-effective when compared with other widely accepted treatments. The use of ICDs is likely to continue to expand in the future. Ongoing clinical trials will define further prophylactic indications of the ICD and clarify its cost-effectiveness ratio in different clinical settings.