Sudden Electrical Death

Survivors of an episode of out-of-hospital ventricular fibrillation (not due to a reversible cause) or hemodynamically significant sustained ventricular tachycardia should in most cases receive an implantable cardioverter defibrillator (ICD) rather than antiarrhythmic drug therapy. A number of recently published clinical trials (summarized later) point to improved survival with ICD implantation. It is also important to identify the cause of the ventricular rhythm and to treat adequately the underlying cardiomyopathy with the appropriate angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, and aspirin. The role of electrophysiologic study is a matter of debate, and it is used less commonly than it was a decade ago.