[Implantable defibrillators. Sudden death: high risk]

The incidence of sudden death remains high. The basic causes are related to ischemic heart disease and heart failure. Automatic defibrillation is the best treatment, as first conceived and implanted by Mirovski twenty years ago. MARKERS OF RISK OF SUDDEN DEATH: Left ventricular dysfunction, functional class and spontaneous and induced ventricular hyperexcitability identify a high-risk population.

Drug treatments used in the post infarction period or for heart failure (beta-blockers, converting enzyme inhibitors and amiodarone) have demonstrated a certain efficacy in preventing sudden death. However, different therapeutic trials comparing the efficacy of defibrillators and drug treatments have demonstrated the 20 to 46% superiority of defibrillation in terms of reduced mortality.