ICD therapy in coronary artery disease. A reappraisal in 2005

25 years after the first coronary artery patient received an implantable cardioverter defibrillator (ICD), many randomized controlled trials on prophylactic ICD therapy have been conducted. Taken together, these trials allow an evidence-based approach to primary prevention of sudden cardiac death in patients after a myocardial infarction. Patients with chronic ischemic cardiomyopathy, a long history of heart failure, and an ejection fraction of < or = 0.30 benefit from preventive device therapy and are thus candidates for prophylactic defibrillator implantation. For this purpose, a single-chamber device appears to be appropriate, since there have been no prospective studies showing convincing clinical benefit by adding an atrial lead. For similar patients who have additional intraventricular conduction delays, a biventricular ICD must be considered. However, this decision must be based on individual considerations until more data from prospective trials become available. Prophylactic ICD therapy should not be used in patients with recent myocardial infarction. There is convincing evidence that ICD benefit in coronary patients accrues after a considerable time having elapsed from the most recent infarct, presumably at least 6 months or perhaps longer.