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Sudden cardiac death and implantable cardioverter defibrillators: two modern epidemics?

Demosthenes G Katritsis1, Mark E Josephson

  • 1Athens Euroclinic, 9 Athanassiadou Street, Athens 11521, Greece. dkatritsis@euroclinic.gr

Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology
|February 7, 2012
PubMed

Insights

Implantable cardioverter defibrillators (ICDs) improve survival in some patients with ventricular arrhythmias, but benefits may be transient with modern therapy. ICDs offer survival benefits primarily in high-risk ischemic cardiomyopathy patients, not solely based on ejection fraction.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Device Efficacy

Background:

  • Implantable cardioverter defibrillators (ICDs) are used to prevent sudden cardiac death.
  • Evidence regarding the survival benefit and cost-effectiveness of ICDs requires critical analysis.
  • Modern medical therapies, including beta-blockers, may influence ICD efficacy.

Purpose of the Study:

  • To critically analyze the existing evidence on the survival benefits of ICDs.
  • To evaluate the role of ICDs in different patient populations and clinical settings.
  • To assess the cost-effectiveness and appropriate use of ICDs based on current evidence.

Main Methods:

  • Critical analysis of existing scientific evidence and clinical trial data.
  • Review of studies examining ICDs in patients with sustained ventricular arrhythmias and cardiac arrest.
  • Evaluation of ICD efficacy in high-risk patients with ischemic cardiomyopathy and specific ejection fraction thresholds.

Main Results:

  • ICDs confer a survival benefit in patients with documented sustained ventricular arrhythmias or cardiac arrest, though this may be transient with optimal medical therapy.
  • In patients without sustained ventricular arrhythmias, ICDs provide significant survival benefit only in high-risk ischemic cardiomyopathy patients with LVEF ≤ 35% from remote myocardial infarction.
  • Left ventricular ejection fraction alone is insufficient for predicting sudden cardiac death risk; benefits in the elderly and women are not established, and cost-effectiveness is limited to specific high-risk groups.

Conclusions:

  • ICD survival benefits are established in specific high-risk groups but may be overestimated in broader populations.
  • Current guidelines may lead to overuse of ICDs, necessitating a more refined approach to patient selection.
  • Further research is needed to clarify ICD benefits in specific demographics like women and the elderly, and to optimize cost-effectiveness.

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