Abstract
The indications for implantable cardioverter-defibrillators (ICDs) for the prevention of sudden cardiac death have rapidly expanded over the past 15 years. Clinical trial data have quickly been implemented into guidelines. Ventricular arrhythmias still account for significant proportion of mortality observed in patients discharged after an acute myocardial infarction, in spite of massive developments in revascularization strategy and adjuvant medical management. At present, we have the results of clinical trials that show ICD use is associated with improved survival in this group of patients with left ventricular dysfunction and either demonstrated or anticipated risk for arrhythmic death. Despite the fact that there are few interventions that in multiple trials settings have consistently produced a 20–30% reduction in total mortality, ICD treatment is largely underutilized. Keeping in mind, in fact that devices fail, and in unpredictable subsets, especially in patients who get inappropriate shocks, quality of life is decreased, we need to use this powerful tool in the most appropriate manner based on the guidelines that resulted from the trials.
Published Version
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