How useful are implantable cardioverter-defibrillators?
When use of an implantable cardioverter-defibrillator (ICD) is being considered for a patient with life-threatening ventricular arrhythmias, the potential risks and benefits must be carefully weighed. The risks of implantation of an ICD should be minimal; however, a low risk is highly dependent on patient selection and other factors, and perioperative risk varies significantly from center to center. The referring physician should not hesitate to ask for perioperative mortality statistics from the referral center. The difficulty in successfully documenting the usefulness of the ICD is especially important today. As the ICD becomes more like the pacemaker, there will be a natural tendency to expand the use of this new technology to patients in lower-risk groups. Suboptimal methods were adequate to document the benefit of the ICD in high-risk patients, but similar methods may not be adequate for low-risk patients. Fortunately, the importance of performing adequate studies has been recognized, as evidenced by the several randomized controlled trials that have been undertaken to study the efficacy of the ICD in these new groups of patients.
Fogoros
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RN
Electrophysiology Laboratory, Allegheny General Hospital, Pittsburgh, PA 15212.
D001145:Arrhythmias, Cardiac / Q000401:mortality / Q000628:therapy*; D004554:Electric Countershock / Q000009:adverse effects / Q000295:instrumentation / Q000592:standards*; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D019736:Prostheses and Implants / Q000009:adverse effects / Q000592:standards* / Q000706:statistics & numerical data; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D012449:Safety; D015996:Survival Rate