A critical appraisal of implantable cardioverter-defibrillator therapy for the prevention of sudden cardiac death.
The indications for implantable cardioverter-defibrillators (ICDs) for the prevention of sudden cardiac death have rapidly expanded over the past 10 years. Clinical trial data have quickly been implemented into guidelines without critical reassessment of the strengths and limitations of the evidence. ICD therapy has inherent risks including infection, unnecessary shocks, potential for proarrhythmia, device malfunction, highly publicized manufacturer advisories, and procedural complications, which can adversely affect morbidity and quality of life. A reappraisal of the benefits and potential hazards of ICD therapy will enable physicians to a have a more mutually informed and balanced dialogue with their patients.
Tung
Roderick
R
Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA. RTung@mednet.ucla.edu
Zimetbaum
Peter
P
Josephson
Mark E
ME
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects; D009202:Cardiomyopathies / Q000150:complications; D003362:Cost-Benefit Analysis; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000517:prevention & control*; D017147:Defibrillators, Implantable / Q000009:adverse effects* / Q000191:economics; D004868:Equipment Failure; D006801:Humans; D017202:Myocardial Ischemia / Q000150:complications; D016032:Randomized Controlled Trials as Topic
D000319:Adrenergic beta-Antagonists; D000889:Anti-Arrhythmia Agents