title: [Remarks on the guideline recommendations for cardioverter-defibrillator implantation for primary prevention of sudden cardiac Death in patients with severe ventricular dysfunction. Consensus Document of the Italian Association of Hospital Cardiologists (ANMCO)/Italian Society of Cardiology (SIC)/Italian Association of Arrhythmology and Cardiac Pacing (AIAC)].
abstract: The indications for implantable cardioverter-defibrillator (ICD) therapy for the prevention of sudden cardiac death in patients with severe left ventricular dysfunction have rapidly expanded over the last 10 years on the basis of the very satisfying results of the numerous randomized clinical trials that have provided the framework for guidelines. However, the analysis of clinical practice in the real world has highlighted some important criticisms in the complex process of selection-management of those patients candidates for ICD therapy: 1) approximately one fourth of all ICD implantations is not justified by clinical evidence, 2) approximately one half of patients with an indication for ICD therapy do not undergo implantation, 3) the benefits from ICD therapy do not apply uniformly to all patients, 4) the relationship between the lifesaving benefit and the potential for harm of ICD therapy is still scarcely known. The main reason for this clinical scenario can be ascribed to the guideline recommendations that are based only on few standard cut-off criteria and therefore too generic and insufficiently detailed. This does not help cardiologists in their decision-making process, and results in fear, uncertainty, and sometimes emotional choices. The aim of this consensus document is to discuss current guideline recommendations and to provide the Italian cardiologists with the most updated information to optimize the selection of patients with severe left ventricular dysfunction who should receive ICD therapy.
authors: Massimo Zoni
authors: MZ
authors: Berisso
authors: Maria Grazia
authors: MG
authors: Bongiorni
authors: Antonio
authors: A
authors: Curnis
authors: Valeria
authors: V
authors: Calvi
authors: Domenico
authors: D
authors: Catanzariti
authors: Fiorenzo
authors: F
authors: Gaita
authors: Michele Massimo
authors: MM
authors: Gulizia
authors: Giuseppe
authors: G
authors: Inama
authors: Maurizio E
authors: ME
authors: Landolina
authors: Maria Teresa
authors: MT
authors: La Rovere
authors: Roberto
authors: R
authors: Mantovan
authors: Giosuè
authors: G
authors: Mascioli
authors: Eraldo
authors: E
authors: Occhetta
authors: Luigi
authors: L
authors: Padeletti
authors: Jorge A
authors: JA
authors: Salerno-Uriarte
authors: Massimo
authors: M
authors: Santini
authors: Biagio
authors: B
authors: Sassone
authors: Michele
authors: M
authors: Senni
authors: Massimo
authors: M
authors: Zecchin
mesh_terms: D016757:Death, Sudden, Cardiac / Q000209:etiology* / Q000517:prevention & control*; D017147:Defibrillators, Implantable / Q000009:adverse effects / Q000191:economics / Q000941:ethics; D006801:Humans; D017410:Practice Guidelines as Topic; D011322:Primary Prevention; D011379:Prognosis; D018570:Risk Assessment; D012720:Severity of Illness Index; D018754:Ventricular Dysfunction / Q000150:complications*