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STATE-OF-THE-ART PAPER

A Critical Appraisal of Implantable Cardioverter-Defibrillator Therapy for the Prevention of Sudden Cardiac Death

Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts

Manuscript received March 24, 2008; revised manuscript received May 19, 2008, accepted May 27, 2008.

^_* Reprint requests and correspondence: Dr. Roderick Tung, Division of Cardiology, David Geffen School of Medicine at UCLA, BH-307 CHS, 10833 Le Conte Avenue, Los Angeles, California 90095 (Email: RTung{at}mednet.ucla.edu).

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.

Key Words: defibrillator • trials • sudden death • proarrhythmia • cost-effectiveness

Abbreviations and Acronyms   CI = confidence interval   CRT = cardiac resynchronization therapy   EF = ejection fraction   HR = hazard ratio   ICD = implantable cardioverter-defibrillator   NYHA = New York Heart Association   VF = ventricular fibrillation   VT = ventricular tachycardia

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