This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Epstein, A. E. Search for Related Content PubMed Articles by Epstein, A. E.

COMMENTARY

Benefits of the Implantable Cardioverter-Defibrillator

Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama

Manuscript received May 28, 2008; accepted June 12, 2008.

^_* Reprint requests and correspondence: Dr. Andrew E. Epstein, Division of Cardiovascular Disease, Department of Medicine, The University of Alabama at Birmingham, Tinsley Harrison Tower 321L, 1530 3rd Avenue South, Birmingham, Alabama 35294 (Email: aepstein{at}uab.edu).

The state-of-the-art review by Tung and colleagues provides a thoughtful perspective on balancing the benefits and risks of implantable cardioverter-defibrillator (ICD) therapy addressing the concerns of many caring physicians. In this response: 1) the clinical benefits of ICD therapy are reviewed using the evidence base resulting from controlled clinical trials; 2) untoward effects of ICDs on quality of life are acknowledged, and it is argued that they do not negate the results of studies in which the aggregate show benefit; and 3) cost-effectiveness of ICD therapy is considered. Although clinical trials evaluating ICD therapy have limitations, there are few interventions in which multiple trial settings have consistently over a >10-year period produced a 20% to 30% reduction in total mortality. Research to better identify patients expected to benefit from ICD therapy is ongoing, but at present we have the results of clinical trials that show improved survival in a broad selection of patients with left ventricular dysfunction and either demonstrated or anticipated risk for arrhythmic death. Evidence-based medicine; the rigorous process of guideline writing, review, and approval; and the ethical consideration of offering proven life-prolonging therapies to all patients provide a compelling rationale for clinicians to carefully consider guidelines in their clinical decision making. Updates in the new Device-Based Therapy Guidelines for the implantation of ICDs and pacemakers advance these goals.

Key Words: implantable cardioverter-defibrillator • evidence-based medicine • sudden death • guidelines • clinical trial

Abbreviations and Acronyms   CRT = cardiac resynchronization therapy   ICD = implantable cardioverter-defibrillator   LVEF = left ventricular ejection fraction   PVC = premature ventricular contraction   SCD = sudden cardiac death

This article has been cited by other articles:

				N. J. Stamato On being critical of implantable cardioverter-defibrillator therapy. J. Am. Coll. Cardiol., March 31, 2009; 53(13): 1162 - 1162. [Full Text] [PDF]

				A. E. Epstein Reply. J. Am. Coll. Cardiol., March 31, 2009; 53(13): 1163 - 1163. [Full Text] [PDF]

				R. Tung Reply. J. Am. Coll. Cardiol., March 31, 2009; 53(13): 1162 - 1163. [Full Text] [PDF]

				A. N. DeMaria, O. Ben-Yehuda, J. J. Bax, G. K. Feld, B. H. Greenberg, W. Y.W. Lew, J. A.C. Lima, A. S. Maisel, S. M. Narayan, D. J. Sahn, et al. Highlights of the Year in JACC 2008. J. Am. Coll. Cardiol., January 27, 2009; 53(4): 373 - 398. [Full Text] [PDF]