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STATE-OF-THE-ART PAPER

Implantable Cardioverter- Defibrillator Therapy in Clinical Practice

David A. Cesario, MD, PhD^_* and G. William Dec, MD^,_*

^_* University of California-Irvine, Irvine, California
Cardiology Division, Massachusetts General Hospital, Heart Failure and Transplantation Unit, Boston, Massachusetts

Manuscript received August 26, 2005; ^_* Reprint requests and correspondence: Dr. G. William Dec, Cardiology Division, Massachusetts General Hospital, Heart Failure and Transplantation Unit, Bigelow 800, Mailstop 817, 55 Fruit Street, Boston, Massachusetts 02114 (Email: gdec{at}partners.org).

Pharmacologic treatment of heart failure has led to dramatic improvements in survival and quality of life. Nonetheless, heart failure often progresses despite treatment with diuretics, angiotensin-converting enzyme inhibitors, beta-adrenergic blockers, aldosterone antagonists, and digoxin. Further, despite a steady decline in the risk of death from pump failure, many patients remain at high risk for sudden cardiac death. The annual incidence of sudden cardiac death in the U.S. alone has been estimated at 184,000 to over 400,000 cases. During the past decade, substantial advances have been made in the use of device-based therapy for this population. The role of the implantable cardioverter-defibrillator (ICD) continues to evolve in routine heart failure management. The current status of ICD therapy in the treatment of heart failure patients based on randomized clinical trial results and published practice guidelines is summarized in this review.

Abbreviations and Acronyms   ARVD = arrhythmogenic right ventricular dysplasia   ECG = electrocardiogram   EP = electrophysiological   HCM = hypertrophic cardiomyopathy   ICD = implantable cardioverter-defibrillator   LQTS = long QT syndrome   NYHA = New York Heart Association   SCD = sudden cardiac death

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