Key result
Primary prevention internal cardioverter defibrillators improve survival in selected high-risk patients with infarct-related cardiomyopathy, but their broader use is limited by significant device-related morbidity and lack of benefit in certain populations.
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This review cautions against the over-application of primary prevention ICD guidelines, noting that trial populations may not reflect real-world patients and highlighting underappreciated implant morbidity.
Sudden cardiac death (SCD) is one of the leading causes of mortality in developed countries. Internal cardioverter defibrillators (ICDs) have been developed to treat potentially life-threatening ventricular arrhythmias. Multiple randomised trials have been completed to assess the efficacy of primary prevention ICDs in selected populations. In response to the randomised, controlled trials guidelines have been established to help guide physicians in choosing appropriate patients who may benefit from primary prevention ICDs. Unfortunately, many patients who currently fall within the guidelines are either not represented in the clinical trials or disregarded. The morbidity associated with ICD implant is also overlooked and the cost-benefit analyses are exaggerated in favour of ICD implant. This review article summarises major clinical trials addressing primary prevention ICDs, and also highlights the evidence supporting the use and abuse of ICDs.
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Silverstein et al. (2012) conducted a review in Sudden cardiac death. Internal cardioverter defibrillators (ICDs) vs. Standard medical therapy was evaluated. Primary prevention internal cardioverter defibrillators improve survival in selected high-risk patients with infarct-related cardiomyopathy, but their broader use is limited by significant device-related morbidity and lack of benefit in certain populations.
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