THE ROLE OF IMPLANTABLE CARDIOVERTER-DEFIBRILLATORS IN DILATED CARDIOMYOPATHY

Depending on the severity of the disease, patients with dilative cardi omyopathy (DCM) have a poor prognosis. No definite data are available to show that complex ventricular ectopy, the presence of ventricular l ate potentials, or programmed electrical stimulation in patients witho ut symptoms with DCM identify patients at risk of sudden cardiac death . Although poor left ventricular function seems to be the most potent predictor of total cardiac death, the prediction of sudden death in pa tients without symptoms with DCM is poor. Studies with either class I antiarrhythmic drugs or amiodarone have not yet demonstrated a reducti on in total mortality rates or Sudden death. The usefulness of an impl antable cardioverter defibrillator (ICD) in patients without symptoms with DCM is currently under investigation. The usefulness of serial el ectropharmacologic testing for patients with documented sustained vent ricular tachycardia or ventricular fibrillation and DCM is still contr oversial. Because most patients with DCM and VT or out-of-hospital car diac arrest have either no inducible ventricular tachyarrhythmia at ba seline or the reproducibility of ventricular tachycardia/ventricular f ibrillation induction is poor, implantation of an ICD should be consid ered in most of these patients. The indication for implantation of an ICD should be made on clinical judgment of the patient's functional st atus and other prognosis-limiting factors, such as rapid progression o f heart failure, end-stage heart failure, and age.