PROPHYLACTIC IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR THERAPY IN HIGH-RISK PATIENTS WITH CORONARY-ARTERY DISEASE

Despite substantial progress in the management of ischemic heart disea se and congestive heart failure, long-term mortality rates as a result of sudden cardiac death in such patients remain significant. Risk str atification that uses a combination of several predictors of clinical outcome has improved our ability to identify persons at high risk for future arrhythmic events. a-Blockers and amiodarone are effective in p rimary prevention of sudden death in selected populations. In view of the impressive reduction in sudden death rates by implantable cardiove rter defibrillators (ICDs) in patients with a history of cardiac arres t, prophylactic implantation may also be beneficial. The best way to t reat these patients is not known. Three ongoing controlled clinical tr ials have been designed for drugs, ICDs, or both and will provide answ ers about whether prophylactic antiarrhythmic intervention with ICDs i mproves survival and whether device therapy is superior to pharmacolog ic treatment. Brief reports on these clinical trials are discussed in this review.