IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR (ICD) INDICATIONS IN 1996 - HAVE THEY CHANGED

The recent progress in the technology of the implantable cardioverter- defibrillator (ICD) and the excellent clinical results achieved with I CD treatment in the prevention of sudden death have facilitated the wi despread acceptance and diffusion of this therapeutic modality, Howeve r, ICD implantation is a costly therapy and its use is still associate d with some important unresolved issues. In particular, owing to the a bsence of randomized controlled clinical trials, it is not yet known w hether ICD really reduces overall mortality. Thus, at the present time , it appears logical to exercise restraint in expanding the use of ICD s as first-choice therapy in patients with life-threatening ventricula r arrhythmias. ICD treatment should be restricted to those well-define d categories of high-risk patients who are most likely to benefit from device implantation in terms of life prolongation. Basically, this me ans patients with hemodynamically poorly tolerated ventricular tachyca rdia or ventricular fibrillation that are not inducible at electrophys iologic study and those, who do not respond to, or do not tolerate, dr ug therapy with amiodarone, sotalol, or beta blockers. patients with i diopathic ventricular fibrillation also seem to be suitable candidates for ICD implantation. Other indications for ICD therapy are, as yet, more controversial and should be carefully evaluated on a case-by-case basis.