What risk should justify implantable cardioverter defibrillator therapy?

Implantable cardioverter defibrillators (ICDs) were developed to prevent su dden cardiac death in patients with ventricular tachycardia (VT) or ventric ular fibrillation (VF). Their safety and efficacy have been proved in multi ple retrospective and prospective studies. Many of the published trials wer e directed at secondary prevention for patients who had already had a sudde n cardiac death or a sustained VT. For primary prevention, the information available is limited, as only 2 trials have yet been published. Ongoing tri als will probably allow us to broaden the indications for prophylactic ICD implantation. Justification of the risk will have to be evaluated against c omplexity of the implant, the latter including not only cost but quality of life and morbidity associated with an ICD. However our efforts still have to be directed to improve risk stratification and to decrease the complexit y of the procedure. (C) 1999 by Excerpta Medica, Inc.