Evidence rather than costs must guide use of the implantable cardioverter defibrillator

Randomized controlled trials have shown superior survival rates with implan table cardioverter defibrillators (ICDs) compared with antiarrhythmic drugs in survivors of cardiac arrest and rife-threatening ventricular tachyarrhy thmias, as well as in high-risk patients with ischemic heart disease and in ducible ventricular tachycardia (VT), Current defibrillators are small and implanted with techniques similar to standard pacemakers, They provide high -energy shocks far ventricular fibrillation (VF) and rapid VT, antitachycar dia pacing for monomorphic VT, and antibradycardia pacing. Limited evidence suggests that ICD therapy is cost-effective when compared with other widel y accepted treatments. The use of ICDs is likely to continue to expand in t he future, Ongoing clinical trials will define further prophylactic indicat ions of the ICD and clarify its cost-effectiveness ratio in different clini cal settings. (C) 2000 by Excerpta Medica, Inc.