Prophylactic implantable cardioverter difibrillator trials: MUSTT, MADIT, and beyond

MUSTT and MADIT have clearly shown the survival benefit of an implantable c ardioverter defibrillator (ICD) in patients with previous myocardial infarc tion, left ventricular ejection fraction greater than or equal to0.40, and nonsustained ventricular tachycardia (VT), and who have had sustained VT in duced at electrophysiology study. Progress in primary prevention of sudden cardiac death (SCD) depends on a concerted effort by clinicians to identify and appropriately treat MUSTT/MADIT-type patients; further research to mor e precisely define patient subgroups at risk for SCD and the willingness of industry to develop a lower priced ICD for prophylactic use are needed.