The role of the implantable cardioverter-defibrillator for prevention of sudden cardiac death

Sudden cardiac death, which accounts for approximately 350 000 deaths each year, is a major health care problem. Antiarrhythmic drugs have not been re liable in preventing sudden cardiac death. Although p-blockers, angiotensin -converting enzyme inhibitors, and revascularization play a role in prevent ion of sudden cardiac death, the development and subsequent refinement of t he implantable cardioverter-defibrillator has made the most important contr ibution to its management. Several randomized, controlled trials have demon strated improved survival in patients resuscitated from cardiac arrest. Two recent trials also suggest a role for primary prevention in selected patie nts with coronary artery disease, ventricular dysfunction, and nonsustained ventricular tachycardia in whom sustained ventricular tachycardia is induc ed. Further technological refinements and development of new, more sensitiv e risk stratifiers with a higher positive predictive value for sudden cardi ac death will expand the indications for this lifesaving therapy.