Primary Prophylaxis With the Implantable Cardioverter-Defibrillator
The Need for Improved Risk Stratification
Anil Gehi, MD;
Donald Haas, MD, MPH;
Valentin Fuster, MD, PhD
JAMA. 2005;294:958-960.
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Identification of patients at risk for sudden cardiac death (SCD) is a major challenge for the medical community. Although there have been advances in the area of risk stratification, it remains troubling that the majority of individuals who die of SCD are among a population that is not identified by current methods of risk stratification.1 Nevertheless, several recent trials have attempted to identify groups of patients who may benefit from an implantable cardioverter-defibrillator (ICD).
Current guidelines recommend that survivors of cardiac arrest (occurring after the first 24 hours following myocardial infarction) receive an ICD for secondary prophylaxis of SCD.2 However, identifying individuals for primary prophylaxis of SCD with an ICD has proven more difficult. Initial studies identified high-risk patients as those surviving myocardial infarction with significant left ventricular dysfunction and an abnormal electrophysiological study.3-4 Most recently, the Sudden Cardiac . . . [Full Text of this Article]
Author Affiliations: The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai School of Medicine, New York, NY.
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Reply
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