You are seeing this message because your Web browser does not support basic Web standards. Find out more about why this message is appearing and what you can do to make your experience on this site better.


ABOUT JAMA
Advanced Search

Welcome   | My Account | E-mail Alerts | Access Rights | Sign In


  Vol. 295 No. 7, February 15, 2006 TABLE OF CONTENTS
  JAMA
  •  Online Features
  Clinical Review
 This Article
 •Full text
 •PDF
 •Send to a friend
 • Save in My Folder
 •Save to citation manager
 •Permissions
 Citing Articles
 •Citation map
 •Citing articles on HighWire
 •Citing articles on ISI (20)
 •Contact me when this article is cited
 Related Content
 •Similar articles in JAMA
 Topic Collections
 •Arrhythmias
 •Alert me on articles by topic

CLINICIAN’S CORNER
Implantable Cardioverter-Defibrillators

Expanding Indications and Technologies

Zachary Goldberger, MD; Rachel Lampert, MD

JAMA. 2006;295:809-818.

Context  Sudden cardiac death (SCD) is a major challenge facing contemporary cardiology. For an increasing number of patients, the current standard of care for the treatment and prevention of SCD is the implantable cardioverter-defibrillator (ICD). Since its introduction, there have been numerous advances in ICD technology, and indications for its use have expanded greatly in the past year.

Objective  To highlight the evolving indications for and the numerous advances in ICD technology, with emphasis on primary and secondary prophylaxis of SCD.

Evidence Acquisition  Electronic literature search of the Pubmed and MEDLINE databases from January 1996 to July 2005, using the Medical Subject Heading implantable defibrillator. Abstracts and titles were reviewed to identify English-language randomized controlled trials that included an ICD group and a non-ICD group and that had end points of all-cause mortality, cardiac death, and/or arrhythmic mortality as the main outcome. A further MEDLINE search was conducted to identify randomized controlled trials of cardiac resynchronization therapy (CRT) with a CRT and a non-CRT group (including both mortality and other end points). Other studies were included that clarify aspects of device function and other relevant issues. A total of 22 trials were identified.

Evidence Synthesis  ICD implantation improves survival in patients with a history of life-threatening ventricular arrhythmia. More recent evidence shows that ICD implantation also improves survival as primary prophylaxis against SCD in patients at high risk for ventricular arrhythmias, including those with left ventricular ejection fraction (LVEF) of 35% or less and New York Heart Association class II or III heart failure and those with a history of myocardial infarction and LVEF of 30% or less. Cardiac resynchronization improves symptoms, quality of life, and survival for patients with advanced heart failure and intraventricular conduction delays and ventricular dyssynchrony.

Conclusions  ICDs have been shown to improve survival as both primary and secondary prophylaxis in an expanding population of patients. Ongoing ICD research may continue to delineate groups with survival benefit from ICDs, and the use and indications of these devices in clinical practice will continue to expand.


Author Affiliations: Department of Medicine, University of Washington Medical Center, Seattle (Dr Goldberger) and Department of Medicine, Yale University School of Medicine, New Haven, Conn (Dr Lampert).



THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Death Without Prior Appropriate Implantable Cardioverter-Defibrillator Therapy: A Competing Risk Study
Koller et al.
Circulation 2008;117:1918-1926.
ABSTRACT | FULL TEXT  

Prophylactic Catheter Ablation for the Prevention of Defibrillator Therapy
Reddy et al.
NEJM 2007;357:2657-2665.
ABSTRACT | FULL TEXT  

Ablation after ICD Implantation -- Bridging the Gap between Promise and Practice
Estes
NEJM 2007;357:2717-2719.
FULL TEXT  

QT variability strongly predicts sudden cardiac death in asymptomatic subjects with mild or moderate left ventricular systolic dysfunction: a prospective study
Piccirillo et al.
Eur Heart J 2007;28:1344-1350.
ABSTRACT | FULL TEXT  

Management and Outcome of Permanent Pacemaker and Implantable Cardioverter-Defibrillator Infections
Sohail et al.
J Am Coll Cardiol 2007;49:1851-1859.
ABSTRACT | FULL TEXT  

A 59-Year-Old Man Considering Implantation of a Cardiac Defibrillator
Zimetbaum
JAMA 2007;297:1909-1916.
ABSTRACT | FULL TEXT  

The Elusive Scourge of Sudden Cardiac Death: Is Rational Decision Making Possible? Should There Be Standards of Risks and Predictions in Medicine?
Butler and Leon
J Am Coll Cardiol 2007;49:1434-1435.
FULL TEXT  

Contemporary Pacemaker and Defibrillator Device Therapy: Challenges Confronting the General Cardiologist
Schoenfeld
Circulation 2007;115:638-653.
FULL TEXT  

Evaluation and Management of Patients After Implantable Cardioverter-Defibrillator Shock
Gehi et al.
JAMA 2006;296:2839-2847.
ABSTRACT | FULL TEXT  





HOME | CURRENT ISSUE | PAST ISSUES | TOPIC COLLECTIONS | CME | SUBMIT | SUBSCRIBE | HELP
CONDITIONS OF USE | PRIVACY POLICY | CONTACT US | SITE MAP
 
© 2006 American Medical Association. All Rights Reserved.