A 59-Year-Old Man Considering Implantation of a Cardiac Defibrillator
- Peter J. Zimetbaum, MD, Discussant
- Author Affiliation: Dr Zimetbaum is Associate Professor of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.
- Corresponding Author: Peter J. Zimetbaum, MD, Division of Cardiology, Beth Israel Deaconess Medical Center, 185 Pilgrim Rd, Baker 4, Boston, MA 02215 (pzimetba{at}bidmc.harvard.edu).
Abstract
Nearly 450 000 individuals experience sudden cardiac death yearly in the United States. A history of prior myocardial infarction with resultant left ventricular dysfunction identifies a group at particularly high risk of sudden arrhythmic death. Implantable cardioverter-defibrillators have proven highly effective at reducing this risk and are now increasingly implanted in patients with this risk profile. The case of Mr M, a 59-year-old man with a history of myocardial infarction, low ejection fraction, and mild congestive heart failure, who is considering implantable cardioverter-defibrillator placement, illustrates the issues in having a device implanted as a prophylactic measure as well as increasing concerns due to device recalls and malfunction. A thorough discussion of the benefits and risks associated with this therapy is necessary for patients and physicians to make appropriate decisions with regard to the primary prevention of sudden death.
