Prophylactic Defibrillator Implantation — Toward an Evidence-Based Approach

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Abstract
Most patients who have an out-of-hospital cardiac arrest do not survive. Thus, the use of a prophylactic implantable cardioverter–defibrillator (ICD) for the primary prevention of sudden death is a conceptually attractive option for high-risk patients. Several clinical trials have previously shown that ICDs reduced mortality in patients with coronary artery disease who had not yet had a life-threatening arrhythmia and who were selected on the basis of either the results of electrophysiological testing or left ventricular dysfunction.14 In the past year, four multicenter clinical trials have helped refine the selection of appropriate patients for ICD therapy. In addition to . . .