IMPLANTABLE DEFIBRILLATORS FOR PREVENTION OF SUDDEN-DEATH - TECHNOLOGY AT A MEDICAL AND ECONOMIC CROSSROAD

Implantable cardioverter-defibrillators (ICD) are being widely used for patients with ventricular tachyarrhythmias. The extent of clinical benefit with respect to patient survival is controversial. Although recurrent sudden death incidence is virtually eliminated, the impact on total cardiac mortality awaits quantitation, particularly vis-a-vis other available antiarrhythmic therapies. Advanced device and lead systems can be expected to further improve both patient survival and quality of life after implant. The economic impact of ICD therapy proliferation on the health care system is substantial, yet available cost-benefit analysis suggests that health care cost per life-year saved could be comparable with other cardiovascular therapies with appropriate risk stratification in patient selection using currently accepted indications. Application to asymptomatic or minimally symptomatic patients at risk for future cardiac arrest is now being investigated. These newer indications will require considerably greater effort in prospective risk stratification to achieve economic viability.