Secondary prevention of sudden arrhythmic death: The role of the implantable cardioverter-defibrillator

Patients with a history of sudden arrhythmic cardiac death (SACD) have a known significant recurrence rate ranging from 30% to 42% at one year. Because of this substantial number, secondary prevention of SACD has been advocated for a long time. Nevertheless, ongoing debate seems to be put to rest by recently published results of several well-designed randomized studies. The results of these secondary prevention trials consistently demonstrated that the implantable cardioverter-defibrillator is the first-choice therapy for secondary prevention of sudden arrhythmic cardiac death or hemodynamically compromising ventricular tachycardia. Thus, it is not very astonishing that these results have led to significant changes in the treatment of patients who have survived sudden cardiac death. Another message, which is supported by recent findings of the MUSST study, derives from the results of the secondary prevention trials: serial electrophysiologic drug testing now seems obsolete.