Implantable Cardioverter Defibrillator Therapy

The benefits of beta blockade, sotalol, and amiodarone in decreasing mortality from SCD pale in comparison to the protective effects of the implantable cardioverter defibrillator (ICD) on high-risk patients.28 The results of recent studies indicate that treatment with an ICD is more effective than electrophysiologically guided treatment with antidysrhythmic agents.29 Although these devices are expensive to insert, their effectiveness over conventional therapy results in a cost of less than $30,000 per year of life saved, which is highly cost-effective. 30 At present, these devices are indicated for preventing SCD in high-risk patients, particularly those with clinically significant coronary artery disease, depressed left ventricular function, and spontaneous life-threatening and/or inducible ventricular dysrhythmias. Further research is necessary to determine the value of ICD therapy in patients with nonischemic cardiomyopathy accompanied by reduced left ventricular function.

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