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Sudden cardiac deaths (SCD), resulting from
ventricular tachycardia or fibrillation (VT/VF) account for about 50% of cardiovascular
mortality1. Extensive clinical experience with the
implantable cardioverter defibrillator (ICD), culminated by recent prospective studies
have demonstrated the ICD to be far more effective against deaths from VT/VF than
amiodarone or other antiarrhythmic drugs. Nevertheless, it has had until now very little
impact on the huge problem of SCD, since most at risk patients die with their first
arrhythmic episode. This problem subsits even though there are now highly effective
screening methods allowing early identification of such patients. It is because of this
dichotomy - on the one hand, having established ways of identifying and effectively
treating these high risk patients; and on the other, the sad fact that only a small
minority receive this protection - that there is now such great interest in prophylactic
ICD studies. Already in 1990, we described these trials and at which populations they
would be aiming at2. Some have now reached conclusion,
and yet others have recently begun. We will discuss hereunder the impact and clinical
implications of these trials.
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