RT-215
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Primary prevention of sudden
arrhythmic death. What did we achieve? What needs to be done with ICD-therapy?
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Helmut Klein, Angelo Auricchio,
Christoph J. Geller, Hans-Dieter Esperer, Sven Reek, Wolfgang Hartung.
Division of Cardiology, University Hospital, Otto-von-Guericke Universität,
Magdeburg, Germany
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Abstract
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Primary prevention of sudden arrhythmic death with ICD
therapy is one of the most challenging tasks in modern cardiology. The MADIT trial has
clearly demonstrated that prophylactic implantation of an ICD is able to prolong overall
mortality in patients with remote myocardial infarction and poor ventricular function,
unsustained ventricular tachycardia on Holter monitoring and inducible but not
drug-suppressible sustained ventricular tachycardia. The study results and the importance
of reliable electrical risk stratification are addressed in this report. In order to
determine if very low LV-EF alone is a risk marker for sudden death, a new study, MADIT
II, is designed. The objective of this new primary prevention trial is to reduce two year
total mortality in patients with previous MI and LV-EF of < 30% from about 20%
in the conventional treatment arm to 12% in the ICD arm.
Until today primary prevention of SCD by ICD implantation has been shown to be
effective only in coronary patients post-MI. The question if prophylactic ICD therapy is
equally effective and recommendable in non-coronary patients remains to be proven by
future randomized trials.
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Key Words
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Implantable cardioverter defibrillator -
primary prevention of sudden death
postinfarction patients, prophylatic ICD implantation, MADIT trial, left ventricular
function, non-sustained ventricular tachycardia, MADIT II trial, CAST trial, SWORD trial,
EMIAT trial, CAMIAT trial, AVID trial, CASH trial, CIDS trial, risk stratification,
electrical instability evaluation technique, mortality rate, R
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