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(Circulation. 1995;91:2115-2117.)
© 1995 American Heart Association, Inc.

Articles

Are Implantable Cardioverter-Defibrillators Better Than Conventional Antiarrhythmic Drugs for Survivors of Cardiac Arrest?

Douglas P. Zipes, MD

From Krannert Institute of Cardiology and Indiana University School of Medicine, Indianapolis, Ind.

Correspondence to Douglas P. Zipes, MD, Krannert Institute of Cardiology, 1111 W 10th St, Indianapolis, IN 46202-4800.

Key Words: Editorials • antiarrhythmia agents • tachyarrhythmias

	Introduction

 
Numerous studies have shown that the implantable cardioverter-defibrillator (ICD) accurately detects and successfully terminates ventricular tachyarrhythmias. In a recent report of 2834 epicardial and endocardial ICD implants in 2807 patients followed for a mean of 11.7 months, more than half of the patients had a combined total of almost 50 000 spontaneous episodes of ventricular tachyarrhythmias that were recognized and terminated by the ICD, with a success rate of about 98%. At 1 year, sudden cardiac death mortality was 1.4% in the epicardial ICD group and 0.6% in the endocardial group. The overall mortality at 1 year was 12.2% and 6.9% for the two groups, respectively, reflecting in part the greater surgical implant mortality for the epicardial (4.1%) compared with the endocardial (0.74%) systems. Complications requiring an invasive intervention totaled 18.9% for the endocardial implants and 9.2% for the epicardial implants.¹ Thus, it becomes amply clear that the ICD effectively performs the functions for which it was created. Data such as these have encouraged many physicians to proceed rapidly to implantation of an ICD in the cardiac arrest survivor rather than spend time searching for a potentially more elusive therapeutic goal, that of an effective antiarrhythmic drug.

Despite these facts (and the "logical" extension that ICDs must save lives if they effectively terminate ventricular tachyarrhythmias), several reports^{2 3 4} have cautioned against a precipitous embrace of ICDs because the ICD effect on total mortality, particularly when compared against antiarrhythmic agents, has not been established in a rigorous fashion, that is, in a . . . [Full Text of this Article]

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