Das Mithilesh
Krannert Institute of Cardiology, Roudebush VA Medical Center, Indiana University School of Medicine, IN, USA.
Expert Rev Cardiovasc Ther. 2009 Feb;7(2):181-95. doi: 10.1586/14779072.7.2.181.
The implantable cardioverter-defibrillator (ICD) is used for primary and secondary prophylaxis of sudden cardiac death in high-risk patients. While several trials have demonstrated the superiority of ICD over standard medical therapy or antiarrhythmic medication in this population, a few trials have not shown survival benefit. The Multicenter Automatic Defibrillator Implant Trial II study revealed that ICD reduces mortality in patients with ischemic cardiomyopathy. The Sudden Cardiac Death-Heart Failure Trial demonstrated that the ICD prevents sudden cardiac death and all-cause mortality in high-risk patients with moderate ischemic and nonischemic cardiomyopathy and heart failure. The ICD is also recommended for high-risk patients with inherited arrhythmia or cardiomyopathy. Cardiac resynchronization therapy reduces mortality and heart failure class as compared with optimal medical therapy in advanced heart failure. The high economic cost of widespread ICD use must also be considered. Therefore, it is prudent to identify a high-risk population who will benefit most from these devices.
植入式心脏复律除颤器（ICD）用于高危患者心脏性猝死的一级和二级预防。虽然多项试验已证明ICD在该人群中优于标准药物治疗或抗心律失常药物，但也有一些试验未显示出生存获益。多中心自动除颤器植入试验II研究表明，ICD可降低缺血性心肌病患者的死亡率。心脏性猝死-心力衰竭试验表明，ICD可预防中度缺血性和非缺血性心肌病及心力衰竭高危患者的心脏性猝死和全因死亡率。ICD也推荐用于遗传性心律失常或心肌病的高危患者。与晚期心力衰竭的最佳药物治疗相比，心脏再同步治疗可降低死亡率并改善心力衰竭分级。还必须考虑广泛使用ICD的高昂经济成本。因此，谨慎地识别出最能从这些设备中获益的高危人群是明智之举。
