Volume 72 Number 1 January 2005	back to contents

1 Clinical Cardiac Electrophysiology Fellow, 2Director, Clinical Cardiac Electrophysiology Section and 3Director, Consultative Services, The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai School of Medicine, New York, NY.

Address all correspondence to J. Anthony Gomes, M.D., Director, Consultative Services, The Zena and Michael A. Wiener Cardiovascular Institute, Box 1054, Mount Sinai School of Medicine, One East 100 th Street, New York, NY 10029.

ABSTRACT

Sudden cardiac death, usually due to fatal ventricular tachyarrhythmias, results in the loss of 300,000 B 400,000 lives each year in the United States. Implantable cardioverter-defibrillator therapy has revolutionized both the secondary and, increasingly, the primary prevention of sudden cardiac death. In the last decade, subcutaneous pectoral implantation with transvenous lead placement has lessened perioperative risk considerably, raising the benefit/risk ratio for many candidates. As a consequence, the list of approved indications for implantable cardioverter-defibrillator therapy has expanded rapidly in recent years. Current devices offer tiered therapy utilizing bradycardia pacing, anti-tachycardia pacing, low-energy cardioversion, and high-energy defibrillation. Hybrid therapy, combining device, drugs and radiofrequency catheter ablation as required, has become the standard of care for reducing both appropriate and inappropriate shocks. As implantation rates continue to rise, so will the number of patients presenting with electrical storm. The dilemma of how our society will cope with the enormous projected costs of implantable cardioverter-defibrillator therapy has yet to be resolved.

KEYWORDS

Sudden cardiac death, ventricular tachycardia, ventricular fibrillation, implantable cardioverter-defibrillator, tiered therapy, hybrid therapy, inappropriate shocks, electrical storm.

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