(Circulation. 2000;101:1638.)
© 2000 American Heart Association, Inc.
Editorial |
Implantable Cardioverter Defibrillator Therapy
The Sickest Patients Benefit the Most
From the Heart Research Follow-up Program of the Cardiology Unit, Department of Medicine, University of Rochester Medical Center, Rochester, NY.
Correspondence to Arthur J. Moss, MD, Heart Research Follow-up Program, Box 653, University of Rochester Medical Center, Rochester, NY 14642. E-mail heartajm@heart.rochester.edu
Key Words: Editorials • defibrillation • arrhythmia • heart failure
At times, our clinical intuition may lead us down the wrong path, but the scientific method helps direct us back to the proper course. In 1970, Mirowski et al1 published their first experience with the standby automatic defibrillator in animals, but their innovative approach to prevent sudden cardiac death was not initially accepted by the cardiac community. Concerns about the practicality of the implanted defibrillator to save lives stimulated Mirowski and colleagues to perform additional investigations; this culminated in their 1980 publication documenting life-saving internal defibrillation with an implantable device in 3 patients.2 The era of the clinical use of the implantable cardioverter defibrillator (ICD) therapy began just 20 years ago, and progress in the field since that time has been astounding.
A series of randomized ICD trials began in the early 1990s. When
my colleagues and I were designing the Multicenter Automatic
Defibrillator Implantation Trial (MADIT), the general attitude was that
the ICD might prolong life for only a short time in patients with
advanced coronary disease. Although the ICD had already been
shown to be effective in terminating acute ventricular
fibrillation, it was assumed that defibrillation in patients with
chronic coronary disease would only be a temporizing measure,
with early occurrence of death due to heart failure. This was not the
case. The results of MADIT were published in 1996,3 and
those of the Multicenter UnSustained Tachycardia Trial
(MUSTT) in 1999.4 These 2 primary prevention trials
substantiated improved survival with ICD therapy in coronary
patients with nonsustained ventricular
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