In this issue of JAMA, the reports by Maisel and colleagues1,2 and by Gould and Krahn3 represent substantial pieces of an information mosaic that is developing about life-sustaining and life-saving implantable arrhythmia device technologies. It is apparent, not only to the medical community, but also to patients, the press, regulators, investors, and the legal community, that this information mosaic is complex. The technologies are complex. The medical issues are complex. The ethical issues are complex. The financial issues are complex. No effort should trivialize this complexity or oversimplify and produce “the solution” without understanding that the information comes with gaps and never forms more than an incomplete mosaic. These 3 studies1- 3 provide new data to inform the most important issue—how physicians and patients should make individual decisions regarding pacemaker or implantable cardioverter-defibrillator (ICD) surgery.
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