Nearly 450 000 individuals experience sudden cardiac death yearly in the United States. A history of prior myocardial infarction with resultant left ventricular dysfunction identifies a group at particularly high risk of sudden arrhythmic death. Implantable cardioverter-defibrillators have proven highly effective at reducing this risk and are now increasingly implanted in patients with this risk profile. The case of Mr M, a 59-year-old man with a history of myocardial infarction, low ejection fraction, and mild congestive heart failure, who is considering implantable cardioverter-defibrillator placement, illustrates the issues in having a device implanted as a prophylactic measure as well as increasing concerns due to device recalls and malfunction. A thorough discussion of the benefits and risks associated with this therapy is necessary for patients and physicians to make appropriate decisions with regard to the primary prevention of sudden death.
Recordings downloaded from the log of an ICD in 2 separate patients. A, Recording demonstrates an episode of ventricular fibrillation (VF) sensed by the ICD and treated with a defibrillation. VS indicates sensing of ventricular event; VP, delivery of pacing pulse. B, Recording demonstrates an episode of ventricular tachycardia treated with rapid ventricular pacing (antitachycardia pacing). TF indicates detection of heart rate consistent with ventricular tachycardia; TP, delivery of pacing pulse; VS, sensing of ventricular event; FS, sensing of fibrillation event. Letters in the abbreviations read vertically in panel B.
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