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Primary prevention of sudden cardiac death using implantable cardioverter defibrillators

BMJ 2002; 325 doi: (Published 09 November 2002) Cite this as: BMJ 2002;325:1050

More patients need to be screened and treated

  1. Janet M McComb, consultant cardiologist (,
  2. A John Camm, professor of cardiologyb
  1. aDepartment of Cardiology, Freeman Hospital, Newcastle upon Tyne NE7 7DN
  2. bRegional Cardiothoracic Centre

    The National Institute for Clinical Excellence (NICE) has recommended that implantable cardioverter defibrillators should be routinely considered for patients who have survived ventricular fibrillation or ventricular tachycardia with haemodynamic compromise for secondary prevention of arrhythmic death. It also recommends it in certain patients who have not yet had a serious arrhythmic event but who are at high risk of sudden cardiac death as primary prevention. This second group comprises mainly patients who have survived a myocardial infarction. Only a tiny minority of these patients is currently being investigated and treated with implantable defibrillators.

    After an infarction, impaired ventricular function with an ejection fraction of 35% or less, non-sustained ventricular tachycardia (three beats or more) on ambulatory 24 hour monitoring, and inducible ventricular tachycardia at electrophysiological testing identify a subgroup of patients at high risk of sudden death. Paradoxically, antiarrhythmic drugs increase the risk of death and should be avoided in patients with significantly impaired ventricular function.1 At best, amiodarone decreases the risk of sudden death …

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