Implantable cardioverter-defibrillators

Implantable cardioverter-defibrillator therapy has been established as an effective method of preventing sudden death from cardiac causes. Few other interventions have been shown as consistently to have equivalent absolute and relative effects on survival among high-risk patients. New models of cardioverter-defibrillators may improve the functional status and quality of life of selected patients who are likely to benefit from biventricular pacing. The implantable defibrillator, however, is invasive and expensive and may expose patients to complications. Optimal use of implantable defibrillators in populations and in individual patients will depend on careful decision making by managers of health care systems, clinicians, and patients.