Should everyone with an ejection fraction less than or equal….pdfVIP

CONTROVERSIES IN CARDIOVASCULAR MEDICINE Should everyone with an ejection fraction less than or equal to 30% receive an implantable cardioverter-defibrillator? Not Everyone With an Ejection Fraction 30% Should Receive an Implantable Cardioverter-Defibrillator Alfred E. Buxton, MD lthough the total number of deaths attributed to late after MI. This information then led to the practice of Acardiovascular disease has decreased during recent administering antiarrhythmic drugs to suppress ventricular decades, an increase in the percentage of cardiac ectopy under the presumption that suppression of asymptom- deaths occurring suddenly (from 56% in 1989 to 63% in atic ectopy would prevent sudden death. This fashion lasted 1998) has actually resulted in an increase in the total number almost 20 years, until the results of the Cardiac Arrhythmia of sudden deaths in the United States.1 The problem of Suppression Trial (CAST) trial demonstrated the harm caused sudden death spans all racial and cultural groups and is by this approach.2 Thus, a sea change in the practice of equally important in men and women. It is now 40 years since cardiology had occurred, from treating only symptomatic continuous ECG monitoring revealed that ventricular patients to therapy aimed at primary prevention of sudden tachycardia and ventricular fibrillation (VT/VF) are respon- death. The initial efforts using antiarrhythmic drugs failed to sible for the majority of sudden deaths. Dissemination of this reduce mortality. information resulted in a marked change in practice. Until the While many physicians in the 1970s were administering 1970s, physicians treated only symptomatic VTs. Therapeutic prophylac