Implantable cardioverter defibrillators (ICDs) are the most effective modality for primary and secondary prevention of sudden cardiac death in patients with LV dysfunction. Studies universally demonstrate greater efficacy compared to antiarrhythmic therapy and a significant reduction in mortality compared to placebo.58-60 Recent studies have expanded the eligible patient populations beyond classic indications, such as prior MI and nonsustained ventricular tachycardia or nonsuppressible ventricular tachycardia during an electrophysiologic study. A clear advantage of implanting ICDs in all symptomatic patients with LVEF less than 35% regardless of etiology or other cardiac parameters has been demonstrated.60 Because ICD implantation and follow-up is associated with a significant economic burden, the cost effectiveness of widespread ICD use continues to be debated. Defining subgroups that would derive the greatest benefit and determining the optimal ICD configuration will aid in improving the potential costs compared to benefits.
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