Profilaxis primaria con desfibrilador-cardioversor implantable en la insuficiencia cardiaca: un punto de vista clínico

摘要: The implantable cardioverter-defibrillator (ICD) is one of the great inventions modern cardiology. Its use for prevention sudden death in patients with left ventricular dysfunction has meant that clinical cardiologists are now fully involved decision-making on implantation these devices. majority trials, which have used low ejection fraction as only or main criterion patient recruitment, shown ICD leads to a significant improvement survival. Three two were carried out soon after myocardial infarction and was performed at same time surgical revascularization, exceptions. However, it important be aware improvements observed most recent trials not been large those seen initial studies. Reduced efficacy Sudden Cardiac Death Heart Failure Trial (SCD-HeFT), instance, 25 ICDs had implanted save life over 2-year period. likely explanation this observation better prognosis achieved by present-day pharmacologic treatment heart failure reduced margin benefit associated use. Another consequence depressed lost some its specificity predicting death. New predictive variables needed improve risk stratification population. Without variables, primary will seem very attractive option from point view good practice.