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or refractory class IV heart failure also reduce the References:
benefit from AICD implant and should be taken into 1. Rao B.H., Sastry B.K., Chugh S.S. Contribution of sudden cardiac death
account. to total mortality in India - a population based study. Int J Cardiol.
2012;154:163–167
Conclusion: 2. The Antiarrhythmics versus Implantable Defibrillators (AVID) Investigators.

A Comparison of Antiarrhythmic-Drug Therapy with Implantable
The Automatic Implantable Cardioverter Defibrillator Defibrillators in Patients Resuscitated from Near-Fatal Ventricular
represents an important advance in the management Arrhythmias. N Engl J Med 1997; 337:1576-1584
of patients at risk of dying suddenly. With 3. Arthur J. Moss, Wojciech Zareba, W. Jackson Hall, Helmut Klein, David J.
advancements in technology over the last few Wilber, David S. Cannom et al. Prophylactic Implantation of a Defibrillator
decades, the device has become smaller and easier in Patients with Myocardial Infarction and Reduced Ejection Fraction. N
to implant and more reliable and effective. The Engl J Med 2002; 346:877-883.
challenge has been in identifying the right patients 4. Gust H. Bardy, Kerry L. Lee, Daniel B. Mark, Jeanne E. Poole, Douglas L.
who will achieve maximum benefit from an AICD. Packer, Robin Boineau et al. Amiodarone or an Implantable Cardioverter–
Multiple studies have been done regarding this and Defibrillator for Congestive Heart Failure. N Engl J Med 2005; 352:225-
237
guidelines have been formulated. It is important for
treating physicians to be familiar with these guidelines 5. Alan Kadish, Alan Dyer, James P. Daubert, Rebecca Quigg, N.A. Mark Estes,
and choose patients appropriately Kelley P. Anderson. Prophylactic Defibrillator Implantation in Patients with
Nonischemic Dilated Cardiomyopathy. N Engl J Med 2004;350:2151-8.
6. Lars Køber, Jens J. Thune, Jens C. Nielsen, Jens Haarbo, Lars Videbæk,
Highlights: Eva Korup, Gunnar Jensen et al. Defibrillator Implantation in Patients with
• AICD is currently the only effective method to Nonischemic Systolic Heart Failure. N Engl J Med 2016; 375:1221-1230
reduce the risk of sudden death in patients at
high risk.
• Most important group of patients at risk are
those who have survived a cardiac arrest.

• Patients with ischemic or non-ischemic
cardiomyopathy with reduced ejection fraction
are eligible for AICD implantation for primary
prevention of sudden death, although the
evidence is stronger for patients with coronary
artery disease
• Patients with hypertrophic cardiomyopathy
who have one of the established risk factors
should be considered for AICD implantation.

GCDC 2017