COMMENTS AND RESPONSES Age and Effectiveness of Prophylactic Implantable Cardioverter-Defibrillators

uating the effectiveness of implantable cardioverter-defibrillators (ICDs) for primary prevention of sudden cardiac death among young and elderly patients concluded that available data do not de-finitively show that ICDs improve survival in elderly patients. We agree with the authors that these findings have important clinical implications and might support the theory that cardiac resynchroni-zation therapy alone may be the best device therapy for elderly (65 years) patients with severe left ventricular dysfunction. However, we would like to raise several points that may shed additional light on the findings and implications of this meta-analysis. The meta-analysis included data on ICD benefits in different age groups without adjustment for clinical characteristics. Important differences exist in the epidemiology, clinical characteristics, manage-ment, and outcome of elderly patients compared with their younger counterparts (2, 3). However, the most important difference is tha