Managing Ventricular Tachyarrhythmias In The Developing World: Insights From Recent ICD Trials

Since the introduction of the implantable cardioverter defibrillator (ICD) by Michel Mirowski in the 1980's, these devices have become an important tenet in management of ventricular arrhythmias1. Numerous observational and randomized trials have demonstrated the superiority of this device over antiarrhythmic drugs in treating ventricular arrhythmias. The clinical implications of these trials are tremendous as sudden cardiac death (SCD) maybe the presenting symptom in these arrhythmias. It is estimated that in the United States alone around 350,000 deaths occur each year due to SCD alone2 . As resuscitation is seldom successful in the community, methods to identify and appropriately treat such patients alone can prevent these events. However, the public health impact of this approach is tremendous, as the ICD is extremely expensive and is out of reach for many individuals. Moreover, not all patients with structural heart disease and ventricular arrhythmias have a malignant outcome. Thus efforts to appropriately stratify patients according to their risk profile and accordingly advocate ICD implant has important fiscal implications for the state with meager health resources, especially in those patients in whom survival benefit with the ICD is modest