Implantable Cardioverter Defibrillators Still Important in Clinical Practice

September 10, 2019 – Evidence supports that implantable cardioverter defibrillators still provide life-saving benefits, but more research is needed to improve the selection of patients for this treatment.

Although it is incorrect to discount the potential benefit of implantable cardioverter defibrillators, it is also critical to improve selection criteria for patients who would derive the most benefit, writes the DCRI’s Sana Al-Khatib, MD, (pictured), in two recent pieces on the topic.

For many patients with heart failure with a reduced ejection fraction (HFrEF), implantable cardioverter defibrillators (ICDs) can prevent sudden cardiac death and save lives. However, some clinicians argue that evidence supporting the benefit of ICDs is more than 15 years old and perhaps not still applicable. In a paper co-authored by Al-Khatib, which was recently published in Circulation, she counters that newer evidence exists that links ICDs with a survival benefit and lists several examples of recent studies and their findings.

The paper also points out that the original randomized clinical trials that supported the use of ICDs did not include good numbers of traditionally underrepresented patient populations, such as women, racial minorities, and older patients. Newer studies have shown that ICDs are associated with survival benefit in these populations.

However, Al-Khatib also writes, in a recent editorial in The Lancet, that patient selection for ICDs needs to be improved because of high costs and potential for complications associated with the device. Attempts to improve selection criteria to determine which patients would live longer with an ICD have so far been unsuccessful.

Al-Khatib also provides analysis of the results of an observational sub-study published in The Lancet, which found that high repolarization dynamics were associated with the greatest reduction in mortality in patients treated with ICDs. Although these results are potentially important, Al-Khatib writes, they need to be verified with further study and randomized clinical trials before being implemented in clinical practice.