Fighting Arrhythmias

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Science  07 Jan 2005:
Vol. 307, Issue 5706, pp. 19
DOI: 10.1126/science.307.5706.19b

People who have suffered a heart attack have a high risk of developing life-threatening arrhythmias. Because drugs do not effectively reduce this risk, there has been increasing interest in the prophylactic use of implantable cardioverter defibrillators (ICDs): electronic devices that detect arrhythmias and shock the heart back to its normal rhythm. The success of ICDs in early clinical trials has been a cause for optimism but has also prompted debate about how widely these devices should be used, given their cost $20,000 each).

The results of a clinical trial by Hohnloser et al. suggest that ICDs provide much less benefit to patients when they are implanted within 6 weeks of a heart attack, as opposed to months or years later. Based on the results of a meta-analysis, Desai et al. conclude that ICDs can significantly increase the survival of a different group of patients—those who have a high risk of cardiac arrhythmias because of a heart condition called nonischemic cardiomyopathy. Together, these results emphasize the need for more extensive studies to define the patient populations most likely to benefit from these devices. — PAK

N. Engl. J. Med. 351, 2481 (2004); JAMA 292, 2874

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