Implantable heart defibrillators

Since their inception in the early 1980s implantable cardioverter defibrillators (ICDs) have helped thousands of patients avoid cardiac death. However, new research by Ratika Parkash and colleagues show only a minority of eligible patients in selected communities in Ontario received an implant over a five-year period beginning in 1997.

The authors suggest that the low implantation rate may be a consequence of a low referral rate, supply constraints, patient preference and a lag between reported effectiveness of the treatment and its implementation in practice. For survivors of out-of-hospital cardiac arrest, implantable cardioverter defibrillators (ICDs) can reduce the high risk of cardiac arrest recurring. Increasing the number of eligible patients who actually receive an ICD could have a significant impact given that each year 45 000 Canadians die from sudden cardiac arrest.

In a related Analysis article, Davis and Tang explain how the new ICDs work, who should receive them and what a primary care physician can do for a patient with an implant that is delivering shocks.

p. 1053 Use of implantable cardioverter defibrillators after out-of-hospital cardiac arrest: a prospective follow-up study
-- R. Parkash et al.

p. 1037 Implantable cardioverter defibrillators: therapy against Canada 's leading killer.
-- D.R. Davis, A.S.L. Tang.

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