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Clinical Crossroads
Clinician's Corner
May 2, 2007

A 59-Year-Old Man Considering Implantation of a Cardiac Defibrillator

Author Affiliations

Clinical Crossroads Section Editor: Margaret A. Winker, MD, Deputy Editor.


Author Affiliation: Dr Zimetbaum is Associate Professor of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.

JAMA. 2007;297(17):1909-1916. doi:10.1001/jama.297.17.1909

Nearly 450 000 individuals experience sudden cardiac death yearly in the United States. A history of prior myocardial infarction with resultant left ventricular dysfunction identifies a group at particularly high risk of sudden arrhythmic death. Implantable cardioverter-defibrillators have proven highly effective at reducing this risk and are now increasingly implanted in patients with this risk profile. The case of Mr M, a 59-year-old man with a history of myocardial infarction, low ejection fraction, and mild congestive heart failure, who is considering implantable cardioverter-defibrillator placement, illustrates the issues in having a device implanted as a prophylactic measure as well as increasing concerns due to device recalls and malfunction. A thorough discussion of the benefits and risks associated with this therapy is necessary for patients and physicians to make appropriate decisions with regard to the primary prevention of sudden death.