Circulation
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Randomized study of implantable defibrillator as first-choice therapy versus conventional strategy in postinfarct sudden death survivors.
In retrospective studies of sudden cardiac death survivors, the implantable cardioverter-defibrillator (ICD) compares favorably with medical and surgical therapy. Thus, use of the conventional strategy of starting treatment with antiarrhythmic drugs (AD), at least in certain patient categories, may be questionable. The goal of this study was to analyze the effectiveness of ICD implantation as first-choice therapy versus the conventional therapeutic strategy of starting with AD. ⋯ These data suggest that ICD implantation as first choice is preferable to the conventional approach in survivors of cardiac arrest caused by old myocardial infarction. Conventionally treated patients are likely to end up with an ICD, and those who remain on AD as sole therapy have a high risk of death regardless of efficacy assessment, including PES.
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Editorial Comment Randomized Controlled Trial Clinical Trial
Are implantable cardioverter-defibrillators better than conventional antiarrhythmic drugs for survivors of cardiac arrest?