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Heart Asia 2009;2009:7-9 doi:10.1136/ha.2009.000828
  • Practice viewpoints

Practice viewpoints: AICD, who and when?

  1. R J Sung1,2,
  2. N-Y Chan3
  1. 1
    Institute of Life Sciences, National Central University, Jhongli, Taoyuan, Taiwan
  2. 2
    Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
  3. 3
    Princess Margaret Hospital, Kowloon, Hong Kong, PR China
  1. Professor R J Sung, Institute of Life Sciences, National Central University, 300, Jhongda Road, Jhongli, Taoyuan, Taiwan; rsung{at}cvmed.stanford.edu
  • Accepted 8 June 2009

Abstract

Automatic implantable cardioverter-defibrillator (AICD) is a costly but effective treatment modality for the prevention of sudden cardiac death (SCD). Causes of SCD are age-dependent, disease-specific and affected by racial/ethnic differences. Atherosclerotic heart disease (ASHD) is the most frequent underlying disease in individuals ≥35 years old. Available information suggests that Asians have a lower rate of SCD compared with African black individuals and Caucasians. Whether it is for secondary or for primary prevention, physicians should be educated to perform a thorough diagnostic work-up and be able to identify transient and/or reversible causes of lethal ventricular tachyarrhythmias such as acute myocardial infarction, residual ischaemia, electrolyte imbalance, adverse effect of drugs, valvular heart diseases, etc before contemplating AICD implantation. Correction of these reversible causes may avoid the necessity of AICD implantation. The status of left ventricular function is not sufficiently specific for guiding AICD implantation in ASHD patients after acute myocardial infarction. The urgent need is to develop better biological or physiological markers for risk stratification so that patients who would actually benefit from AICD implantation can be readily identified. Such an approach will make the use of AICD more cost-effective. Based on molecular genetic data obtained from patients with inherited structural cardiovascular diseases and malignant arrhythmogenic disorders in which the risk of SCD appears to be gene- and/or mutant-specific, a continuous search for genetic markers for better risk stratification is warranted in patients suffering from ASHD.

Footnotes

  • Competing interests: None.

  • Provenance and Peer review: Not commissioned; not externally peer reviewed

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"The publication of a premier cardiology journal, Heart Asia, by BMJ Publishing Group is a significant step forwards as this will become the preferred journal of choice for many of the original research work in the Asia Pacific region,"

Professor Vinay K Bahl, All India Institute of Medical Sciences, New Delhi

"The launch of Heart Asia will provide doctors in China a platform to publish their original research data and it is an important bridge that will allow the Chinese cardiologists to integrate with the international cardiology community,"

Professor Hu Dayi, Chief of the Heart Centre at Peking University’s People’s Hospital, Beijing

"Leading cardiology centres in the Asia Pacific region do some of the finest research in the world and the launch of Heart Asia is timely as it will allow top class research papers to be published in an Asia Pacific cardiology journal,"

Professor Ruey Jen Sung, Professor, Emeritus, Stanford University.

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