Primary prevention of sudden cardiac death

Sudden cardiac death remains a therapeutic challenge for the clinical cardiologist. Although treatment of malignant ventricular tachyarrhythmias has been improved by introduction of the implantable cardioverter defibrillator (ICD) 20 years ago, primary prevention of fatal arrhythmic events in patients with structural heart diseases still constitutes an unfulfilled promise.    The disappointing results of studies using antiarrhythmic drugs to improve survival in patients with organic heart disease – particularly coronary disease, such as CAST (8, 9, 11) and SWORD (24) have led cardiologists to abandon class I drugs and pure class III drugs for prophylactic treatment in patients with coronary artery disease and remote myocardial infarction (MI). In addition, some contrasting results exist with regard to amiodarone to prevent sudden death and to improve survival (1, 12). It is therefore a logical consequence to investigate the use of ICDs for primary prevention of sudden death in different patient groups; such studies are currently ongoing, others have been terminated and published.