[The use of implantable cardioverter-defibrillators in patients at high risk of sudden cardiac death].

We have reviewed literature on contemporary views on sudden cardiac death (SCD), detection of category of patients belonging to the group with high risk of SCD, and methods of SCD prevention. Randomized studies on assessment of efficacy of implantable cardioverter-defibrillators (ICD) for primary and secondary prevention of SCD have been reviewed in detail as well. We also present experience with clinical management of patients with ICD in the Main Military Clinical Hospital named after N.N.Burdenko. Primary implantations were carried out in 42 patients (5 women) aged 52.7+/-11.9 (19-80) years for secondary (40 patients) or primary (2 patients) SCD prevention. In most patients etiological factor of life threatening ventricular arrhythmias was ischemic heart disease and indications on myocardial infarction in anamnesis (28 patients). In remaining 14 patients we diagnosed right ventricular arrhythmogenic dysplasia (6 patients), dilated cardiomyopathy (3 patients), hypertrophic cardiomyopathy (2 patients), long QT syndrome (2 patients), and the Brugada syndrome (1 patient). During follow-up (from 2 to 48 months, mean 23.7+/-15.4 months) 2 patients died in 5 and 11 months after ICD implantation. In this period ICD discharges were registered in 27 patients (64%). Only in 2 of them (5%) at subsequent testing of the device the therapy was considered unjustified.