ICDs are revolutionary devices in the management of patients at risk for electrical sudden death .Its is indeed a boon for patient’ s with a primary electrical disease with occasional risk for VT.
Unfortunately , the usefulness of ICD in patients with severe mechanical dysfunction is marginal at best as these patients succumb sooner or later inspite of ICD, especially if the episodes of arrhythmia is more.
This is understandable as electrical events are directly linked to primary mechanical problem and one begetting the other.Of late , we realised these patients require some methods to stop the arrhythmia generation in the first place rather than terminating it after it manifest.
ICD may be great devices but it simply does nothing in preventing an episode VT.It trys to battle the fire after its ignition.Not a great concept to be pride upon.At best it can be called as back up safety device.So , for long term therapy it seems we need additional support system to ICD .
This can either be RF ablation or medical therapy (Amiodarone ,Sotolol, Mexiletene).It is likely , intensive anti -arrhymic therapy is essential in most.In some patients all three modalities(ICD, RF ablation, drugs) will be required for complete protection.
The VANISH trial has added important data on this issue .