AICD indications (patient selection): Past, present and future

During the course of a seven year implant experience with the Automatic Implantable Cardioverter-Defibrillalor (AfCD) now extending to well over 3,700 implantees, several functional advances have been made in the pulse generators, and criteria for implantation were successively broadened. Survival statistics have been excellent with 1-year arrhythmic survival over 98%, and total survival from all causes of death in excess of 60% at 5 years. Still, only relatively few of the patients who could possibly be helped by this device actually receive one. Reasons for this are probably complex but include, among other things, the relative newness of electrophysiology as a subspecialty, and a lack of appreciation by the general medical public in regard to this particular treatment modality. Small increases in referral patterns thus can have the potential to produce marked increases in the utilization of AICDs. Additionally, other high risk populations appear to be ready for inclusion into AICD therapeutic trials, and techniques also appear at hand to examine presumably healthy populations so as to predict those subject to suffer eventual sudden cardiac arrest. Under such circumstances, the ultimate impact of AICD therapy can hardly be imagined.