Despite important advances in preventive strategies, sudden cardiac death is a problem of enormous magnitude, with almost 400,000 events in the United States every year.<sup>19 Gillum R.F. Sudden coronary death in the United States: 1980–1985 Circulation 1989 ;  79 : 756  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> With the development of ambulatory monitoring and other sophisticated rhythm monitoring techniques, it has become apparent that most of these deaths are arrhythmically mediated, generally secondary to ventricular tachycardia, ventricular fibrillation, or both.<sup>5 Bayes de Luna A., Coumel P., Leclercq J.F. Ambulatory sudden cardiac death: Mechanisms of production of fatal arrhythmia on the basis of data from 157 cases Am Heart J 1989 ;  117 : 151

Cliccare qui per andare alla sezione Riferimenti</sup> Risk factors, such as recent myocardial infarction, congestive heart failure, and frequent and complex ventricular ectopy, have been identified for individuals at highest risk of sudden cardiac death, and studies suggest that primary prevention is a distinct possibility.<sup>8 Buxton A.E., Lee K.L., Fisher J.D. , e al. A randomized study of the prevention of sudden death in patients with coronary artery disease N Engl J Med 1999 ;  341 : 1882  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 31 Moss A.J., Hall W.J., Cannom D.S. , e al. Improved survival with an implanted defibrillator in patients with coronary artery disease at high risk for ventricular arrhythmia N Engl J Med 1996 ;  335 : 1933  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> Initially, efforts at prevention of sudden cardiac death focused on the use of antiarrhythmic drugs, especially medications that suppressed ventricular ectopy effectively. When studied in a placebo-controlled, double-blind manner, these drugs were shown either to have no effect on mortality<sup>9 Cairns J.A., Connolly S.J., Roberts R. , e al. Randomized trial of outcome after myocardial infarction in patients with frequent or repetitive ventricular premature depolarizations. CAMIAT Lancet 1997 ;  349 : 675  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 25 Julian D.G., Camm A.J., Frangi , e al. Randomized trial of effect of amiodarone on mortality in patients with left ventricular dysfunction after recent myocardial infarction. EMIAT Lancet 1997 ;  349 : 667  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 42 Singh S.N., Fletcher R.D., Fishe S.G. , e al. For the Survival Trial of Antiarrhythmic Therapy in Congestive Heart Failure Amiodarone in patients with congestive heart failure and asymptomatic ventricular arrhythmia N Engl J Med 1995 ;  333 : 77  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 44 Torp-Pederson C., Moller M., Block-Thomsen P.E. , e al. Dofetilide in patients with congestive heart failure and left ventricular dysfunction N Engl J Med 1999 ;  341 : 857

Cliccare qui per andare alla sezione Riferimenti</sup> or to increase it.<sup>10 Cardiac Arrhythmia Suppression Trial (CAST) Investigators Preliminary report: Effect of encainide and flecainide on mortality in a randomized trial of arrhythmia suppression after myocardial infarction N Engl J Med 1989 ;  321 : 406

Cliccare qui per andare alla sezione Riferimenti, 16 Echt D.S., Liebson P.R., Mitchell L.B. , e al. Mortality and morbidity in patients receiving encainide, flecainide, or placebo. The Cardiac Arrhythmia Suppression Trial N Engl J Med 1991 ;  324 : 781  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 47 Waldo A.L., Camm A.J., deRuyte H. , e al. Effect of d-sotalol on mortality in patients with left ventricular dysfunction after recent and remote myocardial infarction Lancet 1996 ;  348 : 7  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> In light of these results, the role of the implantable cardiac defibrillator (ICD) has assumed greater importance.