NEJM 8 Oct 2009 Vol 361
1427 Most of us have an internal electric shock machine which often goes off just as we are going to sleep, reminding us of referral letters we meant to do or a job we promised for somebody. That’s bad enough: but a real electric shock machine is worse, and there have been several tirades against implantable defibrillators over recent weeks, as evidence has emerged that they do not improve mortality in women with advanced heart failure or men with marked systolic dysfunction but few symptoms. The latest group to demonstrate that these machines are shockingly ineffective are patients following myocardial infarct who show evidence of ventricular instability. Nearly 900 patients with reduced ejection fraction and tachycardia were selected to have an ICD or no ICD, so the trial was unblinded, but death is a reasonably objective end-point, and occurred equally in the two groups.
http://content.nejm.org/cgi/content/abstract/361/15/1427
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