Pursuing the "Holy Grail".

Over the past decade, several large, randomized trials have allowed us to better define the appropriate population for primary prevention implantable cardioverterdefibrillator (ICD) placement, saving thousands of lives every year. MADIT II (Multicenter Automatic Defibrillator Implantation Trial II) and SCD-HeFT (Sudden Cardiac Death in Heart Failure Trial) have demonstrated a survival benefit of 31% and 23% over 20 and 45.5 months follow-up, respectively.1,2 However, our selection criteria that are mostly based on the left ventricular ejection fraction (LVEF) are of limited specificity. Long-term follow-up data show that only 35% of patients ever receive an appropriate shock for ventricular tachycardia (VT) and ventricular fibrillation (VF) during a 3-year follow-up.3