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Volume 360:937-938 February 26, 2009 Number 9
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Implantable Cardioverter–Defibrillators

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by Myerburg, R. J.
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To the Editor: In his article on implantable cardioverter–defibrillators (ICDs) after myocardial infarction, Myerburg (Nov. 20 issue)1 summarizes the major ICD trials and makes recommendations regarding primary prevention. Unfortunately, he does not mention background medical therapy for the treatment of patients with heart failure, a previous myocardial infarction, and a low ejection fraction. This omission is especially worrisome since optimal medical therapy can promote reverse remodeling, can have a beneficial effect on the ejection fraction, and can reduce morbidity and mortality. Medical therapy was typically required before eligibility for the trials described in this review. For example, the Multicenter Automatic . . . [Full Text of this Article]



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