LAUSR

SEE PAGE 636 T he advent of implantable cardioverterdefibrillator (ICD) therapy ushered in a major paradigm shift in our approach to the treatment of life-threatening ventricular arrhythmias and prevention of sudden cardiac death (SCD). Compared with traditional antiarrhythmic drugs, ICDs are more effective at reducing mortality in both secondary and primary prevention populations (1–3). Thus, ICDs have become the cornerstone of our therapy for life-threatening ventricular arrhythmias. Although ICDs are effective at terminating ventricular arrhythmias and preventing death, recurrent ventricular arrhythmias can still result in significant symptoms and/or hemodynamic compromise, even when treated successfully by an ICD. Although ventricular tachycardia (VT) can often be treated painlessly by antitachycardia pacing (ATP), ICD shocks are still required for arrhythmias where ATP is unsuccessful, particularly polymorphic and/or rapid ventricular arrhythmias. ICD shocks, especially when recurrent, can have a major negative impact on quality of life (4,5) and are associated with an increase in mortality (6). ATP may have adverse effects as well (7). Therefore, despite the benefits of the ICD, and perhaps partly because of it, there remains a pressing clinical need for therapies that will prevent recurrent ventricular arrhythmias in patients with ICDs. In this issue of the Journal, Zareba et al. (8) take a novel approach to addressing this important