Cardiac defibrillation

Approximately one-half of the more than 300,000 deaths due to heart disease each year in the United States are attributed to sudden cardiac death, which has been defined as death within one hour after the onset of symptoms. When sudden cardiac death occurs outside of the hospital, only 1-2% of patients survive to be discharged. The widespread adoption of the implantable cardioverter-defibrillator has made a striking impact on the mortality and morbidity associated with ventricular tachycardia and ventricular fibrillation, common causes of sudden death, but many problems remain to be addressed. Emergency medical techniques must be developed that will allow higher survival rates so that more patients survive to enjoy the benefits of the device. The devices must be improved in order that more survivors are candidates for the therapy. Questions about long-term efficacy and quality of life must be addressed. The improvement of current techniques and the development of new approaches to the management of ventricular fibrillation and sudden cardiac death will require significant contributions from basic science, to understand the mechanisms of fibrillation and defibrillation; engineering, to make the devices more robust, smaller, safer, and less expensive; and clinical science, to demonstrate efficacy and identify those patients who will benefit most from this approach. All of these considerations must be addressed in the context of the national goals of reducing medical costs through more efficient practice. The challenges are substantial, but the potential benefits are enormous