The use of implantable cardioverter- defibrillators (ICDs) has grown rapidly in the last decade. Originally reserved for only the highest-risk patients such as survivors of sudden cardiac death (SCD), use of ICDs has expanded to include primary prevention following the publication of 2 randomized clinical trials establishing their efficacy.1,2 Since then, the great challenge in ICD use has been to identify those at greatest risk for SCD—that is, the population who would benefit the most from implantation. Cardiologists have used various criteria, such as the width of QRS and T-wave alternans, for risk stratification. Meanwhile, the use of ICDs has expanded even beyond those with heart failure to include younger patients with such conditions as arrhythmogenic right ventricular dysplasia, long QT syndrome, and hypertrophic cardiomyopathy.3
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