An AVID dissent.

Despite declarations to the contrary, AVID appears to be a study that is seriously flawed. It is unfairly biased against the ICD; it entails unresolved ethical questions; and it poses a basic question that is inappropriate and subject to broad misinterpretation. Whatever the outcome of the study, harm is likely to follow unless the results are viewed very circumspectly. Rather than conducting such a study, we instead should be directing research funds toward identifying subsets of patients who might best benefit from the ICD. To optimize the use of the ICD, we need to do more patient selection, not less. We need to define subsets of patients in whom the prevention of sudden death by the ICD yields a prolonged overall survival, as well as subsets of patients in whom the device offers little or no benefit. AVID not only fails to do this, but it also threatens to inappropriately curtail (or less likely, to inappropriately expand) the proper use this efficacious tool, the ICD.