The art and science of mixing and matching.

In this issue of the Journal . Natale et al . (1) report clinical advantages of a hybrid biphasic nonthoracotomy defibrillating system compared with their earlier experience using a monophasic device with a congruently designed transvenous defibrillating lead system. This involved preliminary clinical results in patients receiving a standard CPI monophasic implantable cardioverter-defibrillator versus a biphasic implantable cardioverter-defibrillator (Cadence, Ventritex) using the same CPI Endotak (C-60) transvenous lead system with both devices . The authors report lower defibrillation thresholds and improved clinical efficacy and utility (decreased implantation time, shorter patient recovery time and higher implantation rate) based on a retrospective comparison of a new hybrid defibrillating system with an earlier clinical investigational experience . The art of medicine reflects individual innovation . The science of medicine reflects identifiable variables and measurable outcomes . Clinical efficacy and safety (clinical utility) encompasses both science and art from the diverse perspectives of the public, the regulatory agencies re-, ,, -nsible for public safety, competing manufacturers and the medical community, It is the physician's role to responsibly advance the art and science of medicine for patient benefit . Natale et al, recognized some of the uncertainties surrounding the use of hybrid defibrillating systems, but they may be creating more controversy instead of advancing the art and science of medicine . t study. Natale et al. (1) failed to address the starting and termination dates of both series, the investigational protocol status of the nonhybrid implantable cardioverter-defibrillator system, differences in implantation protocol, the "learning curve" influence and available alternative therapies while advancing the advantages of biphasic hybrid use . The report lacks data and description