Implantable cardioverter defibrillators: Uses, abuses, gains and complications

Abstract

Sudden cardiac death (SCD) due to a ventricular arrhythmia is one of the most common causes of death, yet its management continues to be a challenge. Controlled clinical trials have provided evidence that implantable cardioverter defibrillators (ICDs) are effective in reducing the risk of SCD in selected patients with ischaemic or non-ischaemic cardiomyopathy and/or ventricular arrhythmias. As increasing numbers of patients become eligible for ICDs, deciding whom should receive these becomes more complex, especially in patients with borderline risk factors and those with co-morbidities in whom the risk of death from nonarrhythmic cardiovascular cause is higher. What type of ICD a patient should receive remains a challenge. While ICD shocks themselves can affect outcomes adversely, no other therapy has proven more effective to date. Risks of implantation include infection, lead dislodgement and perforation. An ongoing challenge which also needs to be addressed includes whom will be footing the bill for device implants. More data is required to determine which patient population will benefit the most from ICD implants.