Appropriate Indications for the Implantable Defibrillator

Abstract

After more than 15 years of clinical use, the appropriate indications for the implantable cardioverter-defibrillator (ICD) remain in controversy. The reasons for this controversy have nothing whatever to do with the efficacy of the device itself, since the ICD has proven remarkably effective in doing what it was designed to do, namely, preventing sudden death from ventricular arrhythmias [1–5]. Instead, the controversy stems from three factors: a) the relative expense and inconvenience of the ICD as opposed to other available therapies; b) confusion as to whether the device prolongs overall survival as well as preventing sudden death; and c) failure to note that in some patients the ICD can be useful (and therefore effective) without appreciably improving the risk of sudden death or improving overall survival.