scholarly journals Automatic implantable cardioverter defibrillator: when not to implant

2020 ◽  
Vol 90 (1) ◽  
Author(s):  
Maria Teresa La Rovere ◽  
Egidio Traversi
Keyword(s):  
Primary Prevention ◽  
Sudden Cardiac Death ◽  
Implantable Cardioverter Defibrillator ◽  
Cardiac Death ◽  
Reduced Ejection Fraction ◽  
Cardioverter Defibrillator ◽  
Number Of Patients ◽  
Patients With Heart Failure ◽  
Age Dependent ◽  
The Impact

The implantable cardioverter-defibrillator (ICD) is the mainstay therapy for primary prevention of sudden cardiac death in patients with heart failure with a reduced ejection fraction. Current indications for prophylactic ICD are based on the results of randomized controlled trials dating back to 15-20 years ago, which have usually enrolled highly selected patients with few comorbidities and only a small number of patients aged >75 years. Existing literature suggest an age-dependent attenuation of the efficacy of the ICD. Because of the ageing of the population, there is need for data addressing device efficacy among older patients that also considers the impact of geriatric syndromes on health status. The assessment of frailty may be of value in identifying elderly patients who may or may not benefit from ICD placement for primary prevention of sudden cardiac death.

Implantable cardioverter-defibrillator implantation for primary and secondary prevention: indications and outcomes

2017 ◽  
Vol 27 (S1) ◽  
pp. S126-S131 ◽  
Author(s):  
Justin M. Pick ◽  
Anjan S. Batra
Keyword(s):  
Primary Prevention ◽  
High Risk ◽  
Sudden Cardiac Death ◽  
Secondary Prevention ◽  
Implantable Cardioverter Defibrillator ◽  
Cardiac Death ◽  
Implantable Cardioverter Defibrillators ◽  
Cardioverter Defibrillator ◽  
Device Implantation ◽  
Risk Event

AbstractImplantable cardioverter-defibrillators effectively reduce the rate of sudden cardiac death in children. Significant efforts have been made to better characterise the indications for their placement, and over the past two decades there has been a shift in their use from secondary to primary prevention. Primary prevention includes placement in patients thought to be at high risk of sudden cardiac death before the patient experiences any event. Secondary prevention includes placement after a high-risk event including sustained ventricular tachycardia or resuscitated cardiac arrest. Although liberal device implantation may be appealing even in patients having marginal indications, studies have shown high rates of adverse effects including inappropriate device discharges and the need for re-intervention because of hardware malfunction. The indications for placement of an implantable cardioverter-defibrillator, whether for primary or secondary prevention of sudden cardiac death, vary based on cardiac pathology. This review will assist the provider in understanding the risks and benefits of device implantation in order to enhance the shared decision-making capacity of patients, families, and providers.

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