What risk should justify implantable cardioverter defibrillator therapy?

Implantable cardioverter defibrillators (ICDs) were developed to prevent sudden cardiac death in patients with ventricular tachycardia (VT) or ventricular fibrillation (VF). Their safety and efficacy have been proved in multiple retrospective and prospective studies. Many of the published trials were directed at secondary prevention for patients who had already had a sudden cardiac death or a sustained VT. For primary prevention, the information available is limited, as only 2 trials have yet been published. Ongoing trials will probably allow us to broaden the indications for prophylactic ICD implantation. Justification of the risk will have to be evaluated against complexity of the implant, the latter including not only cost but quality of life and morbidity associated with an ICD. However, our efforts still have to be directed to improve risk stratification and to decrease the complexity of the procedure.