Prevention of sudden cardiac death by the implantable cardioverter-defibrillator

Sudden cardiac death (SCD) is a leading cause of death. The advent of the implantable cardioverter‑defibrillator (ICD) has revolutionized prevention of SCD in high‑risk patients with underlying cardiac diseases. However, several challenges remain. Identification of patients at risk who should receive an ICD is suboptimal, and the sole criterion applied in clinical practice is a severely reduced left ventricular ejection fraction despite the fact that SCD occurs mostly in patients with preserved or mildly reduced ejection fraction. Additionally, the majority of patients that do receive the ICD will not benefit from the device at the end. Therefore, improved risk stratification approaches to guide selection of patients for ICD implantation are definitely needed. There are several novel features and developments in the field with the subcutaneous defibrillator being probably the most important one and having the potential to substantially influence clinical practice. The role of catheter ablation of ventricular tachycardia, and particularly the potential to abolish the need for ICD implantation at least in selected patient groups, should be further defined. Internists and general practitioners play a significant role in the management of ICD patients, from identification of candidates for ICD implantation to early detection and appropriate treatment of complications.