Strategic choices to reduce implantable cardioverter-defibrillator-related morbidity

The indications for ICD implantation continue to expand; however, these devices are associated with complications related to the implantation procedure itself and morbidity caused by the normal and abnormal functioning of the components comprising the system. Several factors need to be considered when embarking on initiating ICD implantation. Special consideration should be given to implantation technique and choice of operator to decrease acute complications. After implantation, the device should be appropriately programmed to minimize unnecessary pacing and decrease the likelihood of inappropriate shocks. Therapy should, in most cases, be painless and can be achieved by adhering to simple programming recommendations. A well-established and efficient follow-up program, ideally incorporating remote monitoring, is very important to ensure compliance and to monitor therapy and the integrity of the various device components-particularly given the possibility of device or lead malfunction.