Implantable cardioverter defibrillators (ICDs) in octogenarians

Octogenarians are a growing section of the community. Implantable cardioverter defibrillator (ICD) implantations and replacements in this age group are becoming frequent. There are no randomised control trials or large observational studies of octogenarians and indications for ICD implantations are extrapolated from published primary and secondary prevention trials, where the age group has been in its sixties. About 75% of ICDs are implanted for primary prevention guided by patient's ejection fraction. Most patients who have ICDs do not have a clear idea about the function and limitation of ICDs. Patient education about ICDs is an important aspect which deserves consideration, particularly in this age group. The use of ICDs in octogenarians should be individualised and carefully scrutinised. It should take into consideration overall health status, symptom severity, co-morbidities and intermediate and long-term prognosis. There should be detailed discussion about patient preference and expectations. Physicians must provide a realistic appraisal of potential benefits and risks and address device management issues at end of life. This discussion should also take place when ICD replacement is considered.