[Current indications for an implantable cardioverter defibrillator (ICD)]

Sudden cardiac death is one of the leading causes of death in industrialized countries. The implantable cardioverter/defibrillator (ICD) is the most effective treatment for malignant ventricular tachyarrhythmias. Current guidelines recommend the implantation of a defibrillator in patients who experienced ventricular tachycardia or fibrillation (secondary prevention of sudden cardiac death), as well as in high risk patients for primary prevention. The latter are patients with impaired left ventricular function ≤ 35 %. With the exception of secondary prevention indications (ie. after a "survived sudden cardiac death") indications for ICD implantation in the context of other cardiomyopathies, such as hypertrophic (obstructive) cardiomyopathy and arrhythmogenic right ventricular cardiomyopathy (ARVC), and of channelopathies, such as Brugada syndrome and long QT syndrome are complex. Before deciding to implant an ICD, the indication as well as the potential complications (inappropriate shocks, risk of infection, device or lead replacement, costs, etc.) have to be considered and discussed in detail with the patients and their relatives. There are very few specific hazards or significant limitations in daily life for the patient and his environment caused by the ICD. An ICD can be transiently deactivated if necessary by using a magnet (eg. during surgery) or permanently deactivated by re-programming the device (eg. palliative care).