[We implant too many ICD - contra]

Based on prospective population-based cohort studies from the Netherlands approximately 120,000 sudden cardiac deaths (SCD) have to be assumed in 2014 in Germany for persons older than 55 years of age without an implantable cardioverter defibrillator (ICD). In contrast in 2014 only 30,000 ICD were implanted in Germany. Due to the fact that victims of SCD are difficult to predict many more implantations are actually necessary because only approximately one third of the patients use their ICD during battery running time. Also according to the largest ICD study on ischemic cardiomyopathy at least six patients must be treated with an ICD to save one life after 8 years. Guidelines for ICD implantation are based on 12 randomized studies with more than 9000 patients. In 2014 in Germany 94 % of ICD implantations were carried out in accordance with the guidelines. The most important studies for primary prophylaxis of SCD (MADIT 2 and SCD-HeFT) finished recruitment of patients in 2001 but propensity score-matched ICD patients from a large national data base showed identical survival curves in 2005 and 2006. New ICD developments in recent years, such as suppression of inappropriate ICD therapy by improved programming, cardiac resynchronization, and telemonitoring showed promise for current ICD patients of improved survival in comparison to the original randomized patients from the studies, which led to the indications in the guidelines.