Editorial commentary: When should the patient with an inherited cardiac disease have an ICD?

Area of Science:

• Cardiology
• Electrophysiology
• Genetics

Background:

• Implantable cardioverter defibrillators (ICDs) are frequently used for inherited heart rhythm disorders (IHRDs) without strong randomized trial evidence, particularly for non-ischemic causes.
• Existing research often fails to adequately report adverse outcomes associated with ICDs in IHRD populations.
• Observational data suggest that ICD-related complications in IHRD patients are frequently under-recognized.

Discussion:

• The rational application of ICDs for specific IHRD subtypes is emerging, yet the acceptable risk threshold for device-related complications remains undefined.
• A critical review of the existing evidence on ICD efficacy and safety in IHRD is warranted.
• Current knowledge gaps regarding ICD benefit-risk profiles in IHRD necessitate further investigation.

Key Insights:

• Limited randomized data exist for ICD use in non-ischemic inherited heart rhythm disorders.
• Adverse events following ICD implantation in IHRD patients are often underreported and under-recognized.
• The precise balance of benefits versus harms for ICDs in various IHRD forms is not well established.

Outlook:

• Development of novel risk stratification tools for guiding ICD therapy in IHRD.
• Exploration of alternative and adjunctive therapeutic strategies beyond transvenous ICDs for IHRD management.
• Establishment of clear guidelines for ICD implantation and monitoring in inherited heart rhythm disorders.