Related Experiment Video

Updated: Jan 8, 2026

A New Single Chamber Implantable Defibrillator with Atrial Sensing: A Practical Demonstration of Sensing and Ease of Implantation
16:40

A New Single Chamber Implantable Defibrillator with Atrial Sensing: A Practical Demonstration of Sensing and Ease of Implantation

Published on: February 28, 2012

26.7K

The role of implantable cardioverter-defibrillators in the elderly

Giacomo Mugnai1, Davide Genovese2, Luca Tomasi1

  • 1Division of Cardiology, Cardio-Thoracic Department, University Hospital of Verona, Verona, Italy.

Progress in Cardiovascular Diseases
|December 12, 2025
PubMed

Insights

Implantable cardioverter-defibrillators (ICDs) pose challenges in elderly patients due to competing risks and complications. A personalized approach is needed, considering frailty and shared decision-making for optimal care.

Area of Science:

  • Cardiology
  • Geriatrics
  • Medical Ethics

Background:

  • Implantable cardioverter-defibrillators (ICDs) are vital for preventing sudden cardiac death (SCD).
  • Aging populations present challenges for ICD therapy in elderly patients, particularly those over 75 with frailty and comorbidities.
  • Major clinical trials often excluded or underrepresented this demographic.

Purpose of the Study:

  • To critically examine the evidence for ICD use in elderly patients for primary and secondary prevention of SCD.
  • To highlight the impact of competing risks (non-arrhythmic death) and procedural complications on the risk-benefit ratio in older adults.
  • To advocate for a shift towards individualized care, incorporating geriatric assessment and shared decision-making.

Main Methods:

  • Review of existing clinical trial data and evidence regarding ICD efficacy in elderly populations.
  • Analysis of competing risks of non-arrhythmic death in older individuals.
  • Examination of procedural complications and long-term outcomes, including generator replacement and end-of-life management.
  • Discussion of ethical considerations and consensus on ICD deactivation in palliative care.

Main Results:

  • The efficacy of ICDs is attenuated in the elderly due to competing risks of non-arrhythmic death.
  • Elderly patients face a higher risk of procedural and long-term complications from ICDs.
  • Generator replacement decisions require re-evaluation of goals of care, not routine procedures.
  • High mortality and low appropriate therapy rates are observed post-exchange in the very elderly.
  • Device deactivation is ethically supported in end-of-life care to prevent futile shocks.

Conclusions:

  • ICD implantation in the elderly requires careful consideration beyond ejection fraction and chronological age.
  • A holistic, individualized approach integrating geriatric assessment, comorbidity burden, and shared decision-making is crucial.
  • Management strategies must adapt to the unique needs and risks of older patients, including end-of-life care planning.

Keywords:
ElderlyICDImplantable cardioverter-defibrillatorSudden cardiac death

More Related Videos

Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock06:10

Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock

Published on: June 12, 2021

3.6K
Real-Time Cardiac Mapping with a Noninvasive Imageless Electrocardiographic Imaging System10:17

Real-Time Cardiac Mapping with a Noninvasive Imageless Electrocardiographic Imaging System

Published on: April 11, 2025

1.5K

Related Concept Videos

Cardiomyopathy V: Interprofessional Care01:29

Cardiomyopathy V: Interprofessional Care

Managing cardiomyopathy involves addressing underlying or precipitating causes, treating heart failure with medications, and implementing dietary changes and a balanced exercise and rest regimen.Lifestyle ModificationsCardiomyopathy patients should adopt a low-sodium diet to reduce fluid retention and manage heart failure. A personalized exercise and rest plan helps maintain physical fitness without overstraining the heart. Avoiding alcohol and tobacco is essential to prevent further damage to...
313
Cardiopulmonary Resuscitation III: AED Use01:23

Cardiopulmonary Resuscitation III: AED Use

Introduction to AEDAn Automated External Defibrillator (AED) is a portable medical device that analyzes the heart's rhythm and, if necessary, delivers an electrical shock to help the heart re-establish an effective rhythm during sudden cardiac arrest (SCA). SCA occurs when the heart suddenly and unexpectedly stops beating, leading to a loss of blood flow to the brain and other vital organs. In such emergencies, time is of the essence, and using an AED, combined with Cardiopulmonary...
481
Cardiomyopathy II: Dilated Cardiomyopathy01:30

Cardiomyopathy II: Dilated Cardiomyopathy

Dilated cardiomyopathy, or DCM, is a progressive myocardial disorder characterized by ventricular chamber dilation and contractile dysfunction.EtiologyVarious factors can cause DCM, including hypertension and heavy alcohol intake, which contribute to the weakening and enlargement of the heart muscle. Viral infections, such as Coxsackievirus B, adenoviruses, and influenza, can lead to DCM by causing inflammation and damage to heart tissue. Certain chemotherapeutic agents, including daunorubicin,...
436
Dysrhythmias VI: Management of Dysrhythmias01:25

Dysrhythmias VI: Management of Dysrhythmias

Dysrhythmia management involves a multifaceted approach, incorporating pharmacological treatments, medical procedures, surgical interventions, lifestyle modifications, and patient education.Pharmacological ManagementAntiarrhythmic Drugs:Class I (Sodium Channel Blockers): This class includes quinidine and procainamide, which reduce the speed of impulse conduction in the heart, stabilize the cardiac membrane, and control arrhythmias. Quinidine and procainamide are Class IA agents that prolong the...
411
Heart Failure VI: Adjunct Therapies01:22

Heart Failure VI: Adjunct Therapies

Additional therapies for treating patients with heart failure (HF) may include procedural interventions, supplemental oxygen, the management of sleep disorders, and nutritional therapy.Procedural InterventionsImplantable Cardioverter-Defibrillator: For patients at risk of life-threatening arrhythmias due to severe left ventricular dysfunction, an Implantable Cardioverter-Defibrillator (ICD) can detect and terminate these arrhythmias, preventing sudden cardiac death and improving survival rates.
235
ECG Interpretation of Arrhythmias II: Atrial, Junctional and Ventricular Arrhythmias01:25

ECG Interpretation of Arrhythmias II: Atrial, Junctional and Ventricular Arrhythmias

Arrhythmia is a condition characterized by an irregular heart rhythm, with ECG changes that differ based on its origin and nature. The types of arrhythmias discussed below include atrial, junctional, and ventricular arrhythmias.Atrial ArrhythmiasPremature Atrial Complexes (PACs): PACs are early atrial beats caused by stress, caffeine, alcohol, electrolyte imbalances, hypoxia, hyperthyroidism, or certain medications (e.g., bronchodilators and decongestants). The ECG shows early P waves with an...
421