Implantable cardioverter-defibrillator: present and future indications

Indications for of automatic cardioverter-defibrillators of automatic in patients with ventricular tachyarrhythmias have changed since the publications of first guidelines in 1991. Less invasive surgical approaches reduced the perioperative mortality. Tiered therapy devices improved the quality of life by reducing appropriate and inappropriate shocks. A low annual incidence of sudden death with implantable cardioverter defibrillators and frustrating results with antiarrhythmic drugs caused an extension of implantable cardioverter-defibrillator indications. Despite the absence of prospective studies implantable cardioverter-defibrillators have become a first line treatment for patients with ventricular tachyarrhythmias which are not due to acute myocardial infarction. In cardiac arrest survivors implantable cardioverter-defibrillator therapy has become the gold standard due to the low annual incidence of sudden death seen in implantable cardioverter-defibrillator patients. The results of ongoing prospective studies comparing implantable cardioverter-defibrillator therapy to antiarrhythmic drugs have to be awaited and will influence tomorrow's indications for implantable cardioverter-defibrillator therapy in patients with documented ventricular tachyarrhythmias. Additionally, studies evaluating prophylactic implantable cardioverter-defibrillator implantations in patients at high risk for ventricular tachyarrhythmias might expand indications for implantable cardioverter-defibrillator therapy.