Sudden cardiac death: a critical appraisal of the implantable cardioverter defibrillator


  • Disclosures

    Alefiyah Rajabali, MBBS: No disclosures. E. Kevin Heist, MD PhD: BiotroniK (research grant, honoraria) Boston Scientific (research grant, honoraria, consultant), Medtronic (honoraria), Sanofi (consultant), Sorin (consultant, honoraria) St. Jude Medical (research grant, consultant, honoraria).

  • No conflicts of interest for any of the authors on this manuscript. All authors meet criteria for authorship including acceptance of responsibility for the scientific content of the manuscript.



Approximately 350,000 Americans still die of sudden cardiac death each year. This exceeds the number of patients who die annually from stroke, lung cancer, breast cancer and AIDS combined.


This review aims to trace the history of implantable cardioverter defibrillators (ICD) with reference to landmark trials and their influence on the formulation of Medicare guidelines for ICD implantation criteria. This paper will also discuss the cost-effectiveness of ICDs and the quality of life after implantation. The reasons for the disparity between guidelines for implantation and actual clinical practice will be elucidated, with suggestions for improving overall clinical performance.

Results and conclusion

The ICD has been shown to be cost-effective in reducing sudden cardiac death and all-cause mortality. However, the existing recommendations for ICD implantation have yet to translate completely into clinical practice. Barriers to implementation of existing guidelines include knowledge gaps in the referring physician practices, lack of validated screening tools to assess patient candidacy for the device and patient understanding of the need for the device. Future strategies to increase compliance with the existing guidelines and improve clinical performance are areas of potential research focus.