The incidence of sudden cardiac death increases with age and the proportion of the US population in progressively more advanced age strata is dramatically increasing. While several randomized controlled trials support the use of implantable cardioverter-defibrillators (ICDs) to reduce sudden cardiac death, no randomized trials have been done to evaluate whether there is a mortality benefit of ICDs in an elderly population. In the current review, the authors examined six of the major primary prophylaxis ICD trials for evidence pertaining to the elderly. A majority of these trials suggest a mortality benefit in the elderly patients who have met the stringent inclusion and exclusion criteria to be eligible for enrollment. Subset analysis seems to support ICD implantation in a highly select elderly subgroup, but a prospective randomized trial may be warranted.