Evolution of implantable cardioverter defibrillator indications: comparison of guidelines in the United States and Europe.
BACKGROUND
The rate of implantation of implantable cardioverter defibrillators (ICD) is growing much faster in the United States than in western Europe. Among several factors, education and awareness of the problem of sudden cardiac death might account for this discrepancy.


RESULTS
Guidelines for ICD implantation developed in the United States and various European countries are compared, including the one recently published by the Working Groups on Arrhythmias and Cardiac Pacing of the European Society of Cardiology. Although all guidelines fully concur in their recommendations for patients after cardiac arrest due to ventricular fibrillation and ventricular tachycardia, small but noticeable differences in opinion can be traced for patients with sustained ventricular tachycardia or syncope, and for primary prevention. In general, European guidelines are more restrictive for the latter indications. Whereas U.S. guidelines were quickly updated over the years, this process took much longer in Europe, and several countries only recently adopted their first guidelines.


CONCLUSIONS
Although different in details, the recent release of ICD guidelines in major western European countries will undoubtedly lead to a pronounced increase of patients protected by this form of therapy in Europe in the coming years.
Steinbeck
Gerhard
G
Ludwig-Maximilians-Universität München, Klinikum Grosshadern, Munich, Germany. Steinbeck@med1.med.uni-muenchen.de
D001145:Arrhythmias, Cardiac / Q000628:therapy*; D017147:Defibrillators, Implantable / Q000592:standards*; D005060:Europe; D017408:Guidelines as Topic; D006323:Heart Arrest / Q000628:therapy; D006801:Humans; D013575:Syncope / Q000628:therapy; D017180:Tachycardia, Ventricular / Q000628:therapy; D014481:United States