title: Implementation of guidelines for implantable cardioverter-defibrillator therapy in clinical practice: Which patients do benefit?
abstract: OBJECTIVE
  Based on multiple large clinical trials conducted over the last decades guidelines for implantable cardioverter-defibrillator (ICD) implantations have been evolving. The increase in primary prophylactic ICD implantations challenges us to be critical towards the indications in certain patient populations.
  
  
  METHODS
  We retrospectively collected patient characteristics and rates of appropriate and inappropriate ICD therapy, appropriate and inappropriate ICD shock and mortality of all patients who received an ICD in the University Medical Center Utrecht (UMCU) over the years 2006-2011.
  
  
  RESULTS
  A total of 1075 patients were included in this analysis (74 % male, mean age 61 ± 13 years, left ventricular ejection fraction 30 ± 13 %); 61 % had a primary indication and 58 % had ischaemic heart disease. During a mean follow-up period of 31 ± 17 months, 227 of the patients (21 %) received appropriate ICD therapy (149 (14 %) patients received an appropriate ICD shock). Females, patients with a primary prophylactic indication and patients with non-ischaemic heart disease experienced significantly less ICD therapy. Only a few patients (54, 5 %) received inappropriate ICD therapy; 33 (3 %) patients received an inappropriate ICD shock. Fifty-five patients died within one year after ICD implantation and were therefore, in retrospect, not eligible for ICD implantation.
  
  
  CONCLUSIONS
  Our study confirms the benefit of ICD implantation in clinical practice. Nevertheless, certain patients experience less benefit than others. A more patient-tailored risk stratification based on electrophysiological parameters would be lucrative to improve clinical benefit and cost-effectiveness.
authors.affiliation: Department of Medical Physiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands, s.c.wijers@umcutrecht.nl.
authors.forename: S C
authors.initials: SC
authors.lastname: Wijers
authors.forename: B Y M
authors.initials: BY
authors.lastname: van der Kolk
authors.forename: A E
authors.initials: AE
authors.lastname: Tuinenburg
authors.forename: P A F
authors.initials: PA
authors.lastname: Doevendans
authors.forename: M A
authors.initials: MA
authors.lastname: Vos
authors.forename: M
authors.initials: M
authors.lastname: Meine