title: Prophylactic implantable cardioverter defibrillator in heart failure: the growing evidence for all or Primum non nocere for some?
abstract: Heart failure (HF) is a common health problem and has reached epidemic in many western countries. Despite the current era of HF treatment, the risk of sudden cardiac death (SCD) in HF remains significant. Implantable cardioverter defibrillator (ICD) support has been shown to reduce the risk of SCD in patients with HF and impaired left ventricular function. Prophylactic ICD implantation in HF patients seems a logical step to reduce mortality through a reduction in SCD. However, ICD implantation is an invasive procedure, and both short- and long-term complications can occur. This needs to be carefully considered when evaluating the risk-benefit ratio of ICD implantation for individual patients. As the severity of HF increases, the proportion of SCD compared with HF-related deaths decreases. The challenge lies in identifying patients with HF who are at significant risk of SCD and who would most benefit from an ICD in addition to other anti-arrhythmic strategies. This review offers insight on the applicability and practicability of ICD for this growing population.
authors.affiliation: Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, 1023, New Zealand. khanglil@adhb.govt.nz.
authors.forename: Khang-Li
authors.identifier: 0000-0001-6789-9055
authors.initials: KL
authors.lastname: Looi
authors.affiliation: Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, 1023, New Zealand.
authors.forename: Nigel
authors.initials: N
authors.lastname: Lever
authors.affiliation: Western University, London, ON, Canada.
authors.forename: Anthony
authors.initials: A
authors.lastname: Tang
authors.affiliation: Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, UK.
authors.forename: Sharad
authors.initials: S
authors.lastname: Agarwal
mesh_terms: D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D014943:Global Health; D006333:Heart Failure / Q000150:complications / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D015994:Incidence; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D016277:Ventricular Function, Left / Q000502:physiology*
keywords: Heart failure; Implantable cardioverter defibrillator; Left ventricular ejection fraction; New York Heart Association (NYHA) class