The epidemiology and costs of implantable cardioverter–defibrillator therapy in Australia

The benefit of few medical interventions are as dramatic as the lifesaving effect of an ICD

Over the past three decades, implantable cardioverter–defibrillator (ICD) therapy has become the standard of care for preventing sudden cardiac death in a range of patients who are at particular risk. These patients can be broadly categorised into two groups: patients who have already been resuscitated from a sudden cardiac death event caused by a malignant ventricular arrhythmia (secondary prevention patients); and those who are deemed to be at increased risk because of the nature and severity of their cardiac diagnosis but have not had a malignant ventricular arrhythmia (primary prevention patients). Although new variants of the basic ICD platform, such as subcutaneous ICDs, are becoming available, the fundamental components of an ICD system remain constant: a lead for assessing cardiac rhythm, particularly the onset of a rapid malignant ventricular arrhythmia, and a pulse generator for rapidly delivering a direct current shock to terminate arrhythmia. In the appropriate setting, these devices can be live-saving, and the effects of few interventions in modern medicine are as compelling as the termination of ventricular fibrillation by an appropriate ICD shock.