Implantable cardioverter defibrillators (ICDs) have a long history and have progressed significantly since the 1980s. They have become an essential part of the prevention of sudden cardiac death, with a proven survival benefit in selected patient groups. However, with more recent trials and with the introduction of contemporary heart failure therapy, there is a renewed interest and new questions regarding the role of a primary prevention ICD, especially in patients with heart failure of non-ischaemic aetiology. This review looks at the history and evolution of ICDs, appraises the traditional evidence for ICDs and looks at issues relating to patient selection, risk stratification, competing risk, future directions and a proposed contemporary ICD decision framework.
Keywords: AI; CIED; ICD; anti-tachycardia pacing; arrhythmia risk stratification; competing risk; defibrillator; implantable cardioverter defibrillator; primary prevention; sudden cardiac death; ventricular arrhythmia; ventricular fibrillation; ventricular tachycardia.