Purpose of review: Prevention of ventricular arrhythmias and implantable cardioverter-defibrillator (ICD) therapies in patients with heart failure will be reviewed.
Recent findings: ICD utilization in patients with heart failure has resulted in significantly improved long-term survival. However, there is growing evidence that ICD shocks are associated with increased morbidity and mortality. As a result, there is increasing emphasis on the treatment strategies to avoid ICD therapies. Optimal heart failure management with medical as well as cardiac resynchronization therapy when indicated is an essential part of treatment; however, adjunctive measures may be necessary to suppress ventricular arrhythmias, prevent unnecessary shocks, and improve quality of life.
Summary: Device programming can help avoid ICD therapies by delaying time to detection, increasing detection rate cutoffs, and discriminating between supraventricular and ventricular arrhythmias. Still, as patients live longer with advanced stages of heart failure, there will be a need to suppress sustained ventricular arrhythmias that would otherwise require ICD therapy. Antiarrhythmic drugs offer a noninvasive option to help suppress ventricular arrhythmias. With more experience and better catheter mapping and ablation techniques, there is a movement toward an early invasive strategy for ventricular tachycardia management in patients with heart failure.