Implantable Cardioverter-Defibrillator Therapy in Cardiovascular Risk Management

Implantable cardioverter-defibrillators (ICDs) have emerged as a cornerstone in the prevention of sudden cardiac death in patients at elevated risk of life-threatening ventricular arrhythmias. By continuously monitoring cardiac rhythm and delivering therapies—ranging from anti-tachycardia pacing to high-energy shocks—these devices restore normal rhythm in cases of sustained ventricular tachyarrhythmia. Indications for ICDs include primary prophylaxis in high-risk patients without prior arrhythmic events and secondary prophylaxis in survivors of aborted cardiac arrest. Advances in lead technology, battery longevity and algorithm optimisation have enhanced the safety and efficacy of implantation, while also minimising inappropriate therapies. Large-scale registries highlight the critical role of patient selection, comorbidity management and shared decision-making in tailoring ICD therapy. Integration of ICDs into multidisciplinary care pathways has improved long-term survival, although device-related complications and the psychosocial impact of shocks drive ongoing refinement of follow-up protocols. Current research seeks to refine risk stratification by integrating imaging, biomarkers and electrophysiological metrics to identify those most likely to benefit from ICD therapy and to reduce procedural adverse events.

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Implantable Cardioverter-Defibrillator Therapy in Cardiovascular Risk Management publication trend

The graph below shows the total number of articles in implantable cardioverter-defibrillator therapy in cardiovascular risk management across all publications each year (not limited to Nature Index journals).

Technical terms

Implantable Cardioverter-Defibrillator (ICD): A device implanted under the skin that monitors heart rhythm and delivers electrical therapy to terminate life-threatening arrhythmias.

Sudden Cardiac Death (SCD): An unexpected fatal event due to cardiac causes, occurring within one hour of symptom onset, typically from ventricular arrhythmia.

Primary Prophylaxis: Use of an ICD in patients at high risk of arrhythmic events but without a prior history of sustained ventricular arrhythmia or cardiac arrest.

Secondary Prophylaxis: Implantation of an ICD in patients who have survived a sudden cardiac arrest or have documented sustained ventricular arrhythmia.

Left Ventricular Ejection Fraction (LVEF): The percentage of blood ejected from the left ventricle with each heartbeat, used to assess ventricular function and stratify arrhythmic risk.

References

1. First implantable cardiac defibrillator insertions in New South Wales, 2005–2020: an analysis of linked administrative data. The Medical Journal of Australia (2024).
2. Inequality between women and men in ICD implantation. IJC Heart & Vasculature (2022).
3. 2019 HRS/EHRA/APHRS/LAHRS focused update to 2015 expert consensus statement on optimal implantable cardioverter-defibrillator programming and testing. Journal of Interventional Cardiac Electrophysiology (2020).
4. Predictors of mortality and ICD shock therapy in primary prophylactic ICD patients—A systematic review and meta-analysis. PLOS ONE (2017).
5. Sudden cardiac death: The role of imaging. International Journal of Cardiology (2017).