Contemporary ICDs: What does the latest data say?

Prof Anne Curtis (University of Buffalo, US) and Prof Angelo Auricchio (Fondazione Cardiocentro Ticino, CH) discuss contemporary clinical data of Implantable Cardioverter Defibrillators (ICDs) from real world populations. The discussion is focused on the importance and impact of ICD therapy on prevention of sudden cardiac death by analysing the latest presented data.

In context, the data analysed during the discussion is initially the presentation which Prof Curtis gave at HRS 2023, “Contemporary Implantable Cardioverter-Defibrillator Benefit: A Real-World Analysis”, where they elaborate on the core findings that significantly more ICD patients than previously understood are receiving appropriate lifesaving therapy.

These findings are also confirmed even in patient populations when no therapy was delivered with their first device till replacement while a big percentage of patients appropriately received treatment with the second device according to the study presented during ESC 2023 “Assessing the benefit of a replacement implantable cardioverter-defibrillator device for primary prevention of sudden cardiac death”.

The ongoing underutilisation of ICDs in patients especially under the light of the new heart failure drugs and the perception for low benefit of the device therapy is not confirmed in the third analysis presented at ESC 2023 by Prof Angelo Auricchio, “Mortality benefit of implantable cardioverter-defibrillators for primary prevention of sudden cardiac death: A real-world analysis“. On this patient population and after analysing Optum® de-identified Electronic Health Records, a reduced risk of all-cause mortality after ICD implantation persists in modern heart failure patients with no difference seen in the all-cause mortality benefit of ICDs between patients with or without utilising the new drugs or between ischaemic or non-ischaemic indication.

Similarly to historic landmark trials for ICD, these data confirm that ICD implantation should continue to be offered as a life-saving therapy on patients indicated by the guidelines and being at risk for sudden cardiac death despite the advances in medical treatment.