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The benefit of implantable cardioverter–defibrillators beyond the first generator

Published:November 23, 2018DOI:https://doi.org/10.1016/j.hrthm.2018.11.025
      Implantable cardioverter–defibrillators (ICDs) are lifesaving and are placed based on guideline recommendations for primary or secondary prevention of fatal arrhythmic death due to underlying cardiomyopathic processes.
      • Al-Khatib S.M.
      • Stevenson W.G.
      • Ackerman M.J.
      • et al.
      2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society.
      Although the benefits of ICD therapy are clear, potential drawbacks such as inappropriate shocks can lead to significant morbidity and may be associated with increased mortality.
      • Moss A.J.
      • Schuger C.
      • Beck C.A.
      • et al.
      Reduction in inappropriate therapy and mortality through ICD programming.
      Indwelling leads and devices are prone to bloodstream infections.
      • DeSimone D.C.
      • Sohail M.R.
      Management of bacteremia in patients living with cardiovascular implantable electronic devices.
      Psychosocial aspects, such as posttraumatic stress disorder from shocks,
      • Ingles J.
      • Sarina T.
      • Kasparian N.
      • Semsarian C.
      Psychological wellbeing and posttraumatic stress associated with implantable cardioverter defibrillator therapy in young adults with genetic heart disease.
      and disqualification or restrictions in certain vocations, driving, and competitive sports can be devastating to the psyche of patients.
      • Ferrick A.M.
      • Ferrick K.J.
      Sports and driving with an implantable cardioverter-defibrillator.
      Thus, shared decision-making between the patient and physician should be established before any ICD insertion.
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