Primary prevention with ICDs, are we on the right track?

There is little doubt that the introduction of internal defibrillators (ICD) has saved many lives over the last two decades. Initially, ICD use was only studied and propagated in resuscitated patients, but from the mid-1990s onwards primary prevention studies have been conducted in patients with ischaemic and non-ischaemic cardiomyopathy and a left ventricular ejection fraction (LVEF) ≤30 to 35%.1-3 The study results, mostly indicating a beneficial effect of prophylactic ICD implant, were translated into the current guidelines and the use of ICDs has grown exponentially ever since. …