The fight against sudden cardiac death: Consensus guidelines as a reference

Large clinical trial evidence favours the use of implantable cardioverter defibrillators (ICDs) in primary and secondary prevention of sudden cardiac death (SCD). In response, major cardiology organizations have developed practice guidelines to guide clinicians through their decision-making. Although agreement exists on the use of ICDs in cardiac arrest survivors (i.e. secondary prevention), more discussion has been generated by the recommendations for the use of ICDs in primary prevention of SCD. The dramatic differences in enrolment criteria among the primary prevention trials have created debates amongst experts when it comes to defining the use of ICDs in primary prevention: robust recommendations with a firm level of evidence could be formulated for some patient groups but guidelines remain underpowered for other populations. In the future, more studies are needed to strengthen guidelines for patients with well-characterized risk profiles. Second, a robust assessment of device performance in unselected patient populations is also required. Third, an even closer collaboration between clinicians and industry is justified in order to address the technological challenges posed by the continuous expansion of indications for ICDs.