• Ryan T Borne, Paul D Varosy, and Frederick A Masoudi.
• Department of Medicine, Denver Health and Hospital Authority, Denver, CO, USA. ryan.borne@dhha.org
• JAMA Intern Med. 2013 May 27;173(10):859-65.

ImportanceImplantable cardioverter-defibrillators (ICDs) have revolutionized the approach to the prevention of sudden cardiac death and are commonly used in a wide range of high-risk patients, including the large population of patients with severe left ventricular systolic dysfunction. The benefit of these devices derives from their therapies, including both antitachycardia pacing and high-energy shocks. However, although these therapies may be life saving, devices can also deliver inappropriate shocks.ObjectiveTo review ICD therapies (shocks and antitachycardia pacing), their effects on health outcomes, and current methods to reduce these therapies.Evidence ReviewWe reviewed clinical evidence on ICD shocks and reference lists of retrieved articles. We also examined literature about the methods of reducing ICD therapy.FindingsBoth appropriate and inappropriate ICD shocks are common and are associated with an adverse effect on health outcomes, quality of life, and mortality. Several methods are available to reduce the risk of inappropriate ICD therapies.Conclusions And RelevanceImplantable cardioverter-defibrillators reduce the risk of sudden cardiac death and prolong life in selected populations; however, many patients will receive an ICD shock, either appropriate or inappropriate. It is imperative that patients be counseled regarding this risk and adverse outcomes associated with shocks. Reduction of ICD shock should be individualized to ensure that patients receiving these devices experience the maximal benefits of therapy while minimizing the adverse consequences.

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