In a large cohort of ICD patients, inappropriate shocks were common. The most important finding is the association between inappropriate shocks and mortality, independent of interim appropriate shocks.

The number of implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy (CRT) implantations is increasing drastically worldwide, and hence, the number of implanting centers is also increasing. Despite abundant data on the beneficial effect of these devices, little is known regarding safety and complication rates. Eleven ICD and 7 CRT trials were systematically reviewed to provide data on the frequency of in-hospital mortality and complications related to the implantation. Average in-hospital mortality was 2.7% in trials using both thoracotomy and nonthoracotomy ICDs, 0.2% in trials using nonthoracotomy ICDs, and 0.3% in CRT trials. The pneumothorax rate was similar between the nonthoracotomy ICD and CRT trials (0.9%) Coronary sinus complications occurred in 2.0% of patients undergoing CRT. Lead dislodgement rates were higher in CRT trials (5.7%) than in nonthoracotomy ICD trials (1.8%).

During long-term follow-up, primary prevention patients exhibited a lower risk of appropriate therapy, but comparable mortality rates were observed between both groups. Both groups showed similar occurrence of inappropriate shocks.

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In the population currently receiving ICD treatment outside the setting of clinical trials, a large portion has either a history of AF or permanent AF. Both types of AF have prognostic implications for mortality and appropriate as well as inappropriate device discharge.

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After upgrade from ICD to CRT-D, nonresponders to CRT showed a significant increase in VA burden requiring appropriate device therapy.