Implantable Cardioverter-Defibrillator Implantation, Continuation, and Deactivation in Elderly Patients

Purpose of Review We review the major randomized trials and recent literature which address the impact of age on the decisions to implant, replace, and deactivate implantable cardioverter-defibrillators (ICDs) in elderly patients (≥75 years). Recent Findings Current national trends indicate that increasing numbers of ICD recipients are elderly and that elderly patients receive ICDs in a much higher proportion than was represented in randomized controlled trials. Increasing age and increasing comorbidity burden reduce the potential survival benefit from ICD implantation. Multiple risk assessment models are reviewed, as are their limitations. Perspectives regarding ICD deactivation at end of life are explored. Summary Because elderly patients are more likely to die from nonarrhythmic causes, the survival benefit that elderly patients receive from ICD implantation is reduced. Physicians should accurately represent the benefits and risks when counseling elderly patients with an indication for ICD implantation.