Editorial commentary: When should the patient with an inherited cardiac disease have an ICD?

Abstract

The implantable cardioverter defibrillator (ICD) is often considered a routine intervention for an inherited heart rhythm disorder (IHRD) despite there being little to no randomized data for non-ischemic indications. Furthermore, existing IHRD studies often do not report adverse ICD outcomes, and observational data increasingly show that complications are under-recognized. Only recently have tools emerged to address the rational use of ICDs for specific forms of IHRD, although the acceptable risk of device complications remains unestablished. Here, we summarize the evidence of ICD benefit and harm in IHRD, highlight current knowledge gaps, and propose alternative and adjunctive options to the transvenous ICD.

Keywords: Arrhythmogenic right ventricular cardiomyopathy; Brugada syndrome; Implantable cardioverter defibrillator; Inherited arrhythmia; Long qt syndrome.