In sickness and in health, till death do us part: Is the ICD a lifelong commitment?

The decision-making process around initial implantation of an Implantable Cardioverter Defibrillator (ICD) is well studied, guided by randomized clinical trials which have translated into widely accepted clinical guidelines. For patients who out-live their first device and are eligible for a generator exchange (GE) the indications to replace the battery is much less well-defined. In this latter case, the clinician needs to make the decision based on persistent indications for primary prevention ICD, risk of future arrhythmic death in the absence of ongoing indications for primary prevention, competing causes of non-arrhythmic death and the patient's overall goals of care.