When NOT to Implant an ICD?

When not to implant an ICD?

There are certain situations when the implantation of an implantable cardioverter defibrillator may not be ideal. Some of the following situations may be considered in that category:
As ICD is an expensive device and the implantation procedure is not totally devoid of morbidity, it may be better to defer implantation when survival beyond 1 year with reasonable quality of life is unlikely due other comorbidities like a malignant disease.

Those with incessant ventricular tachycardia or fibrillation may also not be ideal candidates for the simple reason that multiple ICD shocks will be unbearable and the ICD battery will be exhausted soon. Those with significant psychiatric illness which can worsen with ICD shocks and may preclude proper ICD follow up are probably better not implanted with an ICD.

Those with refractory Class IV heart failure when cardiac transplant is not feasible may also not be good candidates for ICD implantation. Those with fully ablatable ventricular tachycardia have to undergo ablation rather than ICD implantation. An example would be posterior fascicular tachycardia. Similarly, those in whom recurrent ventricular tachycardia or fibrillation occurs due to fully reversible causes like drugs and electrolyte abnormalities, may also not need an ICD.