Next-generation ICDs: Individualised Selection for Improved Cardiac Outcomes

Cardiovascular disease is a major global cause of death, with sudden cardiac death accounting for up to half of cases, largely due to ventricular tachyarrhythmias. In the UK, approximately 60,000 out-of-hospital cardiac arrests occur annually, with survival rates of only 2-12%. Younger individuals are also affected, with one cardiac-related death daily in those under 35 years of age. Despite advances in care, arrhythmia recurrence remains high (40-50% within 5 years). ICDs have become pivotal in preventing sudden cardiac death, with continuous innovations in device design, implantation, and arrhythmia detection since their introduction in 1980. Transvenous single-chamber ICDs remain the standard, while dual-chamber and CRT defibrillator devices serve patients needing atrial pacing or heart failure support. Subcutaneous and extravascular ICD systems protect patients not requiring pacing while avoiding lead-related risks. Device selection must be individualised, considering clinical profile, comorbidities, lifestyle, patient preferences, and operator expertise. Ongoing advances, including leadless pacing and modular anti-tachycardia pacing systems, continue to expand personalised device strategies.