CARDIOVASCULAR SYSTEM: Edited by Steve HollenbergInterventions to decrease the morbidity and mortality associated with implantable cardioverter-defibrillator shocksBradfield, Jason S.; Buch, Eric; Shivkumar, KalyanamAuthor Information UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA, Los Angeles, California, USA Correspondence to Kalyanam Shivkumar, MD, PhD, UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, David Geffen School of Medicine at UCLA, 100 Medical Plaza, Suite 660, Los Angeles, CA 90095, USA. Tel: +1 310 206 6433; fax: +1 310 794 6492; e-mail: [email protected] Current Opinion in Critical Care: October 2012 - Volume 18 - Issue 5 - p 432-437 doi: 10.1097/MCC.0b013e328357ae68 Buy Metrics Abstract Purpose of review Implantable cardioverter-defibrillator (ICD) implantation is the standard of care for secondary prevention in patients with previous cardiac arrest and for primary prevention in appropriately selected patients with cardiomyopathy. However, ICD therapies and the arrhythmias that trigger these therapies cause decreased quality of life as well as increased morbidity and mortality. In this review, we summarize the recent evidence for interventions that may prevent ICD therapies. Recent findings Pharmacologic therapy remains central to prevent ICD shocks, but there is limited new evidence for drug therapies. Programming techniques continue to evolve which decrease the risk of inappropriate shocks. Cardiac resynchronization therapy (CRT) improves quality of life and decreases mortality, at least in part because of decreased arrhythmia burden. Procedures such as catheter ablation of ventricular tachycardia and procedures to modulate the autonomic nervous system can help minimize ICD therapy. Summary Pharmacologic therapy and appropriate device programming remain essential to the overall care of ICD patients. The role of CRT continues to grow as we gain a better understanding of its benefits. Advancements in the fields of catheter ablation and new understanding of the autonomic nervous system's effects on ventricular arrhythmias allow interventions to decrease the frequency of ICD shocks. © 2012 Lippincott Williams & Wilkins, Inc.