Long-term follow-up of patients with implantable cardioverter defibrillators in Greece: The Cretan Registry

In the current issue of the Journal, Kanoupakis, et al. present long-term data on mortality and utilization of device therapies in their cohort of primary and secondary prevention implantable cardioverter defibrillator (ICD) recipients on the island of Crete. This is an important registry including data from the only ICD implantation center in Crete, and these data are sufficiently robust to be considered representative of Greece. Actually, the number of ICD implantations performed at Heraklion University Hospital during the past five years exceeded the respective number of ICD implantations performed per million population in Greece, as evidenced by the published EHRA White Books. Moreover, the indications, clinical outcomes, delivered therapies and adverse events identified in this cohort of ICD recipients were in accordance with those reported by other international centers. The ICD is the most effective therapy currently available to prevent sudden cardiac death (SCD). ICD implantation rates are increasing worldwide. This increase was driven by secondary prophylaxis ICDs until 2006 and primary prevention ICDs thereafter. The Cretan Registry is in accordance with European Guidelines and current cardiovascular practice. Large randomized trials have demonstrated that ICD implantation was associated with improved survival through the achievement of primary and secondary SCD prevention. The long-term efficacy of ICD treatment was supported by the findings of an extended 11-year follow-up of a subgroup of the secondary prevention population included in the Canadian Implantable Defibrillator Study (CIDS), which enrolled patients with sustained ventricular arrhythmias combined with hemodynamic instability or reduced left ventricular ejection fraction (LVEF). Long-term ICD treatment (8