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Unexpected death from cardiovascular causes accounts for 300 000 to 350 000 deaths annually in the United States and is one of the most common modes of death in the elderly.1 Despite advances in the management of cardiovascular diseases, the overall incidence of sudden cardiac death (SCD) in the general population has decreased only marginally and is expected to increase with the aging of the population and increased prevalence of chronic heart disease.1,2 Recent randomized, prospective clinical trials comparing antiarrhythmic drug therapy to implantable cardioverter defibrillator (ICD) have demonstrated the usefulness of ICD in reducing the risk of SCD due to cardiac arrhythmias in those at risk of or resuscitated from cardiac arrest or life-threatening ventricular arrhythmias.2–4 However, none of these trials have focused specifically on the efficacy of ICD in the older-elderly. Overall, the average age of patients in the clinical trials of ICD has been in 60s, ranging from 50s into the high 70s. Data on octogenarian and nona-genarians patients are scant, and it is not clear whether the survival benefit observed in the middle-aged and younger-elderly also extends to older-elderly patients with a more limited life span. The impact of ICD on improving survival in the very elderly is difficult to establish because of selection bias in the use of ICD in the elderly, lack of long-term follow-up data and shorter life expectancy due to the high incidence of non-arrhythmic cardiac and non-cardiac deaths in this population. Most published studies in the elderly are retrospective analysis of small number of patients with incomplete follow-up, in which issues related to selection bias have not been fully assessed. Since, the older-elderly constitutes the most rapidly growing segment of the population, it is important to assess the safety, efficacy, and … *Corresponding author. Tel: +1 507 284 0519; fax: +1 507 266 0228. E-mail address : jahangir.arshad{at}mayo.edu

ICDs for secondary prevention of sudden death in the older-elderly