Clinical aspects and socio-economic implications of implantable cardioverter defibrillator treatment

Abstract

Although both ICD and CRT have proven to be an effective treatment strategy for selected patients in large clinical trials, many issues of the effects of defibrillator treatment in routine clinical practice remain unclear. In the current thesis, some of these unresolved questions are clarified based on data from a large cohort of ICD and CRT-D patients with long-term follow-up in routine clinical practice. In the first part the thesis was specifically focused on clinical aspects such as pocket related complications, the mode of death, ventricular arrhythmias and the suitability for subcutaneous device implantation in ICD recipients. In the second part the thesis was focused on socio-economic implications of ICD therapy such as the cost-effectiveness of ICD therapy, device longevity and an evidence-based approach regarding driving restrictions in ICD patients. In addition, the last chapter focused on the development and implementation of criteria that allow better identification of high risk patients and to limit the number of defibrillator implants in patients who will not benefit