Harvard Heart Letter

Ask the doctors: Should I replace my ICD?

Q. I am 90 years old and have had severe heart failure for seven years after having a heart attack. I have an implantable defibrillator. It has never gone off. It is near the end of its lifetime, and the cardiologist asked me if I want it replaced. What would you advise?

A. Many people with severely damaged hearts receive implantable cardioverter-defibrillators (ICDs) because they have a high risk of sudden death from rhythm abnormalities. Fortunately, you have not had this problem, but you remain at considerable risk. If a dangerous arrhythmia occurs, the defibrillator might save your life.

That being said, if you did not have a defibrillator, I would not recommend putting one in, because the chance that a defibrillator will lead to a longer life is low, due to your advanced age. But because you have a defibrillator, not replacing it would seem like a withdrawal of therapy.

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