Implantable Cardioverter Defibrillator (ICD) therapy is a cornerstone for preventing sudden cardiac death in patients at high risk of life-threatening ventricular arrhythmias. This session provides a detailed overview of indications, device selection, implantation technique, programming, and follow-up, modeled on the depth of a dedicated Implantable Cardioverter Defibrillator (ICD) stream within a focused cardiology conference, where clinicians learn to apply advanced ICD management strategies in a wide range of clinical scenarios.

The description begins by revisiting the mechanisms of ventricular tachycardia and ventricular fibrillation, including scar-related reentry, channelopathies, and cardiomyopathies that create arrhythmic substrates. Participants will learn how risk is stratified using left-ventricular ejection fraction, history of sustained arrhythmias or syncope, family history, genetic syndromes, and electrophysiology testing. Primary- and secondary-prevention indications are clearly differentiated.

The session then explores pre-implant evaluation and planning. Attendees will understand how to choose between single-chamber, dual-chamber, CRT-D, and subcutaneous ICD systems, taking into account pacing needs, venous access, infection risk, and patient age. Lead positioning principles, fluoroscopic views, defibrillation-threshold testing, and management of challenging anatomies are discussed in a practical, stepwise manner.

Programming strategies form a major focus, emphasizing how thoughtful programming reduces inappropriate shocks and improves patient comfort. Participants will review detection zones, rate cutoffs, discrimination algorithms, ATP sequences, shock energy settings, and strategies for minimizing therapies during supraventricular tachycardias or oversensing. Case examples demonstrate how small programming changes can dramatically alter patient experience.

Long-term management topics include regular device interrogation, remote monitoring, battery and lead surveillance, infection prevention, and handling lead failure or recalls. The session also addresses psychosocial aspects, such as anxiety after shocks, driving regulations, work considerations, and end-of-life planning including device deactivation when appropriate.

Special clinical scenarios are reviewed, including ICD use in inherited arrhythmia syndromes, ischemic and non-ischemic cardiomyopathy, congenital heart disease, and patients with LVADs or post-transplant arrhythmias. Participants will learn how ICD therapy integrates with medications, ablation, and lifestyle modification to form a comprehensive arrhythmia-prevention strategy.

Emerging trends such as extravascular ICDs, fully leadless systems, improved ATP algorithms, and AI-enhanced arrhythmia detection are discussed to illustrate how the field is evolving. Clear patient education materials and consent frameworks are highlighted, helping clinicians explain risks, benefits, and alternatives in terms patients can understand. Practical templates for follow-up visits, remote-monitoring alerts, and cross-communication between implanting centers and referring physicians ensure that ICD care remains coordinated over many years, even as patients move between different healthcare settings.