20 years from MADIT-II

ICD has established and accepted therapies for the prevention of sudden cardiac death in both primary and secondary preventions. This is based on the evidences by MADIT-II trial in NEJM 2002 and followed by SCD-HeFT trial in NEJM 2005. In the current ICD therapies for 20 years from MADIT-II, discovery of biphasic shock, smaller device size and weight has been advanced as same as reduction device setting for inappropriate shock therapy. In 2015, subcutaneous ICD (S-ICD) was developed and its clinical usage has been progressing in Japan and western countries.
This device is very useful, especially in younger patients, to avoid the trouble shooting of transvenous ICD leads if they had no indication for bradycardia pacing. On the other hand, CRT became available for heart failure patients with reduced LV ejection fraction in 2004, especially in LBBB patients. One of the clinical problems in both ICD and CRT therapy is the presence of atrial fibrillation (AF) in impaired LV function pts. Several clinical guidelines have shown that the indication for selection of CRT-P and CRT-D devices, but some differences were observed between in Japan and western countries.
In this symposium, we focused on 1) how should we select TV-ICD vs. S-ICD devices in primary prevention patients, 2) how should we select CRT-P vs. CRT-D devices in heart failure patients with reduced EF, 3) how should we manage AF for minimizing inappropriate shock in ICD pts and for preserving ventricular pacing in CRT pts, and discuss with US, European and Japanese EP and heart failure specialists.