The MADIT II and COMPANION studies: will they affect uptake of device treatment?

Primary prophylaxis of sudden cardiac death by implantable cardioverter-defibrillator (ICD) treatment will greatly increase ICD implant numbers. This will have major cost and infrastructure consequences. Those studies that have demonstrated the clinical need have been industry driven. Whether their conclusions should now expand ICD indications is debated, but it would be perverse to suggest that hesitancy in ICD treatment expansion relates to reservation about the clinical science rather than to concern about cost and resource implications