Kleemann T, et al. - In this investigation, researchers assessed the contemporary benefit-harm profile in patients undergoing primary prophylactic implantable cardioverter defibrillator (ICD) therapy, implemented into a clinical routine more than 20 years ago. A total of 1222 consecutive patients who had primary prophylactic ICD implantation between 2000 and 2017 were analyzed in a prospective single-center ICD-registry. Data reported that the estimated rate of appropriate ICD therapy after 8 years was 51% in the 2000s and 42% in the 2010s. In patients with primary prophylactic ICD implantation, the rate of ICD therapy for ventricular arrhythmias has decreased over the past two decades. Due to an unchanged rate of ICD shock malfunctions and device infections, the complication rate remains high. In primary prophylactic ICD-therapy, nonischemic cardiomyopathy is an independent predictor of ICD complications without the benefit of ICD therapy.