- Implantable cardioverter defibrillators (ICDs) have become the mainstay preventive measures of sudden cardiac death (SCD) .However, there are limited data on rates of appropriate life-saving ICD shock therapies in contemporary real life settings. To evaluate the rate of appropriate life-saving ICD shock therapies in a contemporary registry. The Israeli ICD Registry includes all implants and other ICD operative procedures, nationwide. The present study comprises 2349 consecutive cases who were enrolled in the Registry and prospectively followed up for information regarding survival, hospitalizations and ICD therapies since 2010. Kaplan-Meier survival analysis showed that the rate appropriate ICD shock therapy at 30 month follow-up was 2.6% among patients who received an ICD for primary prevention as compared with 7.4% among those who received a device for secondary prevention (log-rank p-value<0.001). Rates of appropriate ICD shocks among primary prevention patients were 1.1% at 1-year of follow-up and 2.6% at 30 months, whereas the corresponding rates in the secondary prevention group were 3.8% at 1-year and 7.4% at 30 months (log-rank p-value<0.001). A total of 253 (4.8%) patients died during follow-up, 65% due to non-cardiac causes. Rates of life-saving appropriate ICD shock therapies among patients implanted with a defibrillator for the primary prevention of SCD in a contemporary real world setting are lower than previously reported. These findings suggest a need for improved risk stratification and patient selection in this population. Copyright © 2015. Published by Elsevier Inc.