e336 Article TypeCo respondence To the Editor:

We have read with interest the study by Yung et al1 in which the authors propose that although elderly patients show higher mortality rates after implantation of an implantable cardioverter-defibrillator (ICD), rates of appropriate shocks are similar across age groups. Accordingly, although elderly patients should be evaluated carefully for comorbidities that could increase their risk of nonarrhythmic mortality, their likelihood of receiving appropriate device therapies would not be reduced, and therefore, they could potentially benefit from the ICD. Despite the merit of their research, we do not share the same enthusiasm regarding the role of ICDs for primary prevention in elderly patients. In fact, we believe appropriate ICD therapy is not an accurate surrogate marker for mortality, and thus, the potential ben-efit of the ICD should not be based on the occurrence of appropriat