Implantable cardioverter defibrillators (ICD) offer the potential to prevent sudden cardiac death and demonstrated a survival benefit in high risk cardiac patients. ICD implantation rates vary significantly throughout the countries all over Europe although there are no major differences in cardiovascular morbidity among countries. ICD implantation rates in each European country may be influenced by economic factors, including the gross domestic product, its percentage devoted to public health, and organization of the health system. However, ICD implantation rates vary substantially also among countries with a high gross domestic product. Beyond economy, other important factors that may influence ICD implantation rates are lack of guidelines awareness and poor guidelines adherence especially when treating specific subgroup of patients (such as elderly and those with non ischemic cardiomyopathies).