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This study was designed to examine the prevention of sudden cardiac death with implantable cardioverter defibrillator (ICD) in elderly patients. Therefore device utilization, complication rate and survival of 460 patients younger than 75 years were compared with those of patients being 75 years or older at the time of implantation. It could be shown that ICD therapy is equally effective for sudden cardiac death prevention in patients 75 years old or older compared to patients younger than 75 years without increased complication rate in elderly patients. The Kaplan-Meier estimate for event-free survival showed no significant difference between the two groups. The total mortality rate was significantly higher in patients 75 years of age or older compared to younger patients which was due to an increased rate of heart failure death. The complication rate including all procedure-related, lead-related and generator-related complications associated with ICD implant and ICD therapy was comparable in the younger and older patients. Therefore the operation itself is no hindrance for the ICD-therapy in elderly patients. Total mortality during follow-up is considerably higher in elderly patients due to an increased rate of heart failure death. The current consensus guidelines for ICD therapy therefore can be used for therapy of elderly patients if these patients are otherwise medically fit without end-stage heart failure.