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Implantable cardioverter defibrillators (ICDs) are increasingly being placed in patients worldwide. These patients pose significant perioperative challenges and are at an increased risk of complications; the suitability of ambulatory surgery in this patient population remains controversial. The purpose of the present review is to examine the potential challenges and optimal perioperative care of patients with an ICD.The American Society of Anesthesiologists Advisory for the perioperative management of patients with cardiac rhythm management devices as well as the American College of Cardiologists/American Heart Association guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery recommend that the tachyarrhythmia treatment algorithms of the ICD should be programmed off prior to surgery. However, these recommendations contradict those by the manufacturers and recent reports probably because they are based on data on early generation ICDs. Improvement in ICD technology and better understanding of ICD functions and awareness of potential electromagnetic interference-related problems can reduce ICD-related complications, and improve perioperative safety.Anesthesia practitioners involved in the care of patients with ICDs should familiarize themselves with the response to magnets application on ICD function as well as understand the situations in which magnet use is not advisable. Perioperative communication with the patient's cardiologist and surgeon is critical in reducing adverse outcome.