- The Canadian Heart Rhythm Society in conjunction with the Canadian Cardiovascular Society is committed to the promotion of evidence-based practice in Canada. Since the last Canadian guidelines on the management of sudden cardiac death were published in 2000, several well-conducted clinical trials evaluating the implantable cardioverter defibrillator have been completed and published. The Canadian Cardiovascular Society Council has granted permission to review and update guidelines for the indications for implantable cardioverter defibrillators. Furthermore, data are emerging on the potential benefits of biventricular pacing therapy (cardiac resynchronization) for heart failure; recommendations for the use of this therapy have been included in the present paper. Ethical considerations and the economic implications of these recommendations are also included. Canada's heart rhythm specialists, represented by the Canadian Heart Rhythm Society, have been joined by two heart failure specialists, a medical ethicist and an economist, to develop the present position paper. Members of the Canadian Heart Rhythm Society participated in the discussion of these recommendations in open forum meetings and by electronic communication.