The defibrillator has been shown to reduce mortality in a number of patient groups with cardiac disease. Given the number of individuals with defibrillators it is important to understand the influence of these devices quality of life. Advances have led to smaller devices, less-invasive implantation, and more refined arrhythmia management. The potential impact of the defibrillator on quality of life continues to evolve with these advances. This review discusses the impact of the defibrillator on psychological well-being and quality of life, particularly the results of recent large randomized trials. Observational studies evaluating the relationship between defibrillator implantation and quality of life have not shown consistent results, but recent data from randomized trials provide important insights. Among patients who have survived life-threatening arrhythmias the defibrillator is associated with similar or perhaps superior quality of life versus antiarrhythmic drug therapy. However, patients who experience shocks have poorer quality of life versus those who do not. The reduction in quality of life with multiple shocks is of similar magnitude to serious side effects from antiarrhythmic drugs. While patients with defibrillators are at risk for poor quality of life. The advantages and disadvantages of defibrillator therapy versus amiodarone or usual medical care should be discussed with patients in whom a defibrillator is recommended. Those undergoing defibrillator implantation should be advised that adverse events and/or multiple shocks occur in a minority of patients, but may lead to reduced quality of life and it is vital that support resources be made available for these individuals.