Indications for dual-chamber (DDD) pacing in implantable cardioverter-defibrillator patients.
New technologic development of implantable cardioverter-defibrillators (ICDs) keeps up with the exponential increase of their use for primary and secondary prevention of sudden cardiac death. The first-generation ICD with limited shock capability alone could be considered adequate in most cardiac arrest victims, but it was not suitable for sudden death prevention in all high-risk patients with cardiac disease. The second-generation ICD was comprised of hybrid pacemaker-defibrillator systems that provided on-demand ventricular antibradycardia pacing. The third-generation devices include additional functions, such as antitachycardia pacing for ventricular tachycardia (VT) reversion and low-energy ventricular cardioversion, in addition to ventricular defibrillation and single-chamber ventricular demand pacing. In the near future, advanced dual-chamber atrioventricular (AV) pacing and defibrillating systems will also be available. The dual chamber ICD will allow atrial inhibited/dual-chamber (AAI/DDD) rate-responsive pacing, simultaneous atrial and ventricular sensing to optimize the arrhythmia identification, and ICD shock delivery in the proper arrhythmia-related chamber. Clinical benefits of these devices compared with their cost and complexity will require careful evaluation.
Santini
M
M
Department of Heart Diseases, S. Filippo Neri Hospital, Rome, Italy.
Ansalone
G
G
Auriti
A
A
Magris
B
B
Pandozi
C
C
Altamura
G
G
D002304:Cardiac Pacing, Artificial / Q000379:methods; D017147:Defibrillators, Implantable; D006801:Humans; D017180:Tachycardia, Ventricular / Q000150:complications / Q000628:therapy; D014693:Ventricular Fibrillation / Q000150:complications / Q000628:therapy