title: The implantable cardioverter defibrillator: technology, indications, and impact on cardiovascular survival.
abstract: Since the introduction of the implantable cardioverter defibrillator (ICD) for the management of patients with high risk of arrhythmic SCD, there has been increasing use of this device. Its basic promise to effectively terminate ventricular tachycardia (VT)-ventricular fibrillation (VF) has been repeatedly met. In several randomized trials, the ICD has been shown to be superior to conventional anti-arrhythmic therapy, both in patients with documented VT-VF (secondary prevention) and those with high risk such as left ventricular ejection fraction and no prior sustained VT-VF (primary prevention). In both groups, the ICD showed overall and cardiac mortality reduction. The device now can more accurately detect VT-VF and differentiate these from other arrhythmias through a series of algorithms and direct-chamber sensing. Therapy options include painless antitachycardia pacing, low-energy cardioversion, and high-energy defibrillation. The technique implant is now simple as a pacemaker with one lead attached to an active (hot) can functioning as the other electrode. Among other improvements is its weight, volume, multiprogrammability, and storage of information,dual-chamber pacing and sensing, dual-chamber defibrillation, and addition of biventricular pacing for cardiac synchronization. It is anticipated that further improvement in ICD technology will take place and the list of indications will grow.
authors.affiliation: University of Wisconsin Medical School, Milwaukee, USA.
authors.forename: Atul
authors.initials: A
authors.lastname: Bhatia
authors.forename: Ryan
authors.initials: R
authors.lastname: Cooley
authors.forename: Marcie
authors.initials: M
authors.lastname: Berger
authors.forename: Zalmen
authors.initials: Z
authors.lastname: Blanck
authors.forename: Anwer
authors.initials: A
authors.lastname: Dhala
authors.forename: Jasbir
authors.initials: J
authors.lastname: Sra
authors.forename: Kathleen
authors.initials: K
authors.lastname: Axtell-Mcbride
authors.forename: Cheryl
authors.initials: C
authors.lastname: Vandervort
authors.forename: Masood
authors.initials: M
authors.lastname: Akhtar
mesh_terms: D000465:Algorithms; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D017147:Defibrillators, Implantable; D004562:Electrocardiography; D004867:Equipment Design; D006801:Humans; D013534:Survival; D017180:Tachycardia, Ventricular / Q000503:physiopathology / Q000628:therapy*; D014481:United States; D014693:Ventricular Fibrillation / Q000503:physiopathology / Q000628:therapy*