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General principles of the implantable cardioverter-defibrillator

Leonard I Ganz, MD, FHRS, FACC
Section Editor
Brian Olshansky, MD
Deputy Editor
Brian C Downey, MD, FACC


Ventricular fibrillation (VF) is a common cause of sudden cardiac death (SCD) and is sometimes preceded by monomorphic or polymorphic ventricular tachycardia (VT). Although cardiopulmonary resuscitation, including chest compressions and assisted ventilation, can provide transient circulatory support for the patient with cardiac arrest, the only effective approach for terminating VF is electrical defibrillation. Success with external defibrillation led to the development of an implantable defibrillator in the mid-1960s. It was not until 1980 that the first automatic internal defibrillator was implanted in humans [1,2]. (See "Pathophysiology and etiology of sudden cardiac arrest".)

Since that time, there has been a dramatic increase in the use of the implantable cardioverter-defibrillator (ICD) to monitor for VT/VF and to provide prompt treatment. Because of its high success rate in terminating VT/VF rapidly, results of multiple clinical trials showing improvement in survival, ICD implantation is generally considered the first-line treatment option for the secondary prevention of SCD and for primary prevention in certain populations at high risk of SCD due to VT/VF. Alternatives to ICD implantation include antiarrhythmic drugs, ablative surgery, transcatheter ablation, and, in selected individuals, cardiac transplantation. (See "Sustained monomorphic ventricular tachycardia in patients with a prior myocardial infarction: Treatment and prognosis", section on 'Radiofrequency catheter ablation' and "Secondary prevention of sudden cardiac death in heart failure and cardiomyopathy" and "Pharmacologic therapy in survivors of sudden cardiac arrest".)

This topic will review the general indications for ICD implantation, the elements of the ICD, the features of ICD therapy and programming, and the role of adjunctive therapies in patients who receive an ICD. The clinical trials documenting the efficacy of an ICD in different clinical settings (including both secondary and primary prevention), complications of ICD placement, and follow-up care of patients with ICDs are discussed separately. (See "Secondary prevention of sudden cardiac death in heart failure and cardiomyopathy" and "Primary prevention of sudden cardiac death in heart failure and cardiomyopathy" and "Implantable cardioverter-defibrillators: Complications" and "Cardiac implantable electronic devices: Patient follow-up".)


The main indications for use of an ICD relate to secondary prevention in patients with prior sustained ventricular tachycardia (VT), ventricular fibrillation (VF), or resuscitated sudden cardiac death (SCD) thought to be due to VT/VF as well as primary prevention in patients at increased risk of life-threatening VT/VF. The 2008 American College of Cardiology/American Heart Association/Heart Rhythm Society (ACC/AHA/HRS) guidelines for device-based therapy of cardiac rhythm abnormalities include guidelines for ICD therapy, and in 2013 numerous professional societies (including ACC, AHA, and HRS) jointly published appropriate use criteria discussing indications for ICD and cardiac resynchronization therapy [3,4].

Indications for ICD therapy

Secondary prevention — Implantation of an ICD is recommended for the secondary prevention of death due to VT/VF in the following settings [3]:


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Literature review current through: Sep 2016. | This topic last updated: Jul 6, 2016.
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  1. Mirowski M, Mower MM, Staewen WS, et al. Standby automatic defibrillator. An approach to prevention of sudden coronary death. Arch Intern Med 1970; 126:158.
  2. Mirowski M, Reid PR, Mower MM, et al. Termination of malignant ventricular arrhythmias with an implanted automatic defibrillator in human beings. N Engl J Med 1980; 303:322.
  3. Epstein AE, DiMarco JP, Ellenbogen KA, et al. ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices): developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons. Circulation 2008; 117:e350.
  4. Russo AM, Stainback RF, Bailey SR, et al. ACCF/HRS/AHA/ASE/HFSA/SCAI/SCCT/SCMR 2013 appropriate use criteria for implantable cardioverter-defibrillators and cardiac resynchronization therapy: a report of the American College of Cardiology Foundation appropriate use criteria task force, Heart Rhythm Society, American Heart Association, American Society of Echocardiography, Heart Failure Society of America, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance. J Am Coll Cardiol 2013; 61:1318.
  5. DiMarco JP. Implantable cardioverter-defibrillators. N Engl J Med 2003; 349:1836.
  6. Israel CW, Grönefeld G, Iscolo N, et al. Discrimination between ventricular and supraventricular tachycardia by dual chamber cardioverter defibrillators: importance of the atrial sensing function. Pacing Clin Electrophysiol 2001; 24:183.
  7. Fenelon G, Huvelle E, Brugada P. Initial clinical experience with a new small sized third-generation implantable cardioverter defibrillator: results of a multicenter study. European Ventak Mini Investigator Group. Pacing Clin Electrophysiol 1997; 20:2967.
  8. Thijssen J, Borleffs CJ, van Rees JB, et al. Implantable cardioverter-defibrillator longevity under clinical circumstances: an analysis according to device type, generation, and manufacturer. Heart Rhythm 2012; 9:513.
  9. Anvari A, Stix G, Grabenwöger M, et al. Comparison of three cardioverter defibrillator implantation techniques: initial results with transvenous pectoral implantation. Pacing Clin Electrophysiol 1996; 19:1061.
  10. Cardinal DS, Connelly DT, Steinhaus DM, et al. Cost savings with nonthoracotomy implantable cardioverter-defibrillators. Am J Cardiol 1996; 78:1255.
  11. Pacifico A, Johnson JW, Stanton MS, et al. Comparison of results in two implantable defibrillators. Jewel 7219D Investigators. Am J Cardiol 1998; 82:875.
  12. Flaker GC, Tummala R, Wilson J. Comparison of right- and left-sided pectoral implantation parameters with the Jewel active can cardiodefibrillator. The World Wide Jewel Investigators. Pacing Clin Electrophysiol 1998; 21:447.
  13. Gold MR, Shih HT, Herre J, et al. Comparison of defibrillation efficacy and survival associated with right versus left pectoral placement for implantable defibrillators. Am J Cardiol 2007; 100:243.
  14. Wilkoff BL, Fauchier L, Stiles MK, et al. 2015 HRS/EHRA/APHRS/SOLAECE expert consensus statement on optimal implantable cardioverter-defibrillator programming and testing. Heart Rhythm 2016; 13:e50.
  15. Swerdlow CD, Schsls W, Dijkman B, et al. Detection of atrial fibrillation and flutter by a dual-chamber implantable cardioverter-defibrillator. For the Worldwide Jewel AF Investigators. Circulation 2000; 101:878.
  16. Adler SW 2nd, Wolpert C, Warman EN, et al. Efficacy of pacing therapies for treating atrial tachyarrhythmias in patients with ventricular arrhythmias receiving a dual-chamber implantable cardioverter defibrillator. Circulation 2001; 104:887.
  17. Friedman PA, Dijkman B, Warman EN, et al. Atrial therapies reduce atrial arrhythmia burden in defibrillator patients. Circulation 2001; 104:1023.
  18. Wood MA, Stambler BS, Damiano RJ, et al. Lessons learned from data logging in a multicenter clinical trial using a late-generation implantable cardioverter-defibrillator. The Guardian ATP 4210 Multicenter Investigators Group. J Am Coll Cardiol 1994; 24:1692.
  19. Nunain SO, Roelke M, Trouton T, et al. Limitations and late complications of third-generation automatic cardioverter-defibrillators. Circulation 1995; 91:2204.
  20. Grimm W, Flores BF, Marchlinski FE. Electrocardiographically documented unnecessary, spontaneous shocks in 241 patients with implantable cardioverter defibrillators. Pacing Clin Electrophysiol 1992; 15:1667.
  21. Klein RC, Raitt MH, Wilkoff BL, et al. Analysis of implantable cardioverter defibrillator therapy in the Antiarrhythmics Versus Implantable Defibrillators (AVID) Trial. J Cardiovasc Electrophysiol 2003; 14:940.
  22. Swerdlow CD, Chen PS, Kass RM, et al. Discrimination of ventricular tachycardia from sinus tachycardia and atrial fibrillation in a tiered-therapy cardioverter-defibrillator. J Am Coll Cardiol 1994; 23:1342.
  23. Le Franc P, Kuś T, Vinet A, et al. Underdetection of ventricular tachycardia using a 40 ms stability criterion: effect of antiarrhythmic therapy. Pacing Clin Electrophysiol 1997; 20:2882.
  24. Schaumann A, von zur Mühlen F, Herse B, et al. Empirical versus tested antitachycardia pacing in implantable cardioverter defibrillators: a prospective study including 200 patients. Circulation 1998; 97:66.
  25. Trappe HJ, Klein H, Kielblock B. Role of antitachycardia pacing in patients with third generation cardioverter defibrillators. Pacing Clin Electrophysiol 1994; 17:506.
  26. Saksena S, Chandran P, Shah Y, et al. Comparative efficacy of transvenous cardioversion and pacing in patients with sustained ventricular tachycardia: a prospective, randomized, crossover study. Circulation 1985; 72:153.
  27. Bardy GH, Poole JE, Kudenchuk PJ, et al. A prospective randomized repeat-crossover comparison of antitachycardia pacing with low-energy cardioversion. Circulation 1993; 87:1889.
  28. Clinical outcome of patients with malignant ventricular tachyarrhythmias and a multiprogrammable implantable cardioverter-defibrillator implanted with or without thoracotomy: an international multicenter study. PCD Investigator Group. J Am Coll Cardiol 1994; 23:1521.
  29. Sullivan RM, Russo AM, Berg KC, et al. Arrhythmia rate distribution and tachyarrhythmia therapy in an ICD population: results from the INTRINSIC RV trial. Heart Rhythm 2012; 9:351.
  30. Clemens M, Nagy-Baló E, Herczku C, et al. Long-term arrhythmia variability after monomorphic ventricular tachycardia in patients with an implantable cardioverter defibrillator. Pacing Clin Electrophysiol 2011; 34:1185.
  31. Nasir N Jr, Pacifico A, Doyle TK, et al. Spontaneous ventricular tachycardia treated by antitachycardia pacing. Cadence Investigators. Am J Cardiol 1997; 79:820.
  32. Wathen MS, DeGroot PJ, Sweeney MO, et al. Prospective randomized multicenter trial of empirical antitachycardia pacing versus shocks for spontaneous rapid ventricular tachycardia in patients with implantable cardioverter-defibrillators: Pacing Fast Ventricular Tachycardia Reduces Shock Therapies (PainFREE Rx II) trial results. Circulation 2004; 110:2591.
  33. Wathen MS, Sweeney MO, DeGroot PJ, et al. Shock reduction using antitachycardia pacing for spontaneous rapid ventricular tachycardia in patients with coronary artery disease. Circulation 2001; 104:796.
  34. Pinski SL, Fahy GJ. The proarrhythmic potential of implantable cardioverter-defibrillators. Circulation 1995; 92:1651.
  35. Saksena S, Luceri R, Krol RB, et al. Endocardial pacing, cardioversion and defibrillation using a braided endocardial lead system. Am J Cardiol 1993; 71:834.
  36. Strickberger SA, Klein GJ. Is defibrillation testing required for defibrillator implantation? J Am Coll Cardiol 2004; 44:88.
  37. Rashba EJ, Olsovsky MR, Shorofsky SR, et al. Temporal decline in defibrillation thresholds with an active pectoral lead system. J Am Coll Cardiol 2001; 38:1150.
  38. Newman D, Barr A, Greene M, et al. A population-based method for the estimation of defibrillation energy requirements in humans. Assessment of time-dependent effects with a transvenous defibrillation system. Circulation 1997; 96:267.
  39. Hodgson DM, Olsovsky MR, Shorofsky SR, et al. Clinical predictors of defibrillation thresholds with an active pectoral pulse generator lead system. Pacing Clin Electrophysiol 2002; 25:408.
  40. Carlsson J, Schulte B, Erdogan A, et al. Prospective randomized comparison of two defibrillation safety margins in unipolar, active pectoral defibrillator therapy. Pacing Clin Electrophysiol 2003; 26:613.
  41. Schneider T, Martens PR, Paschen H, et al. Multicenter, randomized, controlled trial of 150-J biphasic shocks compared with 200- to 360-J monophasic shocks in the resuscitation of out-of-hospital cardiac arrest victims. Optimized Response to Cardiac Arrest (ORCA) Investigators. Circulation 2000; 102:1780.
  42. Venditti FJ Jr, John RM, Hull M, et al. Circadian variation in defibrillation energy requirements. Circulation 1996; 94:1607.
  43. Butter C, Meisel E, Tebbenjohanns J, et al. Transvenous biventricular defibrillation halves energy requirements in patients. Circulation 2001; 104:2533.
  44. Kall JG, Kopp D, Lonchyna V, et al. Implantation of a subcutaneous lead array in combination with a transvenous defibrillation electrode via a single infraclavicular incision. Pacing Clin Electrophysiol 1995; 18:482.
  45. Hsu JC, Marcus GM, Al-Khatib SM, et al. Predictors of an inadequate defibrillation safety margin at ICD implantation: insights from the National Cardiovascular Data Registry. J Am Coll Cardiol 2014; 64:256.
  46. Strickberger SA, Daoud EG, Davidson T, et al. Probability of successful defibrillation at multiples of the defibrillation energy requirement in patients with an implantable defibrillator. Circulation 1997; 96:1217.
  47. Day JD, Doshi RN, Belott P, et al. Inductionless or limited shock testing is possible in most patients with implantable cardioverter- defibrillators/cardiac resynchronization therapy defibrillators: results of the multicenter ASSURE Study (Arrhythmia Single Shock Defibrillation Threshold Testing Versus Upper Limit of Vulnerability: Risk Reduction Evaluation With Implantable Cardioverter-Defibrillator Implantations). Circulation 2007; 115:2382.
  48. Healey JS, Gula LJ, Birnie DH, et al. A randomized-controlled pilot study comparing ICD implantation with and without intraoperative defibrillation testing in patients with heart failure and severe left ventricular dysfunction: a substudy of the RAFT trial. J Cardiovasc Electrophysiol 2012; 23:1313.
  49. Guenther M, Rauwolf T, Brüggemann B, et al. Pre-hospital discharge testing after implantable cardioverter defibrillator implantation: a measure of safety or out of date? A retrospective analysis of 975 patients. Europace 2012; 14:217.
  50. Brignole M, Occhetta E, Bongiorni MG, et al. Clinical evaluation of defibrillation testing in an unselected population of 2,120 consecutive patients undergoing first implantable cardioverter-defibrillator implant. J Am Coll Cardiol 2012; 60:981.
  51. Arnson Y, Suleiman M, Glikson M, et al. Role of defibrillation threshold testing during implantable cardioverter-defibrillator placement: data from the Israeli ICD Registry. Heart Rhythm 2014; 11:814.
  52. Phan K, Kabunga P, Kilborn MJ, Sy RW. Defibrillator Threshold Testing at Generator Replacement: Is it Time to Abandon the Practice? Pacing Clin Electrophysiol 2015; 38:777.
  53. Kopp DE, Blakeman BP, Kall JG, et al. Predictors of defibrillation energy requirements with nonepicardial lead systems. Pacing Clin Electrophysiol 1995; 18:253.
  54. Healey JS, Hohnloser SH, Glikson M, et al. Cardioverter defibrillator implantation without induction of ventricular fibrillation: a single-blind, non-inferiority, randomised controlled trial (SIMPLE). Lancet 2015; 385:785.
  55. Bänsch D, Bonnemeier H, Brandt J, et al. Intra-operative defibrillation testing and clinical shock efficacy in patients with implantable cardioverter-defibrillators: the NORDIC ICD randomized clinical trial. Eur Heart J 2015; 36:2500.
  56. Mitchell AR, Spurrell PA, Boodhoo LE, Sulke N. Long-term care of the patient with the atrial defibrillator. Am Heart J 2004; 147:210.
  57. Wilkoff BL, Ousdigian KT, Sterns LD, et al. A comparison of empiric to physician-tailored programming of implantable cardioverter-defibrillators: results from the prospective randomized multicenter EMPIRIC trial. J Am Coll Cardiol 2006; 48:330.
  58. Madhavan M, Friedman PA. Optimal programming of implantable cardiac-defibrillators. Circulation 2013; 128:659.
  59. Moss AJ, Schuger C, Beck CA, et al. Reduction in inappropriate therapy and mortality through ICD programming. N Engl J Med 2012; 367:2275.
  60. Ruwald AC, Schuger C, Moss AJ, et al. Mortality reduction in relation to implantable cardioverter defibrillator programming in the Multicenter Automatic Defibrillator Implantation Trial-Reduce Inappropriate Therapy (MADIT-RIT). Circ Arrhythm Electrophysiol 2014; 7:785.
  61. Ruwald MH, Zareba W, Jons C, et al. Influence of diabetes mellitus on inappropriate and appropriate implantable cardioverter-defibrillator therapy and mortality in the Multicenter Automatic Defibrillator Implantation Trial-Reduce Inappropriate Therapy (MADIT-RIT) Trial. Circulation 2013; 128:694.
  62. Gasparini M, Proclemer A, Klersy C, et al. Effect of long-detection interval vs standard-detection interval for implantable cardioverter-defibrillators on antitachycardia pacing and shock delivery: the ADVANCE III randomized clinical trial. JAMA 2013; 309:1903.
  63. Kloppe A, Proclemer A, Arenal A, et al. Efficacy of long detection interval implantable cardioverter-defibrillator settings in secondary prevention population: data from the Avoid Delivering Therapies for Nonsustained Arrhythmias in ICD Patients III (ADVANCE III) trial. Circulation 2014; 130:308.
  64. Buber J, Luria D, Gurevitz O, et al. Safety and efficacy of strategic implantable cardioverter-defibrillator programming to reduce the shock delivery burden in a primary prevention patient population. Europace 2014; 16:227.
  65. Saeed M, Hanna I, Robotis D, et al. Programming implantable cardioverter-defibrillators in patients with primary prevention indication to prolong time to first shock: results from the PROVIDE study. J Cardiovasc Electrophysiol 2014; 25:52.
  66. Gasparini M, Menozzi C, Proclemer A, et al. A simplified biventricular defibrillator with fixed long detection intervals reduces implantable cardioverter defibrillator (ICD) interventions and heart failure hospitalizations in patients with non-ischaemic cardiomyopathy implanted for primary prevention: the RELEVANT [Role of long dEtection window programming in patients with LEft VentriculAr dysfunction, Non-ischemic eTiology in primary prevention treated with a biventricular ICD] study. Eur Heart J 2009; 30:2758.
  67. Scott PA, Silberbauer J, McDonagh TA, Murgatroyd FD. Impact of prolonged implantable cardioverter-defibrillator arrhythmia detection times on outcomes: a meta-analysis. Heart Rhythm 2014; 11:828.
  68. Best PJ, Hayes DL, Stanton MS. The potential usage of dual chamber pacing in patients with implantable cardioverter defibrillators. Pacing Clin Electrophysiol 1999; 22:79.
  69. Calkins H, Brinker J, Veltri EP, et al. Clinical interactions between pacemakers and automatic implantable cardioverter-defibrillators. J Am Coll Cardiol 1990; 16:666.
  70. Ellenbogen KA, Edel T, Moore S, et al. A prospective randomized-controlled trial of ventricular fibrillation detection time in a DDDR ventricular defibrillator. Ventak AV II DR Study Investigators. Pacing Clin Electrophysiol 2000; 23:1268.
  71. Glikson M, Trusty JM, Grice SK, et al. A stepwise testing protocol for modern implantable cardioverter-defibrillator systems to prevent pacemaker-implantable cardioverter-defibrillator interactions. Am J Cardiol 1999; 83:360.
  72. Mattke S, Markewitz A, Müller D, et al. The combined transvenous implantation of cardioverter defibrillators and permanent pacemakers. Pacing Clin Electrophysiol 1997; 20:2775.
  73. Fisher JD, Teichman SL, Ferrick A, et al. Antiarrhythmic effects of VVI pacing at physiologic rates: a crossover controlled evaluation. Pacing Clin Electrophysiol 1987; 10:822.
  74. Higgins SL, Yong P, Sheck D, et al. Biventricular pacing diminishes the need for implantable cardioverter defibrillator therapy. Ventak CHF Investigators. J Am Coll Cardiol 2000; 36:824.
  75. Young JB, Abraham WT, Smith AL, et al. Combined cardiac resynchronization and implantable cardioversion defibrillation in advanced chronic heart failure: the MIRACLE ICD Trial. JAMA 2003; 289:2685.
  76. Wilkoff BL, Cook JR, Epstein AE, et al. Dual-chamber pacing or ventricular backup pacing in patients with an implantable defibrillator: the Dual Chamber and VVI Implantable Defibrillator (DAVID) Trial. JAMA 2002; 288:3115.
  77. Sweeney MO, Hellkamp AS, Ellenbogen KA, et al. Adverse effect of ventricular pacing on heart failure and atrial fibrillation among patients with normal baseline QRS duration in a clinical trial of pacemaker therapy for sinus node dysfunction. Circulation 2003; 107:2932.
  78. Yu CM, Chan JY, Zhang Q, et al. Biventricular pacing in patients with bradycardia and normal ejection fraction. N Engl J Med 2009; 361:2123.
  79. Fröhlich G, Steffel J, Hürlimann D, et al. Upgrading to resynchronization therapy after chronic right ventricular pacing improves left ventricular remodelling. Eur Heart J 2010; 31:1477.
  80. Murakami Y, Tsuboi N, Inden Y, et al. Difference in percentage of ventricular pacing between two algorithms for minimizing ventricular pacing: results of the IDEAL RVP (Identify the Best Algorithm for Reducing Unnecessary Right Ventricular Pacing) study. Europace 2010; 12:96.
  81. Olshansky B, Day JD, Moore S, et al. Is dual-chamber programming inferior to single-chamber programming in an implantable cardioverter-defibrillator? Results of the INTRINSIC RV (Inhibition of Unnecessary RV Pacing With AVSH in ICDs) study. Circulation 2007; 115:9.
  82. Steinberg JS, Martins J, Sadanandan S, et al. Antiarrhythmic drug use in the implantable defibrillator arm of the Antiarrhythmics Versus Implantable Defibrillators (AVID) Study. Am Heart J 2001; 142:520.
  83. Page RL. Effects of antiarrhythmic medication on implantable cardioverter-defibrillator function. Am J Cardiol 2000; 85:1481.
  84. Goldschlager N, Epstein A, Friedman P, et al. Environmental and drug effects on patients with pacemakers and implantable cardioverter/defibrillators: a practical guide to patient treatment. Arch Intern Med 2001; 161:649.
  85. Ruwald MH, Abu-Zeitone A, Jons C, et al. Impact of carvedilol and metoprolol on inappropriate implantable cardioverter-defibrillator therapy: the MADIT-CRT trial (Multicenter Automatic Defibrillator Implantation With Cardiac Resynchronization Therapy). J Am Coll Cardiol 2013; 62:1343.
  86. Strickberger SA, Man KC, Daoud EG, et al. A prospective evaluation of catheter ablation of ventricular tachycardia as adjuvant therapy in patients with coronary artery disease and an implantable cardioverter-defibrillator. Circulation 1997; 96:1525.
  87. Sra J, Bhatia A, Dhala A, et al. Electroanatomically guided catheter ablation of ventricular tachycardias causing multiple defibrillator shocks. Pacing Clin Electrophysiol 2001; 24:1645.
  88. O'Callaghan PA, Poloniecki J, Sosa-Suarez G, et al. Long-term clinical outcome of patients with prior myocardial infarction after palliative radiofrequency catheter ablation for frequent ventricular tachycardia. Am J Cardiol 2001; 87:975.
  89. Reddy VY, Reynolds MR, Neuzil P, et al. Prophylactic catheter ablation for the prevention of defibrillator therapy. N Engl J Med 2007; 357:2657.
  90. Shanmugam KT, Chan I, Morandi C. Regulation of nitrogen fixation. Nitrogenase-derepressed mutants of Klebsiella pneumoniae. Biochim Biophys Acta 1975; 408:101.
  91. Butler J, Jayson GG, Swallow AJ. The reaction between the superoxide anion radical and cytochrome c. Biochim Biophys Acta 1975; 408:215.
  92. Pavri BB, Lokhandwala Y, Kulkarni GV, et al. Reuse of explanted, resterilized implantable cardioverter-defibrillators: a cohort study. Ann Intern Med 2012; 157:542.