Implantable cardioverter-defibrillators: Overview of indications, components, and functions
- Leonard I Ganz, MD, FHRS, FACC
Leonard I Ganz, MD, FHRS, FACC
- Section Editor — Cardiac Arrhythmias
- Director of Cardiac Electrophysiology
- Heritage Valley Health System
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, followed in 1980 by the first automatic internal defibrillator implantation in humans [1,2]. FDA approval followed in 1985, initially only for secondary prevention in survivors of cardiac arrest. (See "Pathophysiology and etiology of sudden cardiac arrest".)
Because of its high success rate in terminating VT/VF rapidly, along with the results of multiple clinical trials showing improvement in survival, implantable cardioverter-defibrillator (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, catheter 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 as well as the components and functionalities of the ICD. The clinical trials documenting the efficacy of an ICD in different clinical settings (including both secondary and primary prevention), complications of ICD placement, optimal ICD programming, and follow-up care of patients with ICDs are discussed separately. (See "Implantable-cardioverter defibrillators: Optimal programming" and "Secondary prevention of sudden cardiac death in heart failure and cardiomyopathy" and "Primary prevention of sudden cardiac death in heart failure and cardiomyopathy" and "Cardiac implantable electronic devices: Long-term complications" and "Cardiac implantable electronic devices: Patient follow-up" and "Cardiac implantable electronic devices: Peri-procedural complications".)
The main indications for use of an ICD can be divided into two groups [3,4]:
●Secondary prevention of sudden cardiac death (SCD) in patients with prior sustained ventricular tachycardia (VT), ventricular fibrillation (VF), or resuscitated SCD thought to be due to VT/VFTo continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- Secondary prevention
- Primary prevention
- ICD not recommended
- ELEMENTS OF THE ICD
- Pulse generator
- Choosing the optimal pulse generator location
- Choosing the optimal lead placement
- Defibrillation threshold testing
- Periprocedural monitoring
- Reuse of explanted ICDs
- ICD FUNCTIONS
- ECG monitoring and storage
- Antitachycardia pacing
- Bradycardia pacing
- - Cardiac resynchronization therapy
- Perioperative ICD functioning
- WEARABLE CARDIOVERTER-DEFIBRILLATOR
- SUBCUTANEOUS ICD
- SUMMARY AND RECOMMENDATIONS