Technologic advances in implantable cardioverter defibrillators

Multiple technologic advances in the implantable cardioverter defibrillator (ICD) have resulted in smaller size, easier implantation, and improved detection, therapy, and stored diagnostic information. Advanced dual-chamber ICDs are currently available that allow dual-chamber rate-responsive pacing with mode switching, enhanced detection algorithms, antitachycardia pacing, low-energy cardioversion, high-energy shocks, and extensive diagnostics. Based on improvements in lead systems and improved energy waveforms, almost all devices are being implanted with nonthoracotomy leads in the pectoralis area. The results of recent clinical trials have expanded indications for the ICD for primary and secondary prevention of sudden cardiac death. With advances in capacitor and battery technology coupled with improved lead systems and waveform resulting in lower defibrillation thresholds, it is likely that lower-output, smaller devices will be developed. In the future, ICDs may have expanded indications and may incorporate physiologic sensors to access hemodynamic significance of arrhythmias and algorithms for prediction and prevention of cardiac arrhythmias.