Troubleshooting new ICD systems

Advances in ICD technology have improved arrhythmia detection and termination, and the development of nonthoracotomy lead systems has reduced operative mortality and morbidity. Despite these important developments, patients with ICDs continue to experience untoward events that are usually attributable to lead failures, the effects of antiarrhythmic drugs, problems related to signal processing, or the need to modify the ICD program. It is incumbent on physicians who implant ICDs and monitor long-term therapy to appreciate the mechanisms by which these events occur, approaches needed to establish a diagnosis, and therapeutic interventions that can resolve problems associated with ICDs.