[Current status of implantable cardioverter defibrillator]

Clinical trials have established the superiority of the implantable cardioverter defibrillator (ICD) over antiarrhythmic drug therapy in survivors of sudden cardiac arrest and in high risk patients with coronary artery disease. The ICD has evolved to overcome the limitation of earlier devices that required thoracotomy for implantation and inadequate therapies. At present, it is implanted in a similar manner to cardiac pacemakers and incorporates discrimination algorithms to prevent inappropriate therapy. Managing the patients with an ICD requires an understanding of the multiprogrammable features of modern devices. The cost-effectiveness of ICD therapy appears favorable, given the marked survival benefit seen in randomized trials relative to antiarrhythmic drug treatment. A goal of newer-generation ICD devices is to avoid intervention. Such programmable therapies may include pacing to avoid long short coupling, intermittent antiarrhythmic drug infusion, or multisite pacing to improve hemodynamics. Further advances in device technology will undoubtedly expand the role of the ICD in the primary and secondary prevention of sudden cardiac arrest.