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Implantable cardioverter defibrillators: current status and future directions
1Medical College of Virginia, Richmond 23298.
Insights
Sudden cardiac death is a leading cause of mortality. Implantable cardioverter defibrillators (ICDs) effectively prevent sudden death in high-risk patients, with excellent long-term results.
Area of Science:
- Cardiology
- Biomedical Engineering
Background:
- Sudden cardiac death (SCD) is the leading cause of mortality in the US, with up to 450,000 deaths annually.
- Survivors of cardiac arrest and patients with recurrent ventricular tachycardia face high mortality rates, even with antiarrhythmic therapy.
Purpose of the Study:
- To evaluate the efficacy and outcomes of implantable cardioverter defibrillators (ICDs) as a treatment for patients at high risk of sudden cardiac death.
Main Methods:
- The implantable cardioverter defibrillator (ICD), introduced in 1980, consists of a generator and defibrillation/pacing leads.
- Implantation can be performed via various surgical approaches, including median sternotomy and thoracotomy.
Main Results:
- Over 24,000 ICDs have been implanted worldwide, demonstrating effectiveness in preventing sudden death.
- Long-term follow-up shows excellent results, with a 5-year actuarial incidence of sudden cardiac death at 3%.
Conclusions:
- The implantable cardioverter defibrillator (ICD) is an effective therapy for preventing sudden cardiac death in high-risk individuals.
- Ongoing advancements in device technology and defibrillation science promise further improvements in ICD efficacy and patient outcomes.
Abstract:
Sudden cardiac death remains the most common mode of mortality in the United States, accounting for up to 450,000 deaths per year. Survivors of cardiac arrest and patients who have recurrent ventricular tachycardia have a high mortality rate with or without antiarrhythmic therapy. The implantable cardioverter defibrillator (ICD) was introduced in 1980 by Mirowski as a potential treatment for these patients. There are presently over 24,000 implants worldwide and the device has proved to be an effective means of preventing sudden death. The components of an ICD include a generator, defibrillation patches or leads, and pacing/sensing leads. The devices can be implanted with acceptable mortality and morbidity either by median sternotomy, left anterior thoracotomy, subxiphoid, or left subcostal approaches. The long-term results have been excellent with an actuarial incidence of sudden cardiac death of 3% at 5 years. Improvements in battery and capacitor technology, lead design, and tachycardia recognition, combined with the addition of hemodynamic sensors and a better understanding of the science of defibrillation, should lead to further improvements over the next several years in the ICD.