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Related Experiment Videos

Implantable cardioverter-defibrillator advances

R D Lerman1, D S Cannom

  • 1Good Samaritan Hospital, Los Angeles, CA 90017-2395, USA.

Current Opinion in Cardiology
|January 1, 1996
PubMed
Summary

Advances in implantable cardioverter-defibrillator (ICD) therapy improve defibrillation and capacitor technology. Ongoing trials like AVID aim to clarify ICD benefits and survival impact for various patient groups.

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Area of Science:

  • Cardiology
  • Biomedical Engineering

Background:

  • Significant advancements in implantable cardioverter-defibrillator (ICD) technology have improved defibrillation waveforms and capacitor performance.
  • Current non-thoracotomy ICDs with biphasic waveforms achieve implantation success rates near 100%.

Purpose of the Study:

  • To review recent progress in ICD therapy, including technological improvements and clinical applications.
  • To discuss ongoing controversies regarding lead design, tachycardia detection, and patient outcomes.
  • To highlight the role of randomized trials in defining the true benefits of ICDs.

Main Methods:

  • Review of recent scientific advances in defibrillation waveforms and capacitor technology.
  • Analysis of clinical data regarding non-thoracotomy device implantation success rates.
  • Evaluation of antiarrhythmic drug effects, specifically sotalol, on defibrillation thresholds.
  • Discussion of challenges in tachycardia detection algorithms and sensing lead design.
  • Identification of patient subsets with varying prognoses, including those with ventricular fibrillation.

Main Results:

  • Non-thoracotomy ICDs with biphasic waveforms demonstrate high implantation success rates.
  • Sotalol may reduce the defibrillation threshold, though its use alongside ICDs is decreasing.
  • Tachyarrhythmia detection enhancements improve specificity but risk undersensing.
  • Patients with ventricular fibrillation have the poorest prognosis among ICD recipients.

Conclusions:

  • Controversy persists regarding the optimal design for defibrillator sensing leads and the overall impact of ICD therapy on survival.
  • Randomized clinical trials, such as AVID, are crucial for establishing the definitive benefits of ICDs and potentially expanding their indications.

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