Improvements in 25 Years of Implantable Cardioverter Defibrillator Therapy

Abstract

In 1980, Dr. Michel Mirowski and his team inserted the first implantable cardioverter defibrillator (ICD) in a patient. Initially, ICD therapy was not widely accepted, and many physicians actually considered this therapy unethical. Large secondary and primary prevention trials, demonstrating a beneficial effect of ICD therapy in selected patients not only on arrhythmic death but also on all-cause mortality, stimulated a rapid growth in the number of implants and increased patient’s and physician’s acceptance. Improvements in size and weight, arrhythmia discrimination capabilities, battery technology, shock waveform and output, monitoring capabilities and defibrillator electrode technology eventually resulted in the current large number of yearly implants. Today, almost 40 years after the conception of the ICD and 25 years after the first human implant, ICD therapy is the treatment of choice for patients at risk for life-threatening arrhythmias either as secondary or primary prevention. Furthermore, with the more recent addition of resynchronisation therapy to standard ICD therapy, it became possible to treat selected patients with advanced symptoms of heart failure and to lower the risk of sudden death.

Psychological Indices as Predictors for Phantom Shocks in Implantable Cardioverter Defibrillator Recipients

“…12 In the case of a phantom shock, ICD patients subjectively feel that they have received a shock while there has been no actual ICD discharge. 13 The incidence of phantom shocks in ICD recipients is relatively unknown, as are the risk factors.…”

Suitability for subcutaneous defibrillator implantation: results based on data from routine clinical practice

“…Since the first implantation in 1980, ICDs have undergone many improvements and have evolved from large abdominally placed devices into substantially smaller devices placed pectorally 5. Currently, ICDs rely on transvenously implanted leads for cardiac sensing, defibrillation and if necessary also for cardiac pacing.…”

Evaluation of shock waveform configuration on the defibrillation capacity of implantable cardioverter defibrillators in dogs

“…In addition, several features have been developed to improve rhythm discrimination and prevent inappropriate therapies. 3 Since the first ICD implantation in 1980, clinical trials have consistently shown a 20e55% reduction in mortality when ICDs were compared to antiarrhythmics in people at risk for sudden cardiac death. 2,3 There are only two published reports of ICD implantation in dogs with ventricular arrhythmias.…”

“…3 Since the first ICD implantation in 1980, clinical trials have consistently shown a 20e55% reduction in mortality when ICDs were compared to antiarrhythmics in people at risk for sudden cardiac death. 2,3 There are only two published reports of ICD implantation in dogs with ventricular arrhythmias. 4,5 Our group implanted a third ICD in a Doberman Pinscher with dilated cardiomyopathy that died within 36 h of the procedure after the defibrillator failed to terminate an episode of unstable ventricular tachycardia, despite successive delivery of six maximum energy shocks.…”