Implantable cardioverter-defibrillators in cardiovascular care: technologic advances and new indications

PURPOSE OF REVIEW Present generation implantable cardioverter-defibrillators (ICD) have become a proven primary therapeutic option in management of symptomatic ventricular arrhythmias and are now being increasingly used for primary prevention. The addition of biventricular pacing and atrial defibrillation to these devices has had an impact on the management of several new patient populations. The widespread application of these devices requires precise knowledge of their potential benefits and factors that could adversely affect device function. RECENT FINDINGS ICD therapy has improved the survival of coronary disease patients with left ventricular dysfunction by reducing sudden death rate. In congestive heart failure patients, ICD therapy and biventricular pacing improves heart failure status thus improving overall survival and quality of life. Atrial defibrillation can establish rhythm control in drug refractory atrial fibrillation usually in a "hybrid therapy" prescription. SUMMARY Implantable cardioverter defibrillators have proven to be invaluable in the primary and secondary prevention of sudden cardiac death. Incorporation of new technology in these devices has resulted in expanded indications that improve survival and quality of life of new patient populations.