Implantable cardioverter defibrillator (ICD). State of the art

Abstract

Clinical experience suggests that the implantable cardioverter/defibrillator (ICD) can reduce sudden cardiac death in malignant ventricular arrhythmia patients who meet the selection criteria for implantation. Since the introduction of the implantable cardioverter/defibrillator using a non-thoracotomy approach, the intraoperative and perioperative mortality and morbidity has been reduced significantly. A widespread use of these newer devices required the establishment of guidelines for the appropriate application of this new treatment modality. Surgical, medical and economic considerations make it imperative that defibrillator therapy should be chosen on a basis of careful patient selection. The presenting clinical arrhythmia and its hemodynamic stability, underlying heart disease and left-ventricular ejection fraction should also be taken into consideration. The major indication for implantation of a defibrillator is either previous cardiac arrest or a hemodynamically untolerated, sustained ventricular tachycardia remote from acute myocardial infarction and drug-refractory to antiarrhythmic treatment. Based on the currently available data and consensus, three specific classes of indications have been suggested: Accepted indications, relative indications and contraindications. It is of importance to stress that there is no indication for the implantation of a cardioverter/defibrillator if ventricular tachycardia is amenable to transvenous catheter ablation or map-guided antitachycardia surgery. Thus, a curative approach should be considered before making the decision to implant a defibrillator.