The future of the implantable defibrillator

Abstract

As successful as the implantable cardioverter-defibrillator (ICD) has been, the therapy is far from perfect. The device implantations are nontrivial and implant testing still has some morbidity and a relatively rare mortality associated with it. Partly due to the high effectiveness of ICDs, the largest morbidity associated with this therapy is psychiatric due to the pain of shocks especially-but not exclusively-due to inappropriate shocks. In spite of the dramatic positive impact on sudden death, patients with ICDs can still die from sudden death because of high defibrillation threshold fibrillation or nonshockable rhythms such as pulseless electrical activity. This chapter will discuss possibilities for addressing these therapy limitations. © 2009 Springer US.