Pacemakers and Implantable Cardioverter Defibrillators

  • Zachary M. Lill
  • Abrar H. Shah


Since the introduction of the implantable permanent pacemaker (PPM) in 1958 and the implantable cardioverter defibrillator (ICD) in 1980, implantable devices are now commonly used for treating bradycardia and ventricular arrhythmia. During the last several years, the indications for pacemaker and ICD implantation have expanded significantly. PPM are used for symptomatic bradycardia, and ICDs are now used for primary and secondary prevention of sudden cardiac death (SCD). Here, we summarize the indications, function, and complications of pacemakers and ICDs.


Bradycardia Ventricular arrhythmia PPM ICD SCD 


  1. 1.
    Tracy C, Epstein A, Darbar D, DiMarco J, Dunbar S, Estes N, et al. 2012 ACCF/AHA/HRS focused update incorporated into the ACCF/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities. J Am Coll Cardiol. 2013;61(3):e6–e75.CrossRefPubMedGoogle Scholar
  2. 2.
    Curtis A, Worley S, Adamson P, Chung E, Niazi I, Sherfesee L, et al. Biventricular pacing for atrioventricular block and systolic dysfunction. N Engl J Med. 2013;368(17):1585–93.CrossRefPubMedGoogle Scholar
  3. 3.
    2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Eur Heart J. 2013;34(29):2281–329.Google Scholar
  4. 4.
    Antiarrhythmics versus Implantable Defibrillators (AVID) Investigators. A comparison of antiarrhythmic-drug therapy with implantable defibrillators in patients resuscitated from near-fatal ventricular arrhythmias. N Engl J Med. 1997;337(22):1576–84.CrossRefGoogle Scholar
  5. 5.
    Connolly S, Gent M, Roberts R, Dorian P, Roy D, Sheldon R, et al. Canadian Implantable Defibrillator Study (CIDS): a randomized trial of the implantable cardioverter defibrillator against amiodarone. Circulation. 2000;101(11):1297–302.CrossRefPubMedGoogle Scholar
  6. 6.
    Kuck K, Cappato R, Siebels J, Ruppel R. Randomized comparison of antiarrhythmic drug therapy with implantable defibrillators in patients resuscitated from cardiac arrest: The Cardiac Arrest Study Hamburg (CASH). Circulation. 2000;102(7):748–54.CrossRefPubMedGoogle Scholar
  7. 7.
    Moss A, Hall W, Cannom D, Daubert J, Higgins S, Klein H, et al. Improved survival with an implanted defibrillator in patients with coronary disease at high risk for ventricular arrhythmia. N Engl J Med. 1996;335(26):1933–40.CrossRefPubMedGoogle Scholar
  8. 8.
    Moss A, Zareba W, Hall W, Klein H, Wilber D, Cannom D, et al. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med. 2002;346(12):877–83.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Steinbeck G, Andresen D, Seidl K, Brachmann J, Hoffmann E, Wojciechowski D, et al. Defibrillator implantation early after myocardial infarction. N Engl J Med. 2009;361(15):1427–36.CrossRefPubMedGoogle Scholar
  10. 10.
    Hohnloser S, Kuck K, Dorian P, Roberts R, Hampton J, Hatala R, et al. Prophylactic use of an implantable cardioverter–defibrillator after acute myocardial infarction. N Engl J Med. 2004;351(24):2481–8.CrossRefPubMedGoogle Scholar
  11. 11.
    Kadish A, Dyer A, Daubert J, Quigg R, Estes N, Anderson K, et al. Prophylactic defibrillator implantation in patients with nonischemic dilated cardiomyopathy. N Engl J Med. 2004;350(21):2151–8.CrossRefPubMedGoogle Scholar
  12. 12.
    Bardy G, Lee K, Mark D, Poole J, Packer D, Boineau R, et al. Amiodarone or an implantable cardioverter–defibrillator for congestive heart failure. N Engl J Med. 2005;352(3):225–37.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Køber L, Thune J, Nielsen J, Haarbo J, Videbæk L, Korup E, et al. Defibrillator implantation in patients with nonischemic systolic heart failure. N Engl J Med. 2016;375(13):1221–30.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Bristow M, Saxon L, Boehmer J, Krueger S, Kass D, De Marco T, et al. Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med. 2004;350(21):2140–50.CrossRefPubMedGoogle Scholar
  15. 15.
    Moss A, Hall W, Cannom D, Klein H, Brown M, Daubert J, et al. Cardiac-resynchronization therapy for the prevention of heart-failure events. N Engl J Med. 2009;361(14):1329–38.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Nademanee K. Defibrillator versus beta-blockers for unexplained death in Thailand (DEBUT): a randomized clinical trial. Circulation. 2003;107(17):2221–6.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Zachary M. Lill
    • 1
  • Abrar H. Shah
    • 2
  1. 1.Trinity Medical CardiologyOrchard ParkUSA
  2. 2.Rochester Regional Health/CardiologyRochesterUSA

Personalised recommendations