Implantable Cardioverter Defibrillator Technology in the Next 10 Years: What Can Be Expected?

  • M. Block
  • G. Breithardt
Conference paper


Fifteen years after the first implantation of an automatic defibrillator in humans (1), therapy with implantable cardioverter defibrillators (ICD) might become the therapy of first choice in patients with malignant ventricular tachyarrhythmias in the near future (2).The first ICD had no cardioversion and defibrillated the patient once a rhythm was observed above a fixed nonprogrammable heart rate (1). Defibrillation occurred after a fixed duration with a fixed energy. The ICD had to be implanted by a thoracotomy, as at least one defibrillation patch had to be positioned epi-cardially. Due to its volume of 145 ml, the device had to be implanted abdominally. Since 1980, major technical developments have been made which have improved ICD therapy and facilitated its widespread use (3).


Ventricular Tachyarrhythmia Inappropriate Shock Antitachycardia Pace Defibrillation Lead Anti Tachycardia Pace 
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  1. 1.
    Mirowski M, Reid PR, Mower MM et al (1980) Termination of malignant ventricular arrhythmias with an implanted automatic defibrillator in human beings. N Engl J Med 303: 322–324PubMedCrossRefGoogle Scholar
  2. 2.
    Wever E, Hauer R, van Capelle F et al (1995) Randomized study of implantable defibrillator as first-choice therapy versus conventional strategy in postinfarct sudden death survivors. Circulation 91: 2195–2203PubMedGoogle Scholar
  3. 3.
    Block M, Breithardt G (1995) Long-term follow-up and clinical results of implantable cardioverter-defibrillators. In: Zipes DP, Jalife J (eds) Cardiac electrophysiology: from cell to bedside. Saunders, Philadelphia, pp 1412–1425Google Scholar
  4. 4.
    Neuzner J for the European Ventak P2 Investigator Group (1994) Clinical experience with a new cardioverter defibrillator capable of biphasic waveform pulse and enhanced data storage: results of a prospective multicenter study. PACE 17: 1243–1255.CrossRefGoogle Scholar
  5. 5.
    Hammel D, Block M, Geiger A et al (1994) Single-incision implantation of cardioverter defibrillators using nonthoracotomy lead systems. Ann Thorac Surg 58: 1614–1616PubMedCrossRefGoogle Scholar
  6. 6.
    Block M, Hammel D, Bänsch D et al (1995) Prevention of ICD complications. In: Allessie M, Fromer M (eds) Atrial and ventricular fibrillation - mechanisms and device therapy. Futura, ArmonkGoogle Scholar
  7. 7.
    Nunain SO, Roelke M, Trouton T et al (1995) Limitations and late complications of third-generation automatic cardioverter-defibrillators. Circulation 91: 2204–2213PubMedGoogle Scholar
  8. 8.
    Kluger J, Veronneau J, Fisher J (1995) Cluster shocks: a strong predictor of subsequent mortality in patients with internal cardioverter defibrillators. PACE 18: 845 (abstr)Google Scholar
  9. 9.
    Anderson MH, Camm AJ (1994) Legal and ethical aspects of driving and working in patients with an implantable cardioverter defibrillator. Am Heart J 127: 1185–1193PubMedCrossRefGoogle Scholar
  10. 10.
    Block M, Hammel D, Böcker D et al (1995) Internal defibrillation with smaller capacitors–a prospective randomized crossover comparison of defibrillation efficacy obtained with 90 (jF- and 125 jF-capacitors in humans. J Cardiovasc Electrophysiol 6: 333–342PubMedCrossRefGoogle Scholar
  11. 11.
    Block M, Breithardt G (1995) Optimizing defibrillation through improved waveforms. PACE 18 (II): 526–538PubMedCrossRefGoogle Scholar
  12. 12.
    Jung W, Manz M, Moosdorf R et al (1994) Comparative defibrillation efficacy of biphasic and triphasic shock waveforms. New Trends Arrhythmias 9: 765–772Google Scholar
  13. 13.
    Block M, Seidel K, Hammel D et al (1995) Active can versus subcutaneous array. Which lead configuration shows lower defibrillation thresholds? PACE 18 (II): 887 (abstr)Google Scholar
  14. 14.
    Hsia PW, Suresh G, Allen C et al (1995) Improved nonthoraco-tomy defibrillation based on ventricular fibrillation waveform characteristics. PACE 18: 803 (abstr)Google Scholar
  15. 15.
    Sweeney RJ, Gill RM, Reid PR (1995) Characteristics of multiple-shock defibrillation. J Cardiovasc Electrophysiol 6: 89–102PubMedCrossRefGoogle Scholar
  16. 16.
    Zimmermann S, Alt E, Kressierer P et al (1995) Organized de-and repolarization during ventricular fibrillation as indicated by signals with large amplitude and low frequency PACE 18: 938 (abstr)Google Scholar
  17. 17.
    Bardy GH, Johnson G, Poole JE et al (1993) A simplified, single-lead unipolar transvenous cardioversion-defibrillation system. Circulation 88: 543–547PubMedGoogle Scholar
  18. 18.
    Saksena S, Kaushik RR, Varanasi S et al (1995) Optimal lead system(s) for reduced output implantable cardioverter-defibrillators for ventricular defibrillation. PACE 18: 807 (abstr)Google Scholar
  19. 19.
    Bardy GH, Dolack GL, Kudenchuk PJ et al (1994) Prospective comparison in humans of a unipolar defibrillation system with that using an additional superior vena cava electrode. Circulation 89: 1090–1093PubMedGoogle Scholar
  20. 20.
    Song SL (1994) Performance of implantable cardiac rhythm management devices. PACE 17: 692–708PubMedCrossRefGoogle Scholar
  21. 21.
    Wietholt D, Block M, Isbruch F et al (1993) Therapy of ventricular tachyarrhythmias with implantable cardioverter-defibrillators–mortality and complications with epicardial lead systems. Z Kardiol 82: 150–161PubMedGoogle Scholar
  22. 22.
    Mönnich A, Block M, Hammel D et al (1995) Langzeitstabilität der Wahrnehmungs-, Stimulations-und Defibrillationsfunktion einer multifunktionellen transvenösen ICD-Elektrode. Z Kardiol 84 [Suppl.l]: 108 (abstr)Google Scholar
  23. 23.
    Keimel JG, Abeyratne A (1995) Graphical presentation of factors influencing implantable cardioverter defibrillator (ICD) longevity. PACE 18: 889 (abstr)Google Scholar
  24. 24.
    Throne RD, Windle JR, Easley AR et al (1994) Scatter diagram analysis: a new technique for discriminating ventricular tachyarrhythmias. PACE 17: 1267–1275PubMedCrossRefGoogle Scholar
  25. 25.
    Brewer JE, Tvedt MA, Adams TP, Kroll MW (1994) Low voltage shocks have a significantly higher tilt of the internal electric field than do high voltage shocks. PACE 18: 214–220CrossRefGoogle Scholar
  26. 26.
    Fahy GR, Kleman JM, Wilkoff BL et al (1995) Low incidence of lead related complications associated with nonthoracotomy implantable cardioverter defibrillator systems PACE 18: 172–178Google Scholar
  27. 27.
    Kühlkamp V, O’Connor S on behalf of the Endotak DSP™ European Investigator Group (1995) A new downsized trans-venous combined rate sensing and defibrillating electrode, Endotak DSP. PACE 18: 886 (abstr)Google Scholar
  28. 28.
    Leoneiii FM, Wright H, Lattereil ST et al (1995) A long thin electrode is equivalent to a short thick electrode for defibrillation in the right ventricle. PACE 18: 221–224CrossRefGoogle Scholar
  29. 29.
    Sharma AD, Bennet TD, Erickson M et al (1990) Right ventricular pressure during ventricular arrhythmias in humans: potential implications for implantable antitachycardia devices. J Am Coll Cardiol 15: 648–655PubMedCrossRefGoogle Scholar
  30. 30.
    Singer I, Goldsmith J, Maldonado C (1995) Electrode surface area is an important variable for defibrillation. PACE 18: 233–236PubMedCrossRefGoogle Scholar
  31. 31.
    Neuzner J, Pitschner HF, Schlepper M (1995) Programmable VT detection enhancements in implantable cardioverter defibrillator therapy. PACE 18 (II): 539–547PubMedCrossRefGoogle Scholar
  32. 32.
    Swerdlow CD, Chen PS, Kass RM et al (1994) Discrimination of ventricular tachycardia from sinus tachycardia and atrial fibrillation in a tiered-therapy cardioverter-defibrillator. J Am Coll Cardiol 23: 1342–1355PubMedCrossRefGoogle Scholar
  33. 33.
    Schugger CD, Jackson K, Steinman RT, Lehmann MH (1988) Atrial sensing to augment ventricular tachycardia detection by the automatic implantable cardioverter defibrillator: a utility study. PACE 11: 1456–1464CrossRefGoogle Scholar
  34. 34.
    Luceri RM, Zilo P, and the United States and Canadian En-guard Investigators (1995) Initial clinical experience with a dual lead endocardial defibrillation system with atrial pace/sense capability. PACE 18: 163–167PubMedCrossRefGoogle Scholar
  35. 35.
    Kaemmerer WF, Olson WH (1995) Dual chamber tachyarrhythmia detection using syntactic pattern recognition and contexial timing rules for rhythm classification. PACE 18: 872 (abstr)Google Scholar
  36. 36.
    Longo E, Catrini V (1990) Experience and implantation techniques with a new single-pass lead VDD pacing system. PACE 13: 927–936PubMedCrossRefGoogle Scholar
  37. 37.
    Variale P, Pilla AG, Tekrival M (1990) Single-lead VDD pacing system. PACE 13: 757–766CrossRefGoogle Scholar
  38. 38.
    Dunbar SB, Warner CD, Purcell JA (1993) Internal cardioverter defibrillator device discharge: experiences of patients and family members. Heart Lung J Crit Care 22: 494–501Google Scholar
  39. 39.
    Leclercq JF, Maisonblanche P, Cauchemez B, Coumel P (1988) Respective role of sympathetic tone and of cardiac pauses in the genesis of 62 cases of ventricular fibrillation recorded during Holter monitoring. Eur Heart J 9: 1276–1283PubMedGoogle Scholar
  40. 40.
    Marchlinski FE, Buxton AE, Miller JM et al (1987) Prevention of ventricular tachycardia induction during right ventricular programmed stimulation by high current strength pacing at the site of origin. Circulation 76: 332–342PubMedCrossRefGoogle Scholar
  41. 41.
    Shenasa M, Fromer M, Borggrefe M, Breithardt G (1991) Subthreshold electrical stimulation for termination and prevention of reentrant tachycardias. J Electrocardiol 24: 25–31CrossRefGoogle Scholar
  42. 42.
    Skale BT, Kallok MJ, Prystowski EN et al (1985) Inhibition of premature ventricular extrastimuli by subthreshold conditioning stimuli. J Am Coll Cardiol 6: 133–140PubMedCrossRefGoogle Scholar
  43. 43.
    Labhasetwar V, Underwood T, Heil RW et al (1994) Epicardial administration of ibutilide from polyurethane matrices: effects on defibrillation threshold and electrophysiologic parameters. J Cardiovasc Pharmacol 24: 826–840PubMedCrossRefGoogle Scholar
  44. 44.
    Cammilli L, Furlanello F, Perna AM et al (1991) Suppression of precursors of impending ventricular fibrillation by drugs retroinfusion in coronary sinus. Experimental investigation for a possible automatic implantable pharmacological cardioverter defibrillator ( AIPhCD ). New Trends Arrhyth 7: 855–863Google Scholar
  45. 45.
    Zehender M, Faber T, Grom A et al (1994) Continuous monitoring of myocardial ischemia by the implantable cardioverter defibrillator. Am Heart J 127: 1057–1063PubMedCrossRefGoogle Scholar
  46. 46.
    Grimm W, Flores BF, Marchlinski FE (1993) Symptoms and electrocardiographically documented rhythm preceding spontaneous shocks in patients with implantable cardioverter-defibrillator. Am J Cardiol 71: 1415–1418PubMedCrossRefGoogle Scholar
  47. 47.
    Schols W, Sarasin C, Beyer T, Brachmann J (1995) Should patients with the implanted defibrillator resume car driving? PACE 18: 945Google Scholar
  48. 48.
    Schaumann A, Meyer O, Dorszewski A et al (1995) A prospective study of tested versus nontested antitachycardia pacing in implantable cardioverter-defibrillators. PACE 18: 898 (abstr)Google Scholar
  49. 49.
    Bardy GH, Olson WH, Fishbein DP et al (1985) Transvenous right ventricular impedance during spontaneous ventricular arrhythmias. Circulation 72: 474A (abstr)Google Scholar
  50. 50.
    Bakker PF, Meijburg H, de Jonge N et al (1994) Beneficial effects of biventricular pacing in congestive heart failure. PACE 17: 820 (abstr)Google Scholar
  51. 51.
    den Dulk K, Brugada P, Smeets JL, Wellens HJ (1990) Long-term antitachycardia pacing experience for supraventricular tachycardia. PACE 13: 1020–1030CrossRefGoogle Scholar
  52. 52.
    Murgatroyd FD, Johnson EE, Cooper RA et al (1994) Safety of low energy transvenous atrial defibrillation - world experience. Circulation 90: 1–14 (abstr)Google Scholar

Copyright information

© Springer-Verlag Italia, Milano 1996

Authors and Affiliations

  • M. Block
    • 1
  • G. Breithardt
    • 1
  1. 1.Medizinische Klinik und Poliklinik, Innere Medizin CWestfälische-Wilhelms-UniversitätMünsterGermany

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