Continuing Evolution of Implantable Cardioverter/Defibrillators: Smaller Size, Longer Life, Improved Cost-Effectiveness

Abstract

In less than two decades since Michel Mirowski introduced the implantable cardioverter/defibrillator (ICD) into clinical practice, it has been acknowledged as the most effective therapy for protecting patients against sudden arrhythmic death, due to ventricular tachycardia or fibrillation (VT/VF)^1–3. Many factors have contributed to elevating ICD therapy from a treatment “of last resort” to the primary intervention for such patients. Certainly, the growing evidence that no antiarrhythmic drugs have been able to improve survival has played a major role. However, without the improvements in ICD technology, resulting in implantation procedures similar to cardiac pacing, it is unlikely that ICD would have attained the current high degree of acceptance — by physicians and patients. The most obvious aspects of this technological evolution are major improvements in size. transvenous implantation, device reliability and longevity, and ease-of-use. At the same time, continued pressure on health expenditures has brought great focus on proving ICD cost-effectiveness, so that health authorities would grant reimbursement for this sophisticated technology. The questions on ICD therapy which we will address in this chapter concern in particular the balance between cost-effectiveness and rapid technological improvements.