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Implantable Cardioverter-Defibrillator

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Abstract

The basic concept of safe and effective therapy for VT/VF has been the goal of the ICD, even during its early developmental stages. Thus, the concept of measuring a drop in right ventricular pressure as a means of detecting VF was abandoned in favor of the more reliable electrical signal monitoring.[1] Similarly, the early intravascular system was replaced by an epicardial system because of stability and safety concerns with the early right ventricular lead prototypes. The first generation of ICD lead system, which included an epicardial patch and a superior vena cava coil functioning as both sensing and defibrillating electrodes, was also quickly revised. Using the large area of a patch and a coil as a sensing mechanism had caused frequent oversensing of P waves, T waves, and post shock ST-T waves. The sensing method using probability density function (PDF), which detects a tachyarrhythmia based on the fraction of time the signal spends between positive and negative amplitude thresholds that are close to the baseline, was excellent in detecting VF. However, regular, non-sinusoidal VT was not reliably detected and hence, rate detection was soon added (AID-B and AID-BR units).[2] It was later noted that sensing reliability was markedly improved with the use of separate epicardial sensing leads placed closely together. This, along with two epicardial patches constituted the most commonly used epicardial ICD lead system.

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Authors and Affiliations

  1. Experimental Cardiac Electrophysiology, Stanford University Medical Center, Stanford, CA, USA

    L. Bing Liem D.O. (Director)

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© 2001 Springer Science+Business Media Dordrecht

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Liem, L.B. (2001). Device Operation. In: Implantable Cardioverter-Defibrillator. Springer, Dordrecht. https://doi.org/10.1007/978-94-017-1837-0_3

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  • DOI: https://doi.org/10.1007/978-94-017-1837-0_3

  • Publisher Name: Springer, Dordrecht

  • Print ISBN: 978-90-481-5627-6

  • Online ISBN: 978-94-017-1837-0

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