Sudden cardiac death remains a major public health
problem and accounts for 450 000 deaths annually
in the United States and 400 000 in Europe.
Michel Mirowski began developing an implantable
defibrillator in the mid-1960s. The first automatic
defibrillator was finally implanted in a human
patient in 1980. The device presently known as an
implantable cardioverter-defibrillator (ICD) has
proven effective in preventing sudden cardiac
death. Since 1980, technologic advances in device
therapy including miniaturization, improved leads,
optimal waveforms and transvenous implantation
have revolutionized the treatment of malignant ventricular
tachyarrhythmias and sudden cardiac death.
These advances have made ICDs easier and safer to
implant and better accepted by patients and physicians.
Thus, ICDs have evolved from a treatment
of last resort to the gold standard for patients at high
risk for life-threatening ventricular arrhythmias.
Recent advances include dual-chamber ICDs,
additional therapy for atrial arrhythmias, and ICDs
combined with biventricular pacing for selected
heart failure patients. Device-based monitoring of
contemporary ICDs can also record data unrelated
to arrhythmias such as activity and the status of
lung fluid in patients with congestive heart failure.
Finally, ICDs provide health benefits with efficiency
comparable to other well-accepted forms of health
care such as renal dialysis.