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Implantable cardioverted defibrillators: 40 years of history and beyond

P. De Filippo,G. Malanchini,P. Ferrari

Published 2022 in Expert Review of Cardiovascular Therapy

ABSTRACT

More than forty years ago, physicians started to implant cardioverter defibrillators (ICDs), first in patients survived after a cardiac arrest [1]. This disruptive technology has now become the standard of care for primary and secondary prevention of sudden death in patients with heart disease [2]. Sudden cardiac death (SCD) is a phenomenon not completely understood; its numbers are stable, even though lots of interventions are put in place to reduce its incidence: from pharmacological therapy to behavioral advice, to prompt emergency care access in different countries outside the hospital [3]. Coronary heart disease continues to be the most known and advocated cause of sudden cardiac death; nevertheless, a relevant proportion of cases of SCD occurs in patients without prior history of severe heart condition [3]. A relevant growth in ICD implants is expected in the world for the upcoming years, considering the high rate of implantation in high-income countries and substantial variability among utilization in different settings [4]. There are many different conditions that can result in ICD indication; however, the main reason for implant can be summarized as primary and secondary prevention, with the former responsible for majority of implants (from 60 to 79% of cases) [5,6]. During the last two decades, a relevant number of clinical trials (see Table 1) demonstrated the benefit of ICD therapy in secondary prevention and in primary prevention, too. The two main subgroups of patients investigated for primary prevention, on the basis of reduced Left Ventricular Ejection Fraction (LVEF), were historically divided into ischemic and nonischemic heart diseases [7–9].

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