Advances in Implantable Cardioverter Defibrillators 2021

Dear Colleague,

Implantable cardioverter defibrillators (ICDs) have been the subject of scrutiny since the first reported human implant in 1980 [1]. Their role in secondary prevention of sudden cardiac death was established in randomized controlled trials. Subsequent primary prevention trials established their role in primary prevention of sudden death in patients [2,3].

For many years, a great deal of emphasis was placed on reduction in ICD generator size. Recently, concern about operative and long-term complications of transvenous ICD systems has spurred the development of subcutaneous ICD systems [4]. These systems currently require a larger generator and have no pacing capabilities.

Heart failure management has improved since the aforementioned landmark ICD trials. A recent trial suggested no benefit in nonischemic cardiomyopathy beyond that afforded by guideline-directed medical and cardiac resynchronization therapies [5]. Weighing the inconvenience and risks of living with an ICD against an expected survival advantage is often far from straightforward. Many ICD recipients are older patients with multiple comorbidities and individual choices between extended survival, ICD shocks, and quality of life may not be clear-cut [6,7]. 

In this issue of Micromachines, we will explore current and potential future advances in ICD therapy. We will focus on evolving concepts in ICD technology without neglecting evolving indications for device implantation. 

References

1. Mirowski M, Reid PR, Mower MM, Watkins L, Gott VL, Schauble JF, Langer A, Heilman MS, Kolenik SA, Fischell RE, Weisfeldt ML. Termination of malignant ventricular arrhythmias with an implanted automatic defibrillator in human beings. N Engl J Med 1980;303:322–324.
2. Vassallo P, Trohman RG. Prescribing amiodarone: an evidence-based review of clinical indications. JAMA. 2007 Sep 19;298(11):1312-22. 
3. Goldenberg I, Huang DT, Nielsen JC. The role of implantable cardioverter defibrillators and sudden cardiac death prevention: indications, device selection, and outcome.
4. Kaya E, Rassaf T, Wakili R. Subcutaneous ICD: Current standards and future perspective. Int J Cardiol Heart Vasc. 2019 Aug 8;24:100409.
5. Køber L, Thune JJ, Nielsen JC, Haarbo J, Videbæk L, Korup E, Jensen G, Hildebrandt P, Steffensen FH, Bruun NE, Eiskjær H, Brandes A, Thøgersen AM, Gustafsson F, Egstrup K, Videbæk R, Hassager C, Svendsen JH, Høfsten DE, Torp-Pedersen C, Pehrson S; DANISH Investigators. Defibrillator implantation in patients with nonischemic systolic heart failure. N Engl J Med 2016;375:1221–1230.
6. Reeder HT, Shen C, Buxton AE, Haneuse SJ, Kramer DB. Joint shock/death risk prediction model for patients considering implantable cardioverter-defibrillators. Circ Cardiovasc Qual Outcomes. 2019; 12: e005675.
7. Trohman RG. Predicting appropriate therapies and mortality in implantable cardioverter-defibrillator recipients: a work in progress. Pol Arch Intern Med. 2019; 129: 657-658.

Prof. Dr. Richard Trohman
Guest Editor

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