Santini M, Ansalone G, Auriti A, Magris B, Pandozi C, Altamura G
Department of Heart Diseases, S. Filippo Neri Hospital, Rome, Italy.
Am J Cardiol. 1996 Sep 12;78(5A):116-8. doi: 10.1016/s0002-9149(96)00513-9.
New technologic development of implantable cardioverter-defibrillators (ICDs) keeps up with the exponential increase of their use for primary and secondary prevention of sudden cardiac death. The first-generation ICD with limited shock capability alone could be considered adequate in most cardiac arrest victims, but it was not suitable for sudden death prevention in all high-risk patients with cardiac disease. The second-generation ICD was comprised of hybrid pacemaker-defibrillator systems that provided on-demand ventricular antibradycardia pacing. The third-generation devices include additional functions, such as antitachycardia pacing for ventricular tachycardia (VT) reversion and low-energy ventricular cardioversion, in addition to ventricular defibrillation and single-chamber ventricular demand pacing. In the near future, advanced dual-chamber atrioventricular (AV) pacing and defibrillating systems will also be available. The dual chamber ICD will allow atrial inhibited/dual-chamber (AAI/DDD) rate-responsive pacing, simultaneous atrial and ventricular sensing to optimize the arrhythmia identification, and ICD shock delivery in the proper arrhythmia-related chamber. Clinical benefits of these devices compared with their cost and complexity will require careful evaluation.
植入式心脏复律除颤器（ICD）的新技术发展与其用于心脏性猝死一级和二级预防的使用量呈指数增长同步。仅具有有限电击能力的第一代ICD在大多数心脏骤停患者中可能被认为足够，但它并不适用于所有高危心脏病患者的猝死预防。第二代ICD由混合起搏器-除颤器系统组成，可按需进行心室抗心动过缓起搏。第三代设备除了具备心室除颤和单腔心室按需起搏功能外，还包括其他功能，如用于室性心动过速（VT）转复的抗心动过速起搏和低能量心室心脏复律。在不久的将来，先进的双腔房室（AV）起搏和除颤系统也将问世。双腔ICD将允许心房抑制/双腔（AAI/DDD）频率应答起搏、同时进行心房和心室感知以优化心律失常识别，并在与心律失常相关的适当腔室进行ICD电击。与这些设备的成本和复杂性相比，其临床益处需要仔细评估。
