Overview of implantable cardioverter-defibrillator in reducing total mortality in the high-risk coronary patient.

The idea of an implantable cardioverter-defibrillator (ICD) was conceived in the mid- to late 1960s, and working circuits were built and tested at Sinai Hospital of Baltimore in the fall of 1969. After a number of years of preclinical testing, the device entered clinical trials at The Johns Hopkins Hospital in February, 1980, and received Food and Drug Administration (FDA) approval in 1985. The device appeared to be highly effective, but there was criticism that it had not been tested in a randomized fashion, and there was the feeling that drugs would eventually prove to be superior. In 1989, a series of randomized clinical trials were begun. One of these trials, the Multicenter Automatic Defibrillator Implantation Trial (MADIT), has concluded and the outcome has recently been published. The results are landmark in importance and lead the way towards rational treatment of serious ventricular arrhythmia patients in clinical practice.