Abstract
Implantable cardioverter defibrillators (ICDs) are recommended for primary and secondary
prevention of sudden cardiac death and were first implanted more than 40 years ago.
The addition of cardiac resynchronization improved outcomes in the heart failure population
and is now an important part of optimized therapy for this population. In this review,
we will address patient selection, risk stratification, and outcomes after ICD placement
and technological improvements. Gender disparities in referral and outcomes will be
discussed. Far from early technologies with limited pacing capabilities and no antitachycardia
pacing (ATP), we have now moved to complex devices with the addition of ATP/ATP during
charging, cardiac resynchronization therapy, remote monitoring, and improved battery
longevity. The requirement for defibrillation testing at time of implantation has
changed and in most implants are not required as part of new clinical guidelines.
As the components most likely to fail are the leads, and many complications arise
from the intravascular components, extravascular ICDs were developed, the subcutaneous
ICD is now an option for many patients, and substernal devices are under clinical
trials. Because shocks are associated with worse outcomes, optimized ICD programming
is now recommended, with the benefit of reducing appropriate and inappropriate shocks
with a decrease in mortality and no increase in the syncopal events. All these improvements
will have a positive effect on patient outcomes and quality of life, and new technologies
will be developed in the future.
Résumé
Les défibrillateurs cardioverteurs implantables (DCI) sont recommandés pour la prévention
primaire et secondaire de la mort cardiaque subite. La première implantation d’un
DCI remonte à plus de 40 ans. Depuis son introduction, la resynchronisation cardiaque
a permis d’améliorer le devenir des patients atteints d’insuffisance cardiaque; elle
fait maintenant partie intégrante de la thérapie optimisée au sein de cette population.
Nous abordons ici la sélection des patients, la stratification du risque et les résultats
obtenus à la suite de la mise en place d’un DCI et d’améliorations technologiques.
Nous nous penchons aussi sur les disparités entre les sexes en matière d’aiguillage
et d’issue thérapeutique. La technologie a beaucoup évolué depuis la création des
premiers dispositifs aux capacités de stimulation limitées qui n’offraient aucune
stimulation antitachycardie (SAT). Nous disposons maintenant de dispositifs complexes
permettant la délivrance de la SAT avant et pendant la charge, la resynchronisation
cardiaque, la télésurveillance et une meilleure autonomie des piles. Les exigences
relatives au test du seuil de défibrillation au moment de l’implantation ont changé
et ne s’appliquent pas à la plupart des implants selon les nouvelles lignes directrices
cliniques. Comme les sondes sont les composants les plus susceptibles de subir une
défaillance et que de nombreuses complications sont attribuables aux composants intravasculaires,
des DCI extravasculaires ont été mis au point. Les DCI sous-cutanés sont maintenant
une option pour de nombreux patients, et des dispositifs sous-sternaux sont en cours
d’essais cliniques. Les chocs étant associés à de pires résultats, la programmation
optimisée des DCI est maintenant recommandée. Celle-ci offre l’avantage de limiter
la délivrance de chocs appropriés ou inappropriés et de réduire ainsi la mortalité,
sans entraîner d’augmentation des manifestations syncopales. Toutes ces améliorations
influeront favorablement sur le devenir et la qualité de vie des patients, et de nouvelles
technologies sont à venir.
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Article info
Publication history
Published online: February 03, 2022
Accepted:
January 15,
2022
Received:
October 29,
2021
Footnotes
See page 522 for disclosure information.
Identification
Copyright
© 2022 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
