Over the years, in addition to the expansion in indications for implantation there have been advances in ICD technology, as well as the publication of long-term observational studies that have allowed us to risk-stratify various patient cohorts. Patients with ICDs were required to wait at least six months before being allowed to drive as it was felt that the risk of recurrence of VT or VF gradually diminished over time to an acceptable level at six months. Thus, it was generally felt that driving by patients who had an ICD should be restricted so as to avoid possible injury to either themselves or others. Loss of consciousness (or even a lapse in orientation) while driving could potentially have devastating consequences. While drug treatment of arrhythmias (at least in theory) prevented or reduced episodes of VT and VF leading to sudden cardiac death, the ICD could terminate an episode only once it had already occurred. The huge expansion in the number of potential candidates requiring ICD implantation has given rise to an increasing interest in the practical ramifications of this therapy-one of the most important being the ability to continue an active lifestyle, which may involve the ability to safely drive a motor vehicle.
#Ivcd placement trial
With the publication of landmark studies such as the Multicenter Automatic Defibrillator Implantation Trial (MADIT)-I and -II and the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT), over the last few years guidelines from expert panels have also recommended ICD implantation for patients with low ejection fractions secondary to ischemic and non-ischemic cardiomyopathies. Since then, indications for the implantation of ICDs have broadened to include primary prophylaxis for patients deemed to be at a high risk for sudden cardiac death due to hereditary and congenital conditions such as long QT syndrome, Brugada syndrome, and arrhythmogenic right ventricular dysplasia. The use of ICDs effectively transformed sudden death into a chronic illness. With the advent of ICDs, there was a significant reduction in the rates of death secondary to ventricular tachycardia (VT) or ventricular fibrillation (VF). The overwhelming majority of recipients of the first ICDs were survivors of sudden cardiac death. These remarkable devices fulfilled a long-held dream of being able to effectively recognize and terminate life-threatening ventricular arrhythmias using a small surgically implanted device. This development has revolutionized the management of patients who have experienced or are at risk for lethal cardiac arrhythmias. Perhaps one of the most important developments in modern cardiovascular medicine was the development of the implantable cardioverter–defibrillator (ICD) in the early 1980s.
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