Implantable cardioverter-defibrillator (ICD) therapy is one of the most important advances in the therapeutic approach of cardiovascular patients, with a life saving benefit exceeding that of all antiarrhythmic drugs. Since the first defibrillator implantation in 1980, the technology, diagnostic and therapeutic options have dramatically evolved, widening the indication area from secondary to primary prevention of sudden cardiac death. Over the intervening 25 years, implantable defibrillator therapy has become first line therapy for patients who survived cardiac arrest and for patients who are at risk for life-threatening ventricular arrhythmias. Its combination with cardiac resynchronisation therapy proved to be a major asset for heart failure patients, for whom now a real arrhythmia and heart failure management device became available. On the other hand, randomised trials have shown that huge numbers of patients might benefit from prophylactic treatment with simple ICD's.
The implantation rate in Europe is finally increasing but still not at the level of the U.S.A. Anyhow, ICD's are now considered as a part of regular health care, and physicians and personnel at coronary care units, emergency departments and general wards will often encounter patients who have an ICD, or who received an ICD shock or who were symptomatic.
A wide variety of cardiologists, electrophysiologists, fellows, anesthesiologists, nurses, and cardiovascular technicians are involved in delivering care to ICD patients. In addition to the diverse background of these individuals caring for ICD patients, defibrillator therapy became more complex over the last two decades. The advances in technology resulted in the development of tieredtherapy devices, physiologic pacing, resynchronization therapy, extended diagnostic functions, advanced arrhythmia discrimination, stored electrograms and the possibility to telemeter and transmit the data in the device over the internet or over the GSM network.
Device implantation is a fairly common intervention, the difficulties of understanding events during follow-up remain huge, at least for the untrained individual. Training is often given by the device company, and seldom covers the clinical needs, and the advances of devices from other companies.
In order to meet the needs of physicians, scientists, nurses, and cardiovascular technicians, a book that covers this subject in a comprehensive fashion is necessary. The purpose of this textbook is to present information on device diagnostics and clinical cases that we encountered in our daily practice, and to share our experience with all who would like to know more of this advanced electrocardiography.
Rotterdam, January 2007