Abstract

Andrea Natale, MD, FHRS, Consulting EditorView Large Image Figure ViewerDownload Hi-res image Download (PPT)To appreciate the advances in ICD therapy, it’s important to reflect on the past and ask the question, “advances from what?” Today’s advances owe their origins to the proverbial pebble dropped in the pond many years ago. In 1956 Paul Zoll used alternating current defibrillation on post-heart surgery patients and in 1960 Bernard Lown introduced the first DC current defibrillator. While Mirowski and Mower were trying to develop an implantable defibrillator in the 1960s, it is the height of irony that it was Bernard Lown, who was the most vocal opponent advancing the charge (pun intended) that “…implanted defibrillator system represents an imperfect solution in search of a plausible and practical application.”1Lown B. Axelrod P. Implanted Standby Defibrillators.Circulation. 1972; 46: 637-639Crossref PubMed Scopus (63) Google Scholar While this establishment view slowed the development of the ICD, it could not stall it for it was championed by indomitable individuals. In 1985 the FDA approved the first automatic implanted defibrillator. To qualify for an implant, the patient had to survive two episodes of cardiac arrest; contrast that to primary prevention widely practiced today. The initial implanted device envisioned by Mirowski and Mower was a nonthoracotomy device, which delivered the energy via a transducer-tipped catheter, sensing pulsatile pressure, introduced through a peripheral vein into the right ventricle. Technological challenges prevented intracardiac defibrillation in the early years, and the first approved system was implanted by cardiac surgeons, used epicardial patches, and required a thoracotomy for implantation. Transvenous, nonthoracotomy defibrillation became possible a few years later, as shown by Bardy et al, and the implant procedures could be done by electrophysiologists. Innumerable advances, small and large, have occurred since 1985. Despite these advances, both clinical and technological challenges remain. So, we congratulate Drs Wang and Al-Ahmad for their superb editing of this issue of the Cardiac Electrophysiology Clinics focused on “Advances in ICD Therapy.” They have selected topics that are relevant to today’s technology and clinical practice and they have followed the ripples a little further to glimpse into the future.

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