Abstract
Introduction: Indications for implantable cardioverter defibrillators (ICDs) are growing. Based on controlled clinical trial data, ICDs are indicated for sustained ventricular tachycardia and episodic ventricular fibrillation, but have use for secondary prevention (prophylaxis) purposes as well. Implants will likely increase. For the average patient requiring an ICD, which device is best? Several types are available, including single-chamber (VVI) ICDs that pace and sense only in the right ventricle, dual-chamber (DDD) ICDs that pace and sense in both the atria and ventricles, and biventricular devices that coordinate activation in both left and right ventricular chambers. A device that can sense and pace in both atria and ventricles would seem preferable to a single-chamber device; not surprisingly, most ICD implants are dual-chamber devices. The Low Energy Safety Study trial (Gold; Unpublished data), comparing singleto dual-chamber ICDs, showed similar survival for both types of ICDs when adjusting for baseline characteristics. The risk of death was related to New York Heart Association class, age, tachyarrhythmias, and heart block; the study was nonrandomized.
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