The Implantable Cardioverter/Defibrillator

Use of the implantable cardioverter/defibrillator is the most significant advance in the management of patients with life botn threatening cardiac arrhythmias. This device represents an important practical as well as conceptual breakthrough in arrhythmia management. It places on firm footing use of non-pharmacologic tools for clinicians. The text, Implan table Cardioverter/Defibrillator, represents contributions by the leading clinicians in this field from both sides of the Atlantic and is a welcome addition to the library of clinical electrophysiologists as well as cardiac surgeons. The editors have well collated the critical issues related to current use of device therapy in a meaningful and practical fashion. The text amply reminds us that we are in the early growth phases of a technology that promises to completely change our approach to the cure of patients with actual or potentially life-threatening ventricular dysrhythmias. It also reminds us that Dr. Mirwoski's dream continues to live and remains as a perpetual challenge to clinicians and engineers alike to bet ter perfect and utilize device therapy for our patients. I com mend the authors and editors for a superb and timely effort. San Francisco, CA, USA Melvin M. Scheinman, M. D. Preface 1teatment of patients with ventricular tachycardia and pre vention of sudden arrhythmic death is one of the most challenging tasks of modem cardiology. 'len years ago anti arrhythmic drug therapy was the medical tool used most fre quently in the management of patients with life-threatening ventricular tachyarrhythmias.

I: Historical Evolution of the Automatic Implantable Cardioverter Defibrillator.- Historical Evolution of the Automatic Implantable Cardioverter Defibrillator in the Treatment of Malignant Ventricular Tachyarrhythmias.- II: Identification of the Patient at High Risk for Sudden Cardiac Death.- The Role of Ambulatory ECG Monitoring in the Prediction of Sudden Cardiac Death.- Identification of the Patient at High Risk for Sudden Cardiac Death: The Value of Ventricular Late Potentials.- Identification of the Patient at High Risk for Sudden Cardiac Death: The Value of Electrophysiological Studies.- III: Technical and Electrophysiological Aspects of the Automatic Implantable Cardioverter Defibrillator.- Implantable Device Algorithms for Detection and Discrimination of Tachyarrhythmia.- Does Defibrillation Obey the Fundamental Law of Electrostimulation?.- Optimal Waveform Morphology for Defibrillation.- Prerequisites for the Safety and Efficacy of the Implantable Cardioverter Defibrillator.- The Role of Leads and Electrodes.- IV: The Role of the Automatic Implantable Cardioverter Defibrillator in the Treatment of Ventricular Tachyarrhythmia.- Long-Term Clinical Results with the Implantable Defibrillator.- Clinical Results with the Implanted Cardioverter Defibrillator.- Combining Drugs with the Implantable Cardioverter Defibrillator: Clinical Implications.- Antitachycardia Pacing, Cardioversion, and Defibrillation: From the Past to the Future.- Treatment Algorithm for Patients with Life-Threatening Ventricular Tachyarrhytmia.- V: Surgical Aspects of Defibrillation Treatment.- Defibrillator Leads: Optimizing of Configuration, Placement, and Energy Delivery.- Surgical Techniques of Defibrillator Implantation.- Complications Associated with the Automatic Implantable Cardioverter Defibrillator.- Safety Margin for Defibrillation.- VI: Living with the Implantable Defibrillator.- Management and Follow-up of the Implantable Defibrillator Patient.- The Social and Economic Impact of the New Implantable Cardioverter Defibrillator Technology.- Outlook.