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(Circulation. 2007;115:638-653.)
© 2007 American Heart Association, Inc.

Contemporary Reviews in Cardiovascular Medicine

Contemporary Pacemaker and Defibrillator Device Therapy

Challenges Confronting the General Cardiologist

Mark H. Schoenfeld, MD

From the Cardiac Electrophysiology and Pacemaker Laboratory, Hospital of Saint Raphael, Yale University School of Medicine, New Haven, Conn.

Correspondence to Mark H. Schoenfeld, MD, FACC, FAHA, FHRS, Cardiac Electrophysiology and Pacemaker Laboratory, Hospital of Saint Raphael, Yale University School of Medicine, 330 Orchard St, Suite #210, New Haven, CT 06511. E-mail mschoenfeld@srhs.org

Key Words: pacemakers • pacing • cardioverter-defibrillator, implantable

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
Intracardiac pacemaker and defibrillator implantations were initially described a half century and a quarter century ago, respectively.^1,2 Originally conceived as devices for the treatment of symptomatic bradycardia and sustained ventricular tachyarrhythmias, these therapies have subsequently been applied to the management of an increasing host of arrhythmia and other indications, including the treatment of heart failure.³ Although underuse of this technology has occasionally been reported,⁴ it has become abundantly clear that the number of patients deriving benefit from device therapy has risen exponentially; cardiac electrophysiology and pacing has emerged as a subspecialty within cardiology to address the growing needs of cardiac rhythm management.⁵ It is, nonetheless, incumbent on the general cardiologist to become proficient in certain aspects of device therapy.⁶ The goals of the present review are to highlight some of the fundamental areas of knowledge essential for follow-up, to provide an update on newer applications of device therapy, and to address some of the more common challenges and clinical scenarios encountered by the general cardiologist.

	Changing Indications for Device Therapy

 
The implantable cardioverter-defibrillator (ICD) was originally applied to patients surviving life-threatening ventricular tachyarrhythmias—so-called secondary prevention. Subsequently, primary prevention trials identified other patients who were at increased risk for sudden cardiac death but who had yet to manifest such risk,⁷ thereby expanding the indications for ICD therapy. The most recent iteration of guidelines for device implantation has identified additional conditions in which pacemaker and/or ICD therapy are associated with an enhancement of quality of life and/or survival.^3,8 In particular, new ICD indications for primary prevention include . . . [Full Text of this Article]

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