The Nuts and Bolts of ICD Therapy

Offering a systematic approach to ICD therapy for clinician-readers with no formal training in cardiac rhythm management devices or electrophysiology, this illustrated series includes cardiology fellows, medical students, and physicians who are not electrophysiologists and aimed at healthcare professionals."The Nuts and Bolts of ICD Therapy" builds on the series commenced with "The Nuts and Bolts of Cardiac Pacing" and offers a systematic approach to ICD therapy for clinician-readers with no formal training in cardiac rhythm management devices or electrophysiology. While this audience includes nurses and technicians (who often handle most of the routine chores of follow-up visits), it may also include cardiology fellows, medical students, and physicians who are not electrophysiologists. ICD stands for Implantable Cardioverter-Defibrillator. A decade of clinical studies have gradually expanded the indications for these devices from "therapy of last resort" in 1986 (Medicare only approved them in cardiac arrest survivors who did not respond to medication) to broadened criteria in 1991 and again in 1999. In fact, right now, Medicare is reviewing another significant expansion (proposed September 2004) of ICD indications that would allow the device to be implanted in patients with compromised left-ventricular function, even if there was no documented evidence of any rhythm disorder. In short, the number of ICD patients is increasing sharply, particularly in the U.S.; The number of electrophysiologists - physicians who specialize in the electrical system of the heart - is not increasing as dramatically. The result is that more and more ICD patients are being treated by physicians and staffs with little or no ICD training. Few academic courses even address the subject. Most clinicians learn about ICDs from colleagues or from training programs offered by manufacturers. Summary "Most people who get an ICD will have the implant performed by an electro