Development of the Implantable Cardioverter-Defibrillator

Implantable cardioverter-defibrillators (ICDs) represent transformational technology, arguably the most significant advance in cardiovascular medicine in 50 years. The vision and determination of pioneers Mirowski and Mower was fundamental to this monumental achievement, working with limited resources and confronted by skepticism/criticism from medical establishment. The inventors were followed >35 years in which a multitude of innovative clinical scientists and engineers introduced technological advances leading to the sophisticated devices in practice today. A pivotal patient experiment with automated termination of ventricular fibrillation (1980) led to U.S. Food and Drug Administration approval. Transvenous lead systems converted ICDs from thoracotomy-based secondary prevention to primary prevention of sudden death devices in countless patients worldwide. ICD acceptance was solidified by prospective randomized controlled trials showing reduced mortality superior to antiarrhythmic drugs. ICDs eventually expanded from coronary disease to inherited arrhythmia conditions (eg, hypertrophic cardiomyopathy). The ICD breakthrough story demonstrates how significant progress is possible in medicine against all odds, given fearless imagination to pursue novel ideas that conflict with accepted wisdom. (J Am Coll Cardiol 2023;82:353-37 3) & COPY; 2023 Published by Elsevier on behalf of the American College of Cardiology Foundation.

Automated summary

Implantable cardioverter-defibrillators (ICDs) have been the most significant advancement in cardiovascular medicine in the past 50 years. The development of ICDs was a result of the determination and vision of pioneers, and they have now become the primary prevention tool for sudden death in countless patients worldwide. Clinical trials have shown that ICDs can reduce mortality rates and they have been successfully used in the treatment of coronary disease and inherited arrhythmia conditions.