Overview of the AICD: From prototype to therapy of first choice

The concept of automatic implantable defibrillator, which seemed far-fetched when first proposed by Mirowski, has evolved into an effective therapeutic modality which has revolutionized treatment of patients with malignant ventricular arrhythmias. The evolution from a non-programmable, thoracotomy-based, committed device capable of treating ventricular fibrillation and rapid ventricular tachycardia to a transvenous, programmable, non-committed device incorporating antitachycardia and bradycardia pacing with extensive data logging capabilities, has extended the therapeutic applications of this treatment modality. Viewed initially as a treatment of last resort, this therapeutic approach for cardiac arrest resuscitees is now advocated by many as the 'gold standard' against which other therapies should be compared, and even as a therapy worthy of being tested for the prophylactic treatment of patients at high risk of ventricular fibrillation and ventricular tachycardia but who have not yet had an index event.