Technological advances in implantable cardioverter defibrillator leads and waveforms: paving the way for smaller ICDs

  • Seah Nisam
Part of the Developments in Cardiovascular Medicine book series (DICM, volume 183)


Dr. Michel Mirowski’s initial conception of the implantable defibrillator envisioned a pacemaker type implantation, i.e. a device small enough to permit comfortable implantation in the chest and via the use of transvenous leads [1, 2]. Even after demonstrating that intrathoracic defibrillation decreased the required energies ten-fold, to approximately 25 Joules, this still meant that the device would have to provide pulses a million times greater than the 25µ-J. required by pacemakers! The realities of technology available in the early 1970s, when he, Dr. Morton Mower, and their colleagues began their project, led to prototypes having a volume of 150 cc and weighing nearly 300g. Figure 1 illustrates the comparison with the early pacemakers of that period, and the evolution over the 15 years since Mirowski’s initial device was implanted in a human being [3]. Their goal of an endocardial system had to be postponed nearly a decade, until defibrillator leads were developed which permitted reliable ICD therapy without resorting to epicardial “patches”, requiring a thoracotomy. In terms of energy delivery, the key components of an ICD are the batteries and the capacitors. Curiously, in this past decade characterized by tremendous technological evolution, these basic components have evolved very little. The only real contributions to the goal of a simple, pacemaker-like implantation are due to progress in ICD leads and waveforms, our two areas of focus in this chapter.


Implantable Cardioverter Defibrillator Defibrillation Threshold Biphasic Waveform Minimize Energy Loss Transvenous Lead 
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© Kluwer Academic Publishers 1996

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  • Seah Nisam

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