Management of the patient with an implantable cardioverter-defibrillator in the third millennium.

Implantable cardioverter-defibrillator (ICD) devices were originally developed for prevention of sudden cardiac death (SCD). They are now widely regarded as the primary therapy for this condition. Clinical trials have led to a progressive expansion in indications for their use.1,2 Recent clinical reports show effectiveness of these devices in patients with recurrent syncope, in the prevention of SCD in high-risk patients with coronary disease, and in the treatment of atrial fibrillation. Refinements in ICD technology have improved functionality and enhanced safety. Optimal patient management requires intimate knowledge of these complex devices and of the diverse arrhythmias that may be treatable by a single multifaceted ICD device.