Historical Overview of Cardiac Implantable Electrical Devices

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　Since its approval for reimbursement in 1974 in Japan, the artificial pacemaker (PM) for the treatment of bradycardia has come into wide clinical use. In the years that have followed, remarkable structural and functional progress has been made with PMs and the associated lead systems, and the reliability of the PM as an implanted artificial device has been established. In 1996, the implantable cardioverter-defibrillator (ICD) became the next reimbursed device, approved as a therapy for fatal ventricular arrhythmias. ICD have contributed to improved prognosis in patients with these arrhythmias through preventing sudden cardiac death. Cardiac resynchronization therapy (CRT) was recognized as the next effective modality for drug-refractory chronic heart failure. CRT became reimbursable in 2004, followed by CRT with defibrillator function in 2006. Large-scale randomized trials and meta-analyses have confirmed the reduced overall mortality with CRT. Currently, these implanted devices are essential therapeutic modalities, collectively known as cardiac implantable electrical devices (CIEDs), for indications from symptomatic bradycardia and fatal ventricular tachyarrhythmia to severe chronic heart failure. As CIEDs continue to evolve, we should always be updating relevant knowledge and ensuring appropriate indications for CIED implantation.