Abstract
Cardiac implantable electric devices (CIEDs) systems are indispensable for today's cardiac treatment. Most of CIEDs systems consist of device and leads like the pacemaker system. The implantable cardioverter - defibrillator (ICD) was developed to use the patch electrode unlike the pacemaker lead. Finally, today's ICD equipped transvenous shock lead. The transvenous lead system has a large advantage in the implantation procedure. For patients who need the CIEDs, the transvenous approach is less invasive and less risk in the operation than the open chest surgery. Therefore, the development of the transvenous system is significant improvement for CIEDs. Recently CIEDs system infection and the longevity of the lead are focused as the new risk of the CIEDs system. When some troubles are found in the transvenous system, the most miserable scenario is the total system extraction, which involves large risks. Even if the total system extraction is not required, at least it is necessary to replace the leads to the new ones. It is true that the developments of the transvenous lead system have enabled to implant more easily and the transvenous CIEDs system have disseminated the CIEDs therapy. However, the transvenous system is one of the risk factors of the CIEDs therapy.
The recent development of the lead-less pacemakers and subqutaneous ICDs are one of the solution against these risks.
The LV pacing with the conventional epicardial lead has many limitations in the longevity, e.g. lead fracture and threshold rising. The development of the transvenous LV lead was one of the evolutions for the CIEDs therapy. For the resynchronize therapy, stable LV pacing is the most important factor. The development of the transvenous LV lead has achieved the safe and effective treatment for the chronic heart failure patients. On the other hand, the nerve stimulation is developed for the treatment of the intractable pain. Sympathetic or parasympathetic nerve stimulation for chronic heart failure patients was tried using new implantable devices. All these devices has not been accepted with clinical evidences. However, these devices are still improving and renewing.
The CIEDs is not only the therapy device, but also the diagnostic device. The device equipped the Holter ECG function. The pacemaker is able to record the number of the arithmetic events and EGM. The implantable loop recorder (ILR) is the first implantable device for diagnosis. ILR has not therapy function. Recently many implantable diagnostic devices have been developed. Most of them are to observe the cardiac function for chronic heart failure patients. In this session, new implantable therapy devices will be introduced in the first part. Then, new implantable diagnostic devices will be also introduced in the second part.
