Implantable dual-chamber cardioverter-defibrillator-pacemaker.

The fifth generation of implantable cardioverter-defibrillators offer enhanced modes of detection of atrial and ventricular arrhythmias, antitachycardia pacing and shocks, multiprogrammability, intracardiac electrogram storage, and all functions of antibradycardia dual-chamber pacing including rate responsiveness and mode switching. There is no consensus on the indications for dual-chamber pacemaker defibrillator systems. This review focuses on the four major options of newer devices that might benefit patients: 1) permanent dual-chamber pacing in ischemic coronary disease patients, 2) detection and management of atrial fibrillation or other atrial tachyarrhythmias, 3) some newer indications for pacing, and 4) the suppression of inappropriate interventions. On the basis of published data, newer indications for the dual-chamber systems, advantages and limitations, and future perspectives are discussed.