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 "title": "Implantable cardioverter-defibrillator implantation",
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 "excerpt": "Implantable cardioverter-defibrillator (ICD) implantation is the surgical placement of a device that detects ventricular tachycardia or fibrillation and terminates them with pacing or shocks, preventing sudden cardiac death.",
 "snippet": "Implantable cardioverter-defibrillator (ICD) implantation is the surgical placement of a device that detects ventricular tachycardia or fibrillation and terminates them with pacing or shocks, preventing sudden cardiac death.",
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 "markdown": "# Implantable cardioverter-defibrillator implantation\n\n[Implantable cardioverter-defibrillator](https://www.edgepedia.org/implantable-cardioverter-defibrillator) (ICD) implantation is the surgical placement of a device that automatically detects ventricular tachycardia (VT) or ventricular fibrillation (VF) and terminates them with pacing or electrical shocks, preventing sudden cardiac death. ICD implantation is generally considered first-line treatment for secondary prevention of sudden cardiac death and for primary prevention in defined high-risk groups.<sup>[1](http://www.uptodate.com/contents/general-principles-of-the-implantable-cardioverter-defibrillator)</sup> Devices are implanted with transvenous electrodes in the right ventricle and sometimes the right atrium, or entirely outside the vasculature as subcutaneous and extravascular systems.<sup>[2](https://www.merckmanuals.com/professional/cardiovascular-disorders/overview-of-arrhythmias-and-conduction-disorders/implantable-cardioverter-defibrillators-icd)</sup>\n\n| Key fact | Detail |\n|---|---|\n| Therapy delivered | Antitachycardia and antibradycardia pacing, cardioversion, and shocks of up to 25–42 J stored energy; some models deliver up to 8 shocks per episode<sup>[3](https://www.ncbi.nlm.nih.gov/books/NBK459196/)</sup> |\n| Generator longevity | Typically 5 to 7 years<sup>[2](https://www.merckmanuals.com/professional/cardiovascular-disorders/overview-of-arrhythmias-and-conduction-disorders/implantable-cardioverter-defibrillators-icd)</sup> |\n| Procedure duration (transvenous) | Usually a few hours<sup>[4](https://www.mayoclinic.org/tests-procedures/implantable-cardioverter-defibrillators/about/pac-20384692)</sup> |\n| Procedural complication rate | 9.1% pooled across randomized trials vs 3.08% in the US NCDR registry (356,515 implants, 2006–2010)<sup>[5](https://openheart.bmj.com/content/2/1/e000198)</sup> |\n| Mortality benefit (primary prevention) | 31% reduction in the risk of death in MADIT II (prior myocardial infarction, LVEF ≤0.30)<sup>[6](https://www.nejm.org/doi/full/10.1056/NEJMoa013474)</sup> |\n| Newest approved platform | Medtronic Aurora extravascular ICD, FDA-approved October 20, 2023 (announced October 23, 2023)<sup>[7](https://news.medtronic.com/2023-10-23-Medtronic-receives-FDA-approval-for-extravascular-defibrillator-to-treat-abnormal-heart-rhythms,-sudden-cardiac-arrest)</sup> |\n\n## How it works\n\nThe device counts sensed ventricular intervals against programmable rate zones. A defibrillation-only configuration detects sinus rhythm below 200 bpm and VF above 200 bpm; a three-zone configuration separates slow VT (120–160 bpm), fast VT (160–200 bpm), and VF (>200 bpm).<sup>[3](https://www.ncbi.nlm.nih.gov/books/NBK459196/)</sup> Two counting schemes are used: consecutive interval counting, reset by a single non-tachycardia beat, and X-of-Y counting in a rolling window, which is the scheme for the VF zone.<sup>[3](https://www.ncbi.nlm.nih.gov/books/NBK459196/)</sup>\n\nOnce rate criteria are met, SVT-VT discrimination classifies the rhythm as supraventricular tachycardia (therapy withheld) or VT/VF (therapy delivered). Discriminators include atrial-versus-ventricular rate branch, R-R interval stability (programmable as a delta of 80 msec, above which atrial fibrillation is diagnosed and therapy inhibited), sudden onset, and morphology matching against a patient-specific QRS template; ventricular rate alone is a mandatory discriminator.<sup>[3](https://www.ncbi.nlm.nih.gov/books/NBK459196/)</sup><sup> • </sup><sup>[8](https://onlinelibrary.wiley.com/doi/10.1016/j.joa.2015.12.001)</sup> Sensing uses an auto-adjusting threshold, typically starting at 50% of the peak sensed ventricular event.<sup>[3](https://www.ncbi.nlm.nih.gov/books/NBK459196/)</sup>\n\nTherapy is tiered. [Antitachycardia pacing](https://www.edgepedia.org/antitachycardia-pacing) (ATP) paces at a cycle length typically 10% to 20% shorter than the tachycardia, in burst, ramp, or combined patterns; failing that, shocks of 25 to 42 J stored energy are delivered, synchronized with the [QRS complex](https://www.edgepedia.org/qrs-complex) for organized tachycardia and unsynchronized for VF.<sup>[3](https://www.ncbi.nlm.nih.gov/books/NBK459196/)</sup> Consensus programming recommends ATP while charging in the VF zone (for example, 8 pulses at 85%–88% of the VT cycle length) and maximum-output shocks, with any deviation from full output guided by defibrillation testing or patient-specific circumstances.<sup>[9](https://onlinelibrary.wiley.com/doi/10.1002/joa3.12178)</sup> Prolonging detection reduces inappropriate therapy: in MADIT-RIT, a prolonged-detection arm produced a 76% reduction in first inappropriate therapy over mean 1.4-year follow-up.<sup>[8](https://onlinelibrary.wiley.com/doi/10.1016/j.joa.2015.12.001)</sup>\n\n## How it is done\n\nIn a transvenous implantation, the surgeon makes a small chest incision, inserts the leads into a blood vessel near the collarbone, guides them to the heart, and connects them to a shock generator placed under the skin beneath the collarbone; the surgery usually takes a few hours, followed by device testing and programming.<sup>[4](https://www.mayoclinic.org/tests-procedures/implantable-cardioverter-defibrillators/about/pac-20384692)</sup> The lead carries one or two defibrillation coils; with a dual-coil lead, the proximal coil is positioned in the superior vena cava.<sup>[3](https://www.ncbi.nlm.nih.gov/books/NBK459196/)</sup>\n\nDefibrillation testing is no longer routine. Based on the randomized SIMPLE trial, shock-efficacy testing (formerly defibrillation threshold testing) is no longer mandatory after transvenous implantation.<sup>[10](https://pmc.ncbi.nlm.nih.gov/articles/PMC7533987/)</sup> In the NORDIC ICD trial (1,077 patients), first-shock efficacy during median 22.8-month follow-up was non-inferior without testing, and with 40 J devices only 4.8% of inducible patients needed system reconfiguration; testing added about 30 minutes of procedure time, 40% more fluoroscopy, and a small (0.4%) increase in major adverse events.<sup>[11](https://pubmed.ncbi.nlm.nih.gov/26112885/)</sup>\n\nS-ICD and EV-ICD implantation differ in lead route. The [S-ICD](https://www.edgepedia.org/subcutaneous-implantable-cardioverter-defibrillator) uses a purely subcutaneous lead with sensing rings and an 8-cm shock coil alongside the sternum and a generator between serratus anterior and latissimus dorsi, placed by two- or three-incision tunneled techniques.<sup>[10](https://pmc.ncbi.nlm.nih.gov/articles/PMC7533987/)</sup><sup> • </sup><sup>[12](https://www.nice.org.uk/guidance/htg460/resources/subcutaneous-implantable-cardioverter-defibrillator-insertion-for-preventing-sudden-cardiac-death-pdf-1809594347185861)</sup> The EV-ICD lead is tunneled posterior to the sternum.<sup>[13](https://www.acc.org/latest-in-cardiology/articles/2025/01/07/17/44/the-extravascular-implantable-cardioverter-defibrillator)</sup>\n\n## Origin\n\nThe standby automatic defibrillator concept, an approach to prevention of sudden coronary death, was published by M. Mirowski in *Archives of Internal Medicine* in 1970.<sup>[14](https://doi.org/10.1001/archinte.126.1.158)</sup> Termination of malignant ventricular arrhythmias with an implanted automatic defibrillator in human beings was reported by M. Mirowski, Philip R. Reid, Morton M. Mower, and colleagues in the *New England Journal of Medicine* in 1980.<sup>[15](https://doi.org/10.1056/nejm198008073030607)</sup> According to a JACC historical review, the implants were performed on February 4, 1980 at [Johns Hopkins Hospital](https://www.edgepedia.org/johns-hopkins-hospital) in three patients aged 16, 43, and 57; after thoracotomy, a 250-g defibrillator connected to epicardial patch electrodes automatically terminated induced VF seven times, and FDA approval followed five years later.<sup>[16](https://www.jacc.org/doi/10.1016/j.jacc.2023.04.056)</sup> In 1985 the Mirowski/MedRad technology was acquired by CPI; FDA approved CPI's first transvenous dual-coil lead and generators in 1993, and transvenous systems eliminated thoracotomy.<sup>[16](https://www.jacc.org/doi/10.1016/j.jacc.2023.04.056)</sup>\n\n## Variants\n\n**Transvenous ICD (TV-ICD).** The reference platform, with intravascular leads and full pacing capability, including biventricular CRT-D devices that add a left ventricular lead for cardiac resynchronization.<sup>[2](https://www.merckmanuals.com/professional/cardiovascular-disorders/overview-of-arrhythmias-and-conduction-disorders/implantable-cardioverter-defibrillators-icd)</sup>\n\n**Subcutaneous ICD (S-ICD).** An entirely subcutaneous system reported by [Gust H. Bardy](https://www.edgepedia.org/gust-h-bardy) and colleagues in the *New England Journal of Medicine* in 2010<sup>[17](https://doi.org/10.1056/nejmoa0909545)</sup>; a two-incision implantation technique was described by [Reinoud E. Knops](https://www.edgepedia.org/reinoud-e-knops) and colleagues in *Heart Rhythm* in 2013.<sup>[18](https://doi.org/10.1016/j.hrthm.2013.05.016)</sup> It cannot provide long-term pacing<sup>[12](https://www.nice.org.uk/guidance/htg460/resources/subcutaneous-implantable-cardioverter-defibrillator-insertion-for-preventing-sudden-cardiac-death-pdf-1809594347185861)</sup>, and preimplantation QRS-T morphology screening is required; the initial manual screening tool found 7.4% of patients unsuitable.<sup>[10](https://pmc.ncbi.nlm.nih.gov/articles/PMC7533987/)</sup>\n\n**Extravascular ICD (EV-ICD).** A lead placed outside the heart and vasculature, posterior to the sternum, evaluated in the Pivotal Study reported by Paul Friedman and colleagues in 2022<sup>[19](https://doi.org/10.1056/nejmoa2206485)</sup> and FDA-approved as the Medtronic Aurora EV-ICD in October 2023.<sup>[7](https://news.medtronic.com/2023-10-23-Medtronic-receives-FDA-approval-for-extravascular-defibrillator-to-treat-abnormal-heart-rhythms,-sudden-cardiac-arrest)</sup> It delivers 40 J shocks, ATP, and pause-prevention pacing from a 33 cc generator with 11.7-year projected longevity, and is indicated for patients without prior sternotomy who do not need chronic bradycardia pacing.<sup>[7](https://news.medtronic.com/2023-10-23-Medtronic-receives-FDA-approval-for-extravascular-defibrillator-to-treat-abnormal-heart-rhythms,-sudden-cardiac-arrest)</sup> Patients requiring cardiac resynchronization or chronic bradycardia pacing are not candidates.<sup>[13](https://www.acc.org/latest-in-cardiology/articles/2025/01/07/17/44/the-extravascular-implantable-cardioverter-defibrillator)</sup> A wearable vest-like defibrillator exists for short-term use.<sup>[2](https://www.merckmanuals.com/professional/cardiovascular-disorders/overview-of-arrhythmias-and-conduction-disorders/implantable-cardioverter-defibrillators-icd)</sup>\n\n## Applications\n\nSecondary prevention refers to an ICD for survivors of one or more cardiac arrests or episodes of sustained VT or VF (sustained meaning 30 seconds or longer or hemodynamically significant); primary prevention refers to at-risk individuals who have not yet had such events.<sup>[20](https://www.acc.org/guidelines/guidelines/2025/01/13/19/12/auc-implantable-cardioverter-defibrillators-crt-pacing)</sup> In secondary prevention, AVID found a nearly 38% reduction in deaths after one year, and about a 25% reduction in years two and three, versus antiarrhythmic drugs, and CASH compared an ICD with amiodarone or metoprolol<sup>[21](https://www.emjreviews.com/en-us/amj/innovations/article/the-evolving-evidence-base-of-implantable-cardiac-defibrillators-past-present-and-future-j080121/)</sup>, as reported by The Antiarrhythmics versus Implantable Defibrillators (AVID) Investigators in 1997.<sup>[22](https://doi.org/10.1056/nejm199711273372202)</sup>\n\nPrimary prevention rests on ejection-fraction-based trials. MADIT I (196 patients, prior MI, LVEF ≤35%) showed a 54% all-cause mortality reduction, and MUSTT found EP-guided defibrillator therapy halved total mortality<sup>[21](https://www.emjreviews.com/en-us/amj/innovations/article/the-evolving-evidence-base-of-implantable-cardiac-defibrillators-past-present-and-future-j080121/)</sup>, as reported by [Alfred E. Buxton](https://www.edgepedia.org/alfred-e-buxton) and colleagues in 2000.<sup>[23](https://doi.org/10.1056/nejm200006293422602)</sup> MADIT II, reported by [Arthur J. Moss](https://www.edgepedia.org/arthur-j-moss) and colleagues in 2002, enrolled 1,232 patients with prior myocardial infarction and LVEF ≤0.30 and showed a 31% reduction in the risk of death (HR 0.69).<sup>[6](https://www.nejm.org/doi/full/10.1056/NEJMoa013474)</sup> SCD-HeFT, reported by Gust H. Bardy and colleagues in 2005, showed 23% lower mortality with no difference between ischemic and nonischemic subgroups.<sup>[24](https://doi.org/10.1056/nejmoa043399)</sup><sup> • </sup><sup>[25](https://www.jacc.org/doi/10.1016/j.jchf.2024.09.014)</sup> Guideline Class I primary-prevention criteria include ischemic cardiomyopathy with NYHA (new York Heart Association heart-failure severity classes) II–III symptoms and LVEF ≤0.35 at least 40 days post-MI and 90 days post-revascularization, LVEF ≤30% for NYHA I, and nonischemic dilated cardiomyopathy with LVEF ≤0.35 and NYHA II–III on optimal therapy.<sup>[2](https://www.merckmanuals.com/professional/cardiovascular-disorders/overview-of-arrhythmias-and-conduction-disorders/implantable-cardioverter-defibrillators-icd)</sup> DANISH showed no significant overall mortality reduction (HR 0.87) but lower SCD (4.3% vs 8.2%)<sup>[25](https://www.jacc.org/doi/10.1016/j.jchf.2024.09.014)</sup>, and DINAMIT found no benefit early after myocardial infarction.<sup>[21](https://www.emjreviews.com/en-us/amj/innovations/article/the-evolving-evidence-base-of-implantable-cardiac-defibrillators-past-present-and-future-j080121/)</sup>\n\n## Limitations and alternatives\n\n**Procedural complications.** Pooled across randomized trials, the complication rate was 9.1%, with lead displacement 3.1%, pneumothorax 1.1%, hematoma 1.2%, and infection 1.5%; the NCDR registry (356,515 implants) reported a threefold lower major complication rate of 3.08%.<sup>[5](https://openheart.bmj.com/content/2/1/e000198)</sup> Hematoma is a major infection risk: 1-year device-related infection was 11% with hematomas versus 1.5% without (HR 7.7).<sup>[26](https://www.chrsonline.ca/sites/default/files/2018-11/CCS-CHRS-2016-Implantable-Cardioverter-Defibrillator-Guidelines.pdf)</sup>\n\n**Inappropriate shocks and lead failure.** In PRAETORIAN, inappropriate shocks occurred in 9.7% of S-ICD versus 7.3% of TV-ICD patients; S-ICD shocks were mostly from cardiac oversensing (predominantly T-wave), while 93.1% of TV-ICD inappropriate shocks were triggered by supraventricular arrhythmia.<sup>[27](https://www.nejm.org/doi/full/10.1056/NEJMoa1915932)</sup> Appropriate shocks were more frequent with S-ICD (19.2% vs 11.5%) largely because it cannot deliver ATP, which terminated 55% of treated VT episodes in the TV-ICD group.<sup>[27](https://www.nejm.org/doi/full/10.1056/NEJMoa1915932)</sup> A meta-analysis found S-ICD lead-related complications significantly lower (RR 0.14), and reported 10-year mechanical complication rates for transvenous systems as high as 1 in 4, many involving the leads.<sup>[28](https://www.ahajournals.org/doi/10.1161/JAHA.121.024756)</sup> Pocket-related complications are higher with S-ICD (OR 2.18).<sup>[28](https://www.ahajournals.org/doi/10.1161/JAHA.121.024756)</sup> The EV-ICD showed 1-year and 3-year inappropriate shock rates of 9.8% and 17.5%, with P-wave oversensing causing 51% of episodes.<sup>[29](https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.124.071795)</sup> Devices may also fail to deliver therapy because of undersensing, lead or generator migration, fibrosis raising the pacing threshold, or battery depletion.<sup>[2](https://www.merckmanuals.com/professional/cardiovascular-disorders/overview-of-arrhythmias-and-conduction-disorders/implantable-cardioverter-defibrillators-icd)</sup>\n\n## References\n\n1. [Implantable cardioverter-defibrillators: Overview of indications, components, and functions - UpToDate](http://www.uptodate.com/contents/general-principles-of-the-implantable-cardioverter-defibrillator)\n2. [Implantable Cardioverter-Defibrillators (ICD) - Merck Manual Professional Edition](https://www.merckmanuals.com/professional/cardiovascular-disorders/overview-of-arrhythmias-and-conduction-disorders/implantable-cardioverter-defibrillators-icd)\n3. [Implantable Defibrillator - StatPearls - NCBI Bookshelf](https://www.ncbi.nlm.nih.gov/books/NBK459196/)\n4. [Implantable cardioverter-defibrillators (ICDs) - Mayo Clinic](https://www.mayoclinic.org/tests-procedures/implantable-cardioverter-defibrillators/about/pac-20384692)\n5. [A systematic review of ICD complications in randomised controlled trials versus registries: is our 'real-world' data an underestimation?](https://openheart.bmj.com/content/2/1/e000198)\n6. [Prophylactic Implantation of a Defibrillator in Patients with Myocardial Infarction and Reduced Ejection Fraction (MADIT II)](https://www.nejm.org/doi/full/10.1056/NEJMoa013474)\n7. [Medtronic receives FDA approval for extravascular defibrillator (Aurora EV-ICD), Oct 23, 2023](https://news.medtronic.com/2023-10-23-Medtronic-receives-FDA-approval-for-extravascular-defibrillator-to-treat-abnormal-heart-rhythms,-sudden-cardiac-arrest)\n8. [2015 HRS/EHRA/APHRS/SOLAECE expert consensus statement on optimal implantable cardioverter-defibrillator programming and testing](https://onlinelibrary.wiley.com/doi/10.1016/j.joa.2015.12.001)\n9. [2019 HRS/EHRA/APHRS/LAHRS focused update to 2015 expert consensus statement on optimal ICD programming and testing](https://onlinelibrary.wiley.com/doi/10.1002/joa3.12178)\n10. [State-of-the-art consensus on non-transvenous implantable cardioverter-defibrillator therapy](https://pmc.ncbi.nlm.nih.gov/articles/PMC7533987/)\n11. [Intra-operative defibrillation testing and clinical shock efficacy in patients with implantable cardioverter-defibrillators: the NORDIC ICD randomized clinical trial](https://pubmed.ncbi.nlm.nih.gov/26112885/)\n12. [Subcutaneous implantable cardioverter defibrillator insertion for preventing sudden cardiac death (NICE HealthTech guidance 460)](https://www.nice.org.uk/guidance/htg460/resources/subcutaneous-implantable-cardioverter-defibrillator-insertion-for-preventing-sudden-cardiac-death-pdf-1809594347185861)\n13. [The Extravascular Implantable Cardioverter-Defibrillator: A Promising Novel Device (ACC, Jan 2025)](https://www.acc.org/latest-in-cardiology/articles/2025/01/07/17/44/the-extravascular-implantable-cardioverter-defibrillator)\n14. [M. Mirowski (1970). Standby automatic defibrillator. An approach to prevention of sudden coronary death. Archives of Internal Medicine.](https://doi.org/10.1001/archinte.126.1.158)\n15. [M. Mirowski and colleagues (1980). Termination of Malignant Ventricular Arrhythmias with an Implanted Automatic Defibrillator in Human Beings. New England Journal of Medicine.](https://doi.org/10.1056/nejm198008073030607)\n16. [Development of the Implantable Cardioverter-Defibrillator: JACC Historical Breakthroughs in Perspective](https://www.jacc.org/doi/10.1016/j.jacc.2023.04.056)\n17. [Gust H. Bardy and colleagues (2010). An Entirely Subcutaneous Implantable Cardioverter–Defibrillator. New England Journal of Medicine.](https://doi.org/10.1056/nejmoa0909545)\n18. [Reinoud E. Knops and colleagues (2013). Two-incision technique for implantation of the subcutaneous implantable cardioverter-defibrillator. Heart Rhythm.](https://doi.org/10.1016/j.hrthm.2013.05.016)\n19. [Paul Friedman and colleagues (2022). Efficacy and Safety of an Extravascular Implantable Cardioverter–Defibrillator. New England Journal of Medicine.](https://doi.org/10.1056/nejmoa2206485)\n20. [ACC/AHA/ASE/HFSA/HRS/SCAI/SCCT/SCMR 2025 Appropriate Use Criteria for ICDs, CRT, and Pacing](https://www.acc.org/guidelines/guidelines/2025/01/13/19/12/auc-implantable-cardioverter-defibrillators-crt-pacing)\n21. [The Evolving Evidence Base of Implantable Cardiac Defibrillators: Past, Present, and Future](https://www.emjreviews.com/en-us/amj/innovations/article/the-evolving-evidence-base-of-implantable-cardiac-defibrillators-past-present-and-future-j080121/)\n22. [The Antiarrhythmics versus Implantable Defibrillators (AVID) Investigators (1997). A Comparison of Antiarrhythmic-Drug Therapy with Implantable Defibrillators in Patients Resuscitated from Near-Fatal Ventricular Arrhythmias. New England Journal of Medicine.](https://doi.org/10.1056/nejm199711273372202)\n23. [Alfred E. Buxton and colleagues (2000). Electrophysiologic Testing to Identify Patients with Coronary Artery Disease Who Are at Risk for Sudden Death. New England Journal of Medicine.](https://doi.org/10.1056/nejm200006293422602)\n24. [Gust H. Bardy and colleagues (2005). Amiodarone or an Implantable Cardioverter–Defibrillator for Congestive Heart Failure. New England Journal of Medicine.](https://doi.org/10.1056/nejmoa043399)\n25. [Revisiting ICD Therapy for Primary Prevention in Patients With Heart Failure and Reduced Ejection Fraction (JACC: Heart Failure, 2024)](https://www.jacc.org/doi/10.1016/j.jchf.2024.09.014)\n26. [Canadian Cardiovascular Society/Canadian Heart Rhythm Society 2016 ICD Guidelines](https://www.chrsonline.ca/sites/default/files/2018-11/CCS-CHRS-2016-Implantable-Cardioverter-Defibrillator-Guidelines.pdf)\n27. [Subcutaneous or Transvenous Defibrillator Therapy (PRAETORIAN trial)](https://www.nejm.org/doi/full/10.1056/NEJMoa1915932)\n28. [Subcutaneous Versus Transvenous Implantable Defibrillator Therapy: A Systematic Review and Meta-Analysis](https://www.ahajournals.org/doi/10.1161/JAHA.121.024756)\n29. [Performance and Safety of the Extravascular Implantable Cardioverter Defibrillator Through Long-Term Follow-Up: Final Results From the Pivotal Study](https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.124.071795)\n\n---\n*Topic: Encyclopedia › Life and health › Human health and medicine › Clinical assessment and procedures › Medical devices, prosthetics, and implants › Cardiac device therapies*\n\n*Initially written Sep 29, 2026 · Edited: Oct 15, 2026*\n\n*Copyright 2026 EdgeChat AI, a subsidiary of Biostate AI.*\n\nLicense: Edgepedia Community License 1.0, https://www.edgepedia.org/edgepedia/license\n",
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 "credit": "\"Implantable cardioverter-defibrillator implantation\", Edgepedia (EdgeChat), https://www.edgepedia.org/implantable-cardioverter-defibrillator-implantation. Edgepedia Community License 1.0.",
 "credit_md": "\"[Implantable cardioverter-defibrillator implantation](https://www.edgepedia.org/implantable-cardioverter-defibrillator-implantation)\", Edgepedia (EdgeChat), [https://www.edgepedia.org/implantable-cardioverter-defibrillator-implantation](https://www.edgepedia.org/implantable-cardioverter-defibrillator-implantation). [Edgepedia Community License 1.0](https://www.edgepedia.org/edgepedia/license).",
 "credit_html": "\"<a href=\"https://www.edgepedia.org/implantable-cardioverter-defibrillator-implantation\">Implantable cardioverter-defibrillator implantation</a>\", Edgepedia (EdgeChat), <a href=\"https://www.edgepedia.org/implantable-cardioverter-defibrillator-implantation\">https://www.edgepedia.org/implantable-cardioverter-defibrillator-implantation</a>. <a href=\"https://www.edgepedia.org/edgepedia/license\">Edgepedia Community License 1.0</a>.",
 "speakable": "Implantable cardioverter-defibrillator implantation is the surgical placement of a device that detects ventricular tachycardia or fibrillation and terminates them with pacing or shocks, preventing sudden cardiac death."
}