The first decade (1992–2002) of the use of the implantable cardioverter defibrillator in Hungary
Gottsegen György Országos Kardiológiai Intézet, Felnőtt Kardiológiai Osztály, Budapest
Sudden cardiac death (SCD) caused by arrhythmias can be effectively and safely prevented by the implantable cardioverter defibrillator (ICD) therapy. The ICD therapy was developed by a physician M. Mirowsky of polish origin and an American engineer M. Mower between 1980-1985 in the USA. After the FDA permission (1985) the new ICD technology was spread out in the whole world. Hungary joined the new ICD trend with some delay in the early 1990-s. The first ICD implantation in the country was performed at the Hungarian Institute of Cardiology. On 08. 01. 1992 the first non-thoracotomic, transvenous single chamber ICD (VVICD Medtronic 7217/B) with subcutaneous patch electrode was implanted, later on 21. 11. 1997, the first dual chamber ICD (DDICD, CPI/Guidant Ventak II. DR 1821) implantation was performed (cardiac surgeon: T. Richter, cardiologist: J. Borbola). The same team performed the implantation of first re-used VVICD device (Medtronic 7217/B) on 12. 05. 1993 not only in the country, but also in the whole world. The first completely transvenous single chamber ICD (VVICD, Biotronik Phylax 03) was implanted at the Semmelweis University Heart and Vascular Center (2012) by T. Gyöngy (cardiac surgeon) and B. Merkely (cardiologist) on 03. 1994.
In the next years tremendous effort was made for the acceptance of the ICD by the National Healthcare Insurance (OEP) organisation. In this struggle the Arrhythmia and Pacemaker Working Group of the Hungarian Society of Cardiology played a prominent, leading role. After the OEP acceptance, the purchase of the ICDs was arranged by national tenders. After the exemption of the financial restrictions, the ICD implantations were started at the provincial pacemaker implanting centers. At the beginning of the new millennium the ICD implantation number/1 million inhabitants gradually increased (1997: 7; 2005: 52.5; 2007: 70.1). These numbers exceeded the similar numbers of the neighboring countries, but it did not reach the levels of the western countries. At the end of the last millennium, the ICD therapy became an accepted first line device treatment option in the cases of primary and secondary prevention of SCD.