The Pacer‐Cardioverter‐Defibrillator: Function and Clinical Experience

Pacer‐Cardioverter‐Defibrillator. This article reviews the function of the pacer‐cardioverter‐defibrillator (PCD). Detection of ventricular arrhythmias occurs in two programmable zones, with onset and stability modifiers available to diminish overdetection of sinus tachycardia and atrial fibrillation, respectively. The sensing circuitry utilizes an auto‐adjusting sensitivity with exponential decay to allow detection of low‐amplitude ventricular fibrillation electrograms without T wave oversensing. Treatment can be accomplished by tiered therapy with two types of antitachycardia pacing, cardioversion and defibrillation. Cardioversion and defibrillation shocks are programmable between single pathway when two leads are used and simultaneous or sequential shock delivery when a three‐lead system is used. A telemetered marker channel and electrogram aid in assessing device function during implantation and follow‐up. Previously published literature is cited to expand on various aspects of PCD function and programming.