What is the difference between a pacemaker and an implantable defibrillator?

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1. 1

   Implantable cardioverter-defibrillator (Wikipedia)

   WikipediaPublished Sep 29, 2026Checked Oct 17, 2026

   “An implantable cardioverter-defibrillator (ICD) or automated implantable cardioverter defibrillator (AICD) is a device implantable inside the body, able to perform defibrillation, and depending on the type, cardioversion and pacing of the heart. The ICD is the first-line treatment and prophylactic therapy for patients at risk for sudden cardiac death due to ventricular fibrillation and ventricular tachycardia. "AICD" was trademarked by the Boston Scientific corporation, so the more generic "ICD" is preferred terminology. On average ICD batteries last from six to ten years. Advances in technology, such as batteries with more capacity or rechargeable batteries, may allow batteries to last for more than ten years. The leads (electrical cable wires connecting the device to the heart) have much longer average longevity, but can malfunction in various ways, specifically insulation failure or fracture of the conductor; thus, ICDs and leads generally require replacement every 5 to 10 years. The process of implantation of an ICD system is similar to implantation of an artificial pacemaker.”

2. 2

   Innovations in cardiac device therapy in the era of advanced rhythm management: implantable defibrillators and conduction system pacing.

   Heart (British Cardiac Society) (Pujol-Lopez et al.)Published Aug 12, 2026Checked Oct 17, 2026

   “Despite these advancements, the S-ICD system is limited by its inability to provide bradycardia pacing and antitachycardia pacing. This limitation prompted the development of a modular cardiac rhythm management system, integrating a new leadless pacemaker with an S-ICD that uses unidirectional communication to command the pacemaker to deliver antitachycardia pacing.Conduction system pacing, including His bundle pacing and left bundle branch area pacing (LBBAP), has emerged as a physiological alternative to biventricular resynchronisation therapy and conventional pacing, pending results of large clinical trials. LBBAP offers superior electrical parameters and long-term performance compared with His bundle pacing. The capability to provide defibrillation via the same lead used for LBBAP represents an unresolved challenge that is currently under ongoing research.This state-of-the-art review presents the latest developments and innovations in cardiac device therapy, offering a comprehensive overview of current technologies that increasingly enable therapy to be tailored to individual patient needs.”

3. 3

   Beyond one-size-fits-all: personalized selection of contemporary implantable cardioverter-defibrillator therapies.

   Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacingPublished Oct 1, 2026Checked Oct 17, 2026

   “The subcutaneous ICD avoids intravascular leads and is particularly attractive in younger patients and those at high risk of infection, although it lacks ATP and has shorter device longevity. The extravascular ICD is an emerging alternative designed to combine the advantages of both systems by providing ATP and shock therapy without intravascular leads, though implantation is more complex and long-term evidence remains limited. Given these differences, ICD selection should be guided by patient-specific clinical characteristics rather than a one-size-fits-all approach. Key determinants include pacing indication, prior lead failure, infection risk, body mass index, age, and arrhythmic substrate. The proposed clinical pathway offers a practical framework to support tailored ICD selection by integrating these variables into a structured decision-making process. Such an individualized approach may improve patient outcomes, reduce device-related complications, and enhance the appropriate adoption of contemporary ICD technologies.”

4. 4

   Cardiac implantable electronic devices in heart failure: needs, challenges, and real-world implementation.

   Heart failure reviews (Žižek et al.)Published Sep 1, 2026Checked Oct 17, 2026

   “As BVP remains the standard approach for CRT, recent data bestow LBBAP as a promising alternative and integration platform. Newer implantable cardioverter-defibrillator technologies, including subcutaneous and extravascular systems, may reduce lead-related complications while maintaining effective arrhythmia termination and recognition. Advances in atrial fibrillation management, implantable hemodynamic monitoring, and novel pacing indications such as atrioventricular recoupling and personalized pacing in HF with preserved ejection fraction are expanding the therapeutic potential of CIEDs. However, the adoption of these innovations is challenged by limited randomized evidence, procedural complexity, and substantial disparities in access and implementation across healthcare systems. Ongoing clinical trials will help define the role of emerging device technologies and monitoring strategies, while efforts to improve guideline adherence, value-based procurement, and equitable access remain essential to maximize the benefits of CIED therapy in patients with HF.”

5. 5

   Perioperative management of cardiac implantable electronic devices: a state of the art narrative review.

   Journal of thoracic disease (Fernando et al.)Published May 27, 2026Checked Oct 17, 2026

   “Only papers in the English language were considered.Key content and findingsFive guidance documents were retrieved based on the search. Some had endorsement from numerous groups, but notable organizations included: (I) the American Society of Anesthesiologists (ASA); (II) European Heart Rhythm Association (EHRA)/Heart Rhythm Society; (III) British Heart Rhythm Society; (IV) American Heart Association (AHA)/American College of Cardiology (ACC); and (V) AHA.ConclusionsFamiliarity with these devices and how to manage them perioperatively is necessary to safely care for these patients in the perioperative period. Although there are similarities between perioperative management strategies, differences exist between recommendations from various societies. Furthermore, the scope of each of these documents differs, with some being more detailed and others lacking details. In the absence of a universal protocol, clinicians could benefit from being familiar with guidance from each of these organizations, taking into consideration the strengths and limitations of the documents, and applying the recommendation that is most relevant and specific to their patient.”