Implantable Cardioverter Defibrillators (ICDs)

A heart arrhythmia is an abnormal or irregular heartbeat that occurs when the electrical signals that tell the heart to beat are not functioning properly. This results in a heartbeat that is too fast, too slow, or erratic. There are two basic types of arrhythmias: an abnormally slow heart rate, or bradycardia (less than 60 beats per minute[bpm]), or abnormally fast heart rate, tachycardia (greater than 100 bpm).

Ventricular fibrillation (VF or Vfib) is a dangerous arrhythmia characterized by rapid, chaotic electrical signals that cause the lower heart chambers to quiver instead of squeezing in a normal, coordinated manner. The condition is serious and may lead to sudden cardiac arrest (SCA) and death if a regular heartbeat is not restored within minutes.

There are two main types of life-saving implantable electrical pacing devices – pacemakers and implantable cardioverter defibrillators (ICDs) – both used to control the heart’s rhythm by delivering electrical impulses to stimulate the heart. While a pacemaker helps control an abnormally slow heart rhythm, an ICD sends an electric shock to the heart if it detects a tachycardia to restore the heart to its normal rhythm, and is designed to prevent SCA.

A traditional, transvenous ICD (TV-ICD) delivers stimulation via flexible, insulated wires (leads) that serve as the “conduit” of mild electrical pulses. Leads are threaded or “tunneled” through veins (therefore termed “transvenous”) and placed on or inside the heart muscle; leads are connected to the battery-powered implantable pulse generator (IPG) that instructs the leads to deliver a series of rapid pacing pulses, or deliver an electric shock to return the heart to a normal rhythm.

Over the past decade, non-transvenous – termed either “extravascular” or “subcutaneous” ICDs (EV/S-ICDs) – have been developed that may significantly reduce complications (such as infection or lead malfunction) associated with TV-ICDs. This is because EV/S-ICD leads avoid the heart and are implanted either above or below the sternum. To date, EV/S-ICDs include two products offered by Boston Scientific and Medtronic, both of which are experiencing a gradual uptick in sales (a comparatively smaller but growing segment of total ICD revenues).

In 2023, the global market for ICDs totaled nearly $5bn and is expected to grow at a healthy single-digit rate over the forecast period.

Market drivers include: a large and growing global elderly population prone to cardiac rhythm disorders, ongoing technical improvements, increased adoption of innovative ICD technologies (e.g., EV/S-ICDs), and several other factors.

Factors limiting market growth include: high device cost, device/surgical risks, lack of access to skilled surgeons, ongoing macroeconomic factors, and other factors.

• Note: For information on the global pacemaker market, which includes leadless pacemakers, see Meddevicetracker’s Pacemaker report.

Key topics covered

This analysis includes a discussion of products, current revenues and forecast markets, competitors, and opportunities in the global market for ICD systems. This market, as covered by the scope of this report, includes revenues derived from: battery-powered implantable ICD devices, including traditional TV-ICDs and next-generation EV/S-ICDs, CRT-Ds, stimulation leads, remote monitoring software/mobile apps, tunneling tools/surgical instruments, and other related products.

Countries covered by this report include the US, five major European markets (France, Germany, Italy, Spain, and the UK), Japan, and the Rest of World. The forecast range for this report is 2023–28.

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