Cardiac Pacing, Defibrillation and Resynchronization: A Clinical Approach

Cover
Title Page
Copyright Page
Contents
Contributors
Preface
Chapter 1 Pacing and Defibrillation: Clinically Relevant Basics for Practice
	Anatomy and physiology of the cardiac conduction system
	Electrophysiology of myocardial stimulation
	Pacing basics
		Stimulation threshold
		Variations in stimulation threshold
		Clinical considerations when considering threshold
		Sensing
	Lead design
		Bipolar and unipolar pacing and sensing
		Left ventricular and His bundle pacing leads
		Epicardial leads
		Defibrillator leads – special considerations
		Leadless pacemakers
	Pulse generators
		Pacemaker nomenclature
	Essentials of defibrillation
		Critical mass
		Upper limit of vulnerability
		Progressive depolarization
		Virtual electrode depolarization
		Electroporation as a mechanism for defibrillation
		Defibrillation theory summary
	The importance of waveform
		Biphasic waveforms
		Phase duration and tilt
		Polarity and biphasic waveforms
		Mechanism of improved efficacy with biphasic waveforms
		Measuring shock dose
	Measuring the efficacy of defibrillation
		Threshold and dose–response curve
		Relationship between defibrillation threshold and dose–response curve
		Patient-specific defibrillation threshold and safety margin testing – clinical indications
		Management of the patient who fails defibrillation testing
		Upper limit of vulnerability to assess safety margin
		Practical implications of defibrillator therapies
	Drugs and defibrillators
	Antitachycardia pacing
	Summary
	References
Chapter 2 Hemodynamics of Cardiac Pacing: Optimization and Programming to Enhance Cardiac Function
	Cardiovascular physiology
		Abnormal physiology
	Basics of hemodynamic pacing
		Chronotropic response
		Atrioventricular dissociation and ventriculoatrial conduction
		Atrioventricular synchrony
	Rate-adaptive atrioventricular intervals
		Atrioventricular optimization
		Principles of echocardiographic atrioventricular optimization
	Atrial mechanical function
	Effect of pacing mode on morbidity and mortality
		Pressure–volume optimization
		Optimal ventricular pacing sites
	Pacing in heart failure
		Influence of pacing site
		Mechanisms underlying the benefits of left ventricular and biventricular pacing
		Left ventricular diastolic function
	Atrioventricular optimization in cardiac resynchronization therapy
	Ventricular timing optimization (ventriculo-ventricular optimization)
		Optimizing site of pacing (left ventricular and/or right ventricular)
		Electrical parameters for ventriculo-ventricular optimization
		QRS vector fusion
		Echocardiography for ventricular timing optimization
		Clinical approaches to ventriculo‐ventricular optimization
		Newer programming features to optimize hemodynamics via pacing
		Other endpoints for optimization
		Right ventricular function
		Cardiac contractility modulation pacing
		Ventricular rate regulation
	Less common indications for pacing for hemodynamic improvement
		Pacing in hypertrophic obstructive cardiomyopathy
		Hemodynamic benefits of pacing in neurocardiogenic syndromes
		Hemodynamic benefits of pacing in first-degree atrioventricular block
	Conclusions
	References
Chapter 3 Indications for Pacemakers, Implantable Cardioverter-Defibrillators, and Cardiac Resynchronization Therapy: Identifying Patients Who Benefit from Cardiac Rhythm Devices
	Indications for permanent pacing
		Atrioventricular block
		Acute myocardial infarction
		Chronic bifascicular and trifascicular block
		Sinus node dysfunction
		Neurally mediated reflex syncope
		Tachyarrhythmias
		Hypertrophic cardiomyopathy
		Congestive heart failure
		Pacing after cardiac transplantation
	Indications for the implantable cardioverter‐defibrillator
		Secondary prevention
		Primary prevention
		Coronary artery disease
		Dilated cardiomyopathy
		Long QT syndrome
		Brugada syndrome and sudden unexplained death syndrome
		Other channelopathies
		Arrhythmogenic right ventricular dysplasia
		Hypertrophic cardiomyopathy
		Congenital heart disease
	Wearable cardioverter-defibrillator therapy
	Contraindications to implantable cardioverter-defibrillator therapy
	Acknowledgement
	References
Chapter 4 Choosing the Device Generator and Leads: Matching the Device with the Patient
	Pacemaker selection
		Symptomatic bradycardia
		Pure sinus node dysfunction
		Pure atrioventricular block
	Neurocardiogenic syncope and carotid sinus hypersensitivity
	Choosing specific programmable options
	Choosing the rate-adaptive sensor
	Choosing the lead or leads
		Threshold reduction
		Lead polarity
		Electrode design
		Lead conductor
		Lead insulation
		Lead diameter
		Compatibility of lead and pulse generator
		Epicardial leads
		Resources for lead performance and survival data
	Leadless pacemakers
	Generator and lead selection in defibrillators
		Lead design considerations for internal cardioverter-defibrillator leads
		Programmable waveforms
	Dual-chamber or single-chamber internal cardioverter-defibrillator?
		Factors favoring single-chamber defibrillators
		Factors favoring dual-chamber defibrillators
		Specific device and lead features influencing selection
	Conclusions
	References
Chapter 5 Implanting and Extracting Cardiac Devices: Technique and Avoiding Complications
	Implantation facility
	Anesthesia
	The pulse generator pocket
	Venous approaches
		Axillary (extrathoracic subclavian) approach
		Subclavian approach
		Cephalic approach
		Jugular approach
		Iliac vein approach
	Ventricular lead placement
	Coronary sinus lead placement
		Coronary sinus cannulation
		Coronary sinus venography
	Securing permanent leads
	Dual-chamber pulse generator implantation
	Measurement of pacing and sensing thresholds
		Determination of pacing threshold
		Determination of sensing threshold
	Epicardial systems
	Hardware adaptations
	Special considerations in pediatric patients
	Device implantation after cardiac transplantation
		Leadless pacemaker implantation
		Selective conduction system pacing
		Delivery tools
		Subcutaneous implantable cardioverter-defibrillator implantation
		Interventional techniques for device implantation procedures
	Hospital stay after implantation
	Pulse generator replacement
	Postimplant order set
	Homegoing instructions
	Lead extraction
		Indications for lead extraction
		Facility requirements for lead extraction
		Outcomes of lead extraction
		Complications of lead extraction
		Extraction techniques
	References
Chapter 6 Implant-Related Complications: Relevant Anatomy and Approaches for Prevention
	Inadvertent left ventricular lead placement
	Lead dislodgment
	Loose connector block connection
		Pneumothorax
		Lead perforation
		Pericarditis
		Pulse generator pocket hematoma
		Pain
		Arrhythmias
		Extracardiac stimulation
		Infection
		Allergic reaction
		Twiddler’s syndrome
		Thrombosis
		Battery depletion
		Loss of circuit integrity from therapeutic radiation
		Patients with conventional cardiac implantable electronic device undergoing magnetic resonance imaging
		Abandoned and nonfunctioning, noninfected leads
		Subclavian crush, lead fracture, and insulation defect
		Pacemaker syndrome
		Tricuspid regurgitation
		Dyssynchrony and cardiomyopathy
	Complications in specific devices
		Magnetic resonance conditional devices
		Cardiac resynchronization therapy device
		Subcutaneous implantable cardioverter defibrillator
		Leadless pacemaker
	Acknowledgements
	References
Chapter 7 Timing Cycles
	Basic approach
		Pacing modes
		Atrial inhibited pacing
		Single-chamber triggered-mode pacing
		Rate-modulated pacing
		Atrioventricular sequential, ventricular inhibited pacing (DVI)
		Atrioventricular sequential, non-P-synchronous pacing with dual-chamber sensing (DDI)
		Atrioventricular sequential, non-P-synchronous, rate-modulated pacing with dual-chamber sensing (DDIR)
		Atrial synchronous (P-tracking/P-synchronous) pacing (VDD)
		Dual-chamber pacing and sensing with inhibition and tracking (DDD)
	Portions of pacemaker timing cycles
		Atrioventricular interval
		Comparison of atrial with ventricular-based timing
		Dual-chamber rate-modulated pacemakers: effect on timing cycles
		Mode switching
		Avoiding atrial pace/sense competition
		Timing components of ventricular avoidance pacing algorithms
		Endless-loop tachycardia
		Timing cycles with algorithms responding to sudden bradycardia
		Timing cycles unique to biventricular pacing
		Timing cycles in implantable cardioverter-defibrillators
	Initial electrocardiographic interpretation
		Response to magnet application
		Single-chamber pacemakers
		Dual-chamber pacemakers
		Biventricular paced electrocardiogram: position, adequacy, and timing
		Characteristic electrocardiographic patterns with specific lead locations
		Timing intervals and the electrocardiogram
		Atrioventricular interval programming
		Electrocardiographic considerations in the patient not responding to cardiac resynchronization therapy
	Conclusions
	References
Chapter 8 Programming: Maximizing Benefit and Minimizing Morbidity Programming
	Defibrillator programming
		Implantable cardioverter-defibrillator sensing
		Implantable cardioverter-defibrillator detection
		Supraventricular tachycardia–ventricular tachycardia discriminators
		Dual-chamber supraventricular tachycardia–ventricular tachycardia discriminators
		Ventricular therapies
		Atrial defibrillators: detection and therapies
		Optimizing programming: general consideration
		Optimizing programming: manufacturer-specific recommendations
	Subcutaneous implantable defibrillator
	Cardiac resynchronization programming
		Algorithms to promote continuous tracking
		Algorithms to manage premature ventricular complexes
		Algorithms to manage atrial fibrillation
		Device-based optimization for cardiac resynchronization
	Conclusions
	References
Chapter 9 Sensor Technology for Rate-Adaptive Pacing and Hemodynamic Optimization
	Indications for rate-adaptive pacing
	Sensors available for rate-adaptive pacing
		Activity sensors
		Minute ventilation sensors
		SonR sensor (previously called peak endocardial acceleration sensor)
		Right ventricular impedance-based sensor
		Stimulus-T or QT, sensing pacemaker
		Temperature-sensing rate-adaptive pacemakers
		Other sensors
	Dual-sensor rate-adaptive pacing
	Sensor applications for hemodynamic management
	Programming
		Programmable parameters
	Rate-adaptive pacing with cardiac resynchronization devices
		Programming atrioventricular and interventricular optimization
	Future of rate-adaptive sensors
	References
Chapter 10 Troubleshooting
	Fundamentals
		Issues common to all cardiovascular implantable electronic devices
		History specific to troubleshooting implantable cardioverter-defibrillator shocks
	Basics of troubleshooting sensing
		Electrogram sources
		Event markers, undersensing, and oversensing
		Stored versus real-time electrograms
		Near-field versus far-field electrograms
	Pacemaker troubleshooting
		Absence of expected pacing
		Pacing with an altered rate or escape interval
		Failure to capture
		Other pacemaker issues
	Implantable cardioverter-defibrillator troubleshooting
		Troubleshooting antitachycardia therapy
		Ventricular oversensing: diagnosis and management
		Diagnosis of implantable cardioverter-defibrillator lead failure
		Approach to the patient with frequent shocks
		Unsuccessful shocks
		Failure to deliver or delayed therapy
		Troubleshooting the subcutaneous implantable cardioverter-defibrillator
		Troubleshooting subcutaneous implantable cardioverter-defibrillator oversensing
	Troubleshooting cardiac resynchronization devices
		Resynchronization of <90–95% of R-R intervals
		Troubleshooting other problems in cardiac resynchronization therapy systems
	References
Chapter 11 Radiography of Implantable Devices
	Introduction
	Pulse generators
	Leads
		Pacemaker leads
		Transvenous atrial leads
		Transvenous ventricular leads
		Epicardial leads
	Implantable cardioverter-defibrillator leads
		Epicardial implantable cardioverter-defibrillator leads
		Transvenous implantable cardioverter-defibrillator leads
		Coronary venous leads
	Miscellaneous considerations
	Conclusions
	References
Chapter 12 Electromagnetic Interference: Sources, Recognition, and Management
	Pacemaker responses to noise
		Asynchronous pacing
		Mode resetting (power-on reset, or electrical reset)
		Environmental electromagnetic interference
		Clinical advice
		Hacking
	References
Chapter 13 Follow-up
	Requirements for a device follow-up clinic
		Space
		Personnel
		Equipment
	Pacemaker follow-up
		Trans-telephonic monitoring
		Equipment
		Trans-telephonic monitoring sequence
		Remote monitoring and integration
		Pacemaker clinic follow-up visit
		Leadless intracardiac pacing system
	Implantable cardioverter-defibrillator follow-up
		Assessment of the patient’s clinical status
		Pulse generator assessment
		Capacitor status
		Assessing lead function
		Defibrillation efficacy assessment
		Medications
		Strategies to minimize shocks
		Subcutaneous implantable cardioverter-defibrillators
	Cardiac resynchronization therapy follow-up specifics
		Patients’ concerns during follow-up
		Medical advisories and recalls
		Lifestyle and personal concerns
		Psychologic issues encountered following device implantation
		Withdrawal of device support
	Conclusions
	References
Index
EULA