BOOK
Clinical Cardiac Pacing, Defibrillation and Resynchronization Therapy E-Book
Kenneth A. Ellenbogen | Bruce L. Wilkoff | G. Neal Kay | Chu Pak Lau | Angelo Auricchio
(2016)
Additional Information
Book Details
Abstract
Your must-have bench reference for cardiac electrophysiology is now better than ever! This globally recognized gold standard text provides a complete overview of clinical EP, with in-depth, expert information that helps you deliver superior clinical outcomes. In this updated 5th Edition, you’ll find all-new material on devices, techniques, trials, and much more – all designed to help you strengthen your skills in this fast-changing area and stay on the cutting edge of today’s most successful cardiac EP techniques.
- Expert guidance from world authorities who contribute fresh perspectives on the challenging clinical area of cardiac electrophysiology.
- New focus on clinical relevance throughout , with reorganized content and 15 new chapters.
- New coverage of balloons, snares, venoplasty, spinal and neural stimulation, subcutaneous ICDs and leadless pacing, non-CS lead implantation, His bundle pacing, and much more.
- New sections on cardiac anatomy and physiology and imaging of the heart, a new chapter covering radiography of devices, and thought-provoking new information on the basic science of device implantation.
- State-of-the-art guidance on pacing for spinal and neural stimulation, computer simulation and modeling, biological pacemakers, perioperative and pre-procedural management of device patients, and much more.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| Inside Front Cover | ifc1 | ||
| Clinical Cardiac Pacing, Defibrillation and Resynchronization Therapy | i | ||
| Copyright Page | ii | ||
| Dedication | iii | ||
| Contributors | iv | ||
| Preface | ix | ||
| Table Of Contents | xi | ||
| Video Contents | xiii | ||
| 1 Basic Principles | 1 | ||
| 1 Cardiac Anatomy and Pathology | 3 | ||
| The Heart in the Chest | 3 | ||
| Relationships of Cardiac Chambers | 3 | ||
| The Right Atrium | 4 | ||
| Right Atrial Appendage, Terminal Crest, and Sinus Node | 4 | ||
| Eustachian Valve, Vestibule, Triangle of Koch, and Atrioventricular Node | 5 | ||
| The Venous Component, Orifices of Caval Veins, and Coronary Sinus | 7 | ||
| The Anterior Wall and the Atrial Septum | 7 | ||
| The Right Ventricle | 8 | ||
| The Left Atrium | 9 | ||
| The Left Ventricle | 10 | ||
| The Cardiac Veins | 11 | ||
| References | 13 | ||
| 2 Imaging of Cardiac Anatomy | 15 | ||
| Imaging Techniques in Cardiology | 15 | ||
| Fluoroscopic Anatomy | 15 | ||
| The Position of the Heart | 15 | ||
| Anatomy | 15 | ||
| Imaging Technique | 16 | ||
| The Esophagus | 16 | ||
| Anatomy | 16 | ||
| Imaging Techniques | 16 | ||
| The Right Atrium | 17 | ||
| Anatomy | 17 | ||
| Imaging Techniques | 17 | ||
| General Concepts | 17 | ||
| Terminal Crest | 19 | ||
| 2 Engineering and Construction of Devices and Leads | 249 | ||
| 8 Power Sources and Capacitors for Pacemakers and Implantable Cardioverter-Defibrillators | 251 | ||
| Introduction | 251 | ||
| Batteries | 251 | ||
| Basic Function and Electrochemistry of Batteries | 251 | ||
| Energy Storage in Batteries | 251 | ||
| Chemical Reactions | 251 | ||
| Major Components of Batteries | 251 | ||
| Anode and Cathode | 251 | ||
| Electrolyte | 252 | ||
| Separator | 252 | ||
| Current Collector | 252 | ||
| Sealing of Batteries | 252 | ||
| Classification of Batteries | 252 | ||
| Primary Batteries | 252 | ||
| Secondary Batteries | 252 | ||
| Functional Characteristics of Batteries | 252 | ||
| Capacity | 252 | ||
| Energy and Energy Density | 253 | ||
| Stoichiometry and Cell Balance | 253 | ||
| Cell Voltage and Current | 253 | ||
| Internal Resistance and Impedance | 253 | ||
| Nonideal Battery Behavior | 253 | ||
| Polarization | 253 | ||
| Self-Discharge and Other Parasitic Reactions | 253 | ||
| Use of Batteries in Implantable Cardiac Rhythm Management Devices | 254 | ||
| Implantable Battery Design Requirements | 254 | ||
| Power Requirements | 254 | ||
| Average Versus Instantaneous Current Drain | 254 | ||
| Shape, Size, and Mass Constraints | 254 | ||
| Relationship Between Size, Energy Density, and Current Drain | 255 | ||
| The Battery and Longevity of the Pulse Generator | 255 | ||
| Effect of Pulse Width on Pacing Current | 255 | ||
| Effect of Pulse Amplitude on Pacing Current | 255 | ||
| Effect of Lead Impedance on Pacing Current | 256 | ||
| Summary of Programming Effects on Longevity of Bradycardia Pulse Generators | 256 | ||
| Considerations for Longevity of ICDs | 256 | ||
| Battery End-of-Service Indication | 256 | ||
| Elective Replacement Indicator | 256 | ||
| Methods for Monitoring State of Battery Discharge | 256 | ||
| Battery Voltage | 256 | ||
| Battery Impedance | 257 | ||
| Consumed Charge | 257 | ||
| Blended Methods | 257 | ||
| False RRT Triggering | 257 | ||
| Clinical Indicators of the Battery Replacement Time | 257 | ||
| Battery Chemistries Used in Pacemakers | 258 | ||
| The Lithium/Iodine Battery | 258 | ||
| Lithium/Iodine Cell Structure | 258 | ||
| Discharge Curve for the Lithium/Iodine Battery | 258 | ||
| Effects of Current Drain on Deliverable Capacity of Lithium/Iodine Cells | 258 | ||
| The Lithium/Carbon Monofluoride Battery | 258 | ||
| The Lithium/Hybrid Cathode Battery | 258 | ||
| The Lithium/Manganese Dioxide Battery | 259 | ||
| Battery Chemistries Used in Defibrillators | 259 | ||
| Comparison of Pacemaker and Defibrillator Batteries | 259 | ||
| Types of Batteries Used in ICDs | 260 | ||
| Li/SVO Batteries | 260 | ||
| Charge Time-Optimized Li/SVO ICD Batteries | 261 | ||
| Lithium/Manganese Dioxide Batteries | 261 | ||
| Silver-Vanadium Oxide-Carbon Monofluoride (Layered Dual Cathode and Hybrid Cathode) | 262 | ||
| Safety | 262 | ||
| Emerging Power Sources | 262 | ||
| Rechargeable Lithium-Ion Batteries | 262 | ||
| Principles of Operation | 263 | ||
| Method of Recharge | 263 | ||
| End-of-Service Life Indication | 263 | ||
| Miniature Batteries for Leadless Devices | 263 | ||
| Energy Harvesting | 264 | ||
| Predictive Models and Accelerated Test Methods | 264 | ||
| Capacitors | 264 | ||
| Basic Function of Capacitors | 264 | ||
| ICD Device Requirements Important for Capacitors | 265 | ||
| ICD Capacitor Types | 265 | ||
| Anode Materials in Current ICD Capacitors | 265 | ||
| Cathode Materials in Current ICD Capacitors | 266 | ||
| Parasitic Reactions in Current ICD Capacitors | 266 | ||
| Energy Delivery | 266 | ||
| Energy Density | 266 | ||
| ICD Capacitor Construction | 267 | ||
| Stacked-Plate Aluminum Electrolytic Construction | 267 | ||
| Tantalum Electrolytic Capacitor Construction | 267 | ||
| Long-Term Degradation of Uncharged Capacitors: Deformation | 267 | ||
| Future Developments | 268 | ||
| Effects of Batteries and Capacitors on Defibrillation Performance | 268 | ||
| Energy Losses in Defibrillators | 268 | ||
| Clinical Implications of Battery and Capacitor Design on Defibrillation Therapy | 268 | ||
| References | 269 | ||
| 9 Lead Connection Systems and Standards for Cardiac Implantable Electronic Devices | 270 | ||
| Early Years: Clinical Confusion and Need for Standardized Connection Systems | 270 | ||
| Unipolar Pacemaker Connection Systems | 270 | ||
| Bipolar Pacemaker Connection Systems | 270 | ||
| Advent of Adaptors: A Necessary Evil | 271 | ||
| Initial Voluntary Connector Standards | 272 | ||
| Voluntary Standard 1 | 272 | ||
| IS-1 Pacing Lead Connector Standard | 273 | ||
| Early ICD Lead Connectors | 274 | ||
| DF-1 Standard | 274 | ||
| DF4/IS4 Standard | 275 | ||
| DF4 and IS4 Connector Labeling and Use | 275 | ||
| DF4 and IS4 Device Connector Cavity Design | 277 | ||
| DF4 and IS4 Clinical Advantages and Disadvantages | 278 | ||
| DF4 and IS4 Preclinical Testing and Subsequent Regulatory and Clinical Approach | 279 | ||
| DF4/IS4 Connector System Patient Testing at Implant | 279 | ||
| Conclusions | 279 | ||
| References | 280 | ||
| 10 Sensors for Implantable Cardiac Pacing Devices | 281 | ||
| Basis of Rate-Adaptive Pacing | 281 | ||
| Exercise Response in Heart Failure | 281 | ||
| Heart Rate Response for Nonexercise Needs | 281 | ||
| Ideal Sensor Characteristics | 281 | ||
| Classification of Sensors and Algorithms | 281 | ||
| Technical Classification | 282 | ||
| Activity Sensing | 284 | ||
| Principle of Activity Sensing | 284 | ||
| Technical Aspects of Activity Sensors | 285 | ||
| Algorithms | 287 | ||
| Current Activity-Sensing Devices | 287 | ||
| Medtronic Activity-Sensing Devices | 287 | ||
| St. Jude Medical Activity-Sensing Devices | 289 | ||
| Boston Scientific Activity-Sensing Devices | 289 | ||
| Biotronik Activity-Sensing Devices | 289 | ||
| Sorin Activity Sensors | 290 | ||
| Clinical Experience with Activity Sensors | 290 | ||
| Limitations of Activity-Sensing Devices | 291 | ||
| Minute Ventilation Sensing | 291 | ||
| Physiologic Principle | 291 | ||
| Relationship Between Heart Rate and Respiratory Parameters During Exercise | 291 | ||
| Anaerobic Threshold | 292 | ||
| Effect of Pulmonary Disease and Congestive Heart Failure on Minute Ventilation Sensing | 292 | ||
| The Minute Volume Sensor | 292 | ||
| Algorithm | 293 | ||
| Current Minute Ventilation-Sensing Devices | 293 | ||
| Boston Scientific Minute Ventilation-Sensing Devices | 293 | ||
| Sorin Minute Ventilation-Sensing Devices | 294 | ||
| Sleep Apnea Monitoring | 294 | ||
| Clinical Experience of Minute Ventilation-Sensing Pacemakers | 294 | ||
| Limitations of Minute Ventilation Sensing | 294 | ||
| Unipolar Ventricular Impedance: Closed-Loop Stimulation Sensor | 295 | ||
| Sensor and Algorithm | 295 | ||
| Clinical Experience of Closed-Loop Stimulation Pacemakers | 296 | ||
| Advantages and Limitations | 298 | ||
| Special Lead Sensors | 298 | ||
| Peak Endocardial Acceleration | 298 | ||
| Sensor and Algorithm | 298 | ||
| Clinical Use of Peak Endocardial Acceleration Sensor | 298 | ||
| Central Venous Temperature | 299 | ||
| Variations of Central Venous Temperature Changes on Exercise and Other Physiologic Conditions | 299 | ||
| Sensor and Algorithm | 300 | ||
| Clinical Performance | 300 | ||
| Advantages and Limitations | 300 | ||
| 3 Established and Emerging Clinical Concepts | 373 | ||
| 13 Pacing for Sinus Node Disease | 375 | ||
| Pathophysiology of Sinus Node Disease | 375 | ||
| Cellular Electrophysiology of Sinus Node Disease | 375 | ||
| Clinical Electrophysiology of Sinus Node Disease | 375 | ||
| Clinical Presentation | 378 | ||
| Diagnosis of Sinus Node Disease | 378 | ||
| Natural History | 378 | ||
| Clinical Outcomes in Sinus Node Disease | 378 | ||
| Pacing and Survival in Sinus Node Disease | 378 | ||
| Pacing and Atrial Fibrillation in Sinus Node Disease | 379 | ||
| Atrial Fibrillation Detection in Pacemakers | 380 | ||
| Atrial Based Versus Ventricular Pacing for Prevention of Atrial Fibrillation | 382 | ||
| Atrial Pacing Versus Dual-Chamber Pacing for Prevention of Atrial Fibrillation | 383 | ||
| Pacing Algorithms for Prevention of Atrial Fibrillation | 383 | ||
| Are There Subgroups Who Benefit From Atrial Fibrillation Prevention Pacing Therapies? | 384 | ||
| Pacing Algorithms for Termination of Atrial Fibrillation | 384 | ||
| Site-Specific Atrial Pacing for Prevention of Atrial Fibrillation | 386 | ||
| Pacing and Stroke in Sinus Node Disease | 386 | ||
| Relationship Between Stroke Risk and Atrial Fibrillation Burden/Atrial Fibrillation Duration | 388 | ||
| Pacing and Pacemaker Syndrome in Sinus Node Disease | 388 | ||
| Pacing and Heart Failure in Sinus Node Disease | 389 | ||
| Pacing and Quality of Life in Sinus Node Disease | 390 | ||
| Chronotropic Incompetence | 390 | ||
| Potential Detrimental Effects of Ventricular Pacing in Sinus Node Disease | 390 | ||
| Ventricular Pacing and Risk of Atrial Fibrillation | 390 | ||
| Right Ventricular Pacing and Heart Failure Risk | 390 | ||
| Algorithms to Minimize Right Ventricular Pacing | 391 | ||
| Dynamic/Adaptive Atrioventricular Intervals | 391 | ||
| Mode Switching From AAI to DDD | 391 | ||
| Clinical Outcomes With Algorithms to Minimize Right Ventricular Pacing | 392 | ||
| Is One Mode for Minimizing Ventricular Pacing Superior? | 394 | ||
| Complications/Clinical Nuances of Algorithms to Minimize Ventricular Pacing | 394 | ||
| Treatment of Sinus Node Disease | 394 | ||
| Pacing Modalities in Sinus Node Disease | 394 | ||
| Chronotropic Incompetence and Rate-Adaptive Pacing | 395 | ||
| Alternative Ventricular Pacing Sites | 396 | ||
| Biologic Pacemakers | 396 | ||
| References | 396 | ||
| 14 Atrioventricular Conduction System Disease | 399 | ||
| Anatomy | 399 | ||
| Anatomy of the His Bundle | 399 | ||
| Diagnosis of Atrioventricular Conduction Disturbances | 399 | ||
| Electrocardiography | 399 | ||
| Electrophysiologic Study | 405 | ||
| Identifying Patients at Risk for Atrioventricular Block | 406 | ||
| Classification, Epidemiology, and Natural History of Atrioventricular Conduction Disturbances | 407 | ||
| First-Degree Atrioventricular Block | 408 | ||
| Second-Degree Atrioventricular Block | 408 | ||
| Complete Heart Block | 409 | ||
| Paroxysmal Atrioventricular Block | 409 | ||
| Idiopathic Paroxysmal Atrioventricular Block | 409 | ||
| Bundle Branch Block | 409 | ||
| Congenital Atrioventricular Block | 410 | ||
| Inherited Conduction System Diseases | 410 | ||
| Cardiac Sodium Channel and Conduction Disorders | 411 | ||
| Acquired Causes of Atrioventricular Block | 413 | ||
| Indications for Permanent Pacing in Chronic Atrioventricular Block | 418 | ||
| Acute Myocardial Infarction | 419 | ||
| Atrioventricular Block Without Bundle Branch Block | 420 | ||
| Atrioventricular Block with Bundle Branch Block | 420 | ||
| Impact of Reperfusion | 421 | ||
| Bundle Branch Block after Recovery | 423 | ||
| Electrophysiologic Studies in Atrioventricular Block and Bundle Branch Block | 423 | ||
| Indications for Pacing | 423 | ||
| Temporary Pacing | 423 | ||
| Permanent Pacing | 424 | ||
| Selection of Pacing Mode in Atrioventricular Block | 425 | ||
| VDD(R) Pacing | 427 | ||
| Optimal Atrioventricular Interval Programming | 428 | ||
| Site-Specific Ventricular Pacing in Atrioventricular Block | 430 | ||
| Biventricular Pacing | 434 | ||
| Permanent His Bundle Pacing | 434 | ||
| Criteria for His Bundle Pacing | 436 | ||
| Pacing Outcomes | 437 | ||
| His Bundle Pacing in Atrioventricular Block | 439 | ||
| His Bundle Pacing in Bundle Branch Block | 441 | ||
| Implantation Site of Permanent His Bundle Pacing Lead | 441 | ||
| Effect of His Bundle Pacing on Cardiac Function | 441 | ||
| Special Considerations with His Bundle Pacing | 442 | ||
| Future Directions in His Bundle Pacing | 444 | ||
| Automatic Capture Verification and Pacing Output Management | 446 | ||
| Summary | 449 | ||
| Conclusion | 450 | ||
| References | 450 | ||
| 15 Pacing in Reflex (Neurally-Mediated) Syncopes | 454 | ||
| The Clinical Spectrum of Reflex Syncopes | 454 | ||
| Vasovagal Syncope (Typical and Atypical Forms) | 454 | ||
| Clinical Perspective | 454 | ||
| Epidemiology | 454 | ||
| Conservative Therapy | 455 | ||
| Lifestyle Measures | 455 | ||
| Physical Counterpressure Maneuvers | 455 | ||
| Tilt Training (Standing Training) | 455 | ||
| Additional Treatments | 456 | ||
| Pharmacologic Therapy | 456 | ||
| Rationale and Evidence for Cardiac Pacing Therapy | 456 | ||
| Evidence From the Trials on Patients With Tilt-Induced Vasovagal Syncope | 456 | ||
| Evidence From the Trials in Patients With Suspected or Certain Vasovagal (Reflex) Syncope and Electrocardiogram-Documented Asystole | 456 | ||
| Carotid Sinus Syndrome | 458 | ||
| Clinical Perspective | 458 | ||
| Diagnosis With Carotid Sinus Massage | 458 | ||
| Rationale and Evidences for Cardiac Pacing Therapy | 458 | ||
| Evidence From the Trials in Patients With Carotid Sinus Syndrome | 458 | ||
| Adenosine-Sensitive Syncope | 459 | ||
| Reflex Syncopes: Indications for Pacing | 461 | ||
| Reflex Syncopes: Choice of Pacing Mode | 462 | ||
| References | 462 | ||
| 16 Defibrillation Therapy | 464 | ||
| Implantable Cardioverter-Defibrillators | 464 | ||
| Early Clinical Trials with Implantable Cardioverter-Defibrillators in Cardiac Arrest Survivors | 464 | ||
| Clinical Trials in Primary Prevention of Sudden Cardiac Death | 464 | ||
| Current Implantable Cardioverter-Defibrillator Indication Guidelines | 467 | ||
| Remote Monitoring of Devices | 469 | ||
| Implantable Cardioverter-Defibrillator Programming | 470 | ||
| Cardiac Resynchronization Therapy | 472 | ||
| Wearable Cardioverter Defibrillators | 475 | ||
| Subcutaneous Implantable Cardioverter-Defibrillators | 477 | ||
| Real World Effectiveness | 478 | ||
| Conclusion | 479 | ||
| References | 479 | ||
| 17 Subcutaneous and Epicardial Defibrillators | 482 | ||
| Subcutaneous Implantable Cardioverter-Defibrillator System: Technology and Development | 482 | ||
| Implantation | 482 | ||
| Effectiveness and Safety | 482 | ||
| Arrhythmia Detection, Sensitivity, and Discrimination | 484 | ||
| Indications | 486 | ||
| Limitations | 486 | ||
| 4 Implantation Techniques | 629 | ||
| 26 Permanent Pacemaker and Implantable Cardioverter-Defibrillator Implantation in Adults | 631 | ||
| Personnel | 631 | ||
| Physician/Surgeon | 631 | ||
| Support Personnel | 631 | ||
| Implantation Facility and Equipment | 632 | ||
| Preoperative Planning and Assessment | 634 | ||
| Inpatient Versus Outpatient Procedure | 634 | ||
| Additional Preoperative Patient Assessment | 634 | ||
| Preoperative Orders | 635 | ||
| General Information | 636 | ||
| Site Preparation and Draping | 636 | ||
| Anesthesia, Sedation, and Pain Relief | 636 | ||
| Antibiotic Prophylaxis and Wound Irrigation | 637 | ||
| Anatomic Approaches for Implantation | 638 | ||
| Transvenous Pacemaker Placement | 641 | ||
| Cephalic Venous Access | 641 | ||
| Subclavian Venous Access | 642 | ||
| Axillary Venous Access | 643 | ||
| Methods of Multilead Introduction | 652 | ||
| Multiple Separate Venipunctures and Use of Multiple Sheath Sets | 652 | ||
| One Percutaneous Puncture and Use of Large Sheath With Passage of Multiple Electrodes | 652 | ||
| Retained-Guidewire Technique | 652 | ||
| Sheath Set Technique With Cutdown Approach | 652 | ||
| Placement of the Right Ventricular Lead | 653 | ||
| Placement of Atrial Leads | 658 | ||
| Implantable Cartioverter-Defibrillator-Specific Lead Issues | 660 | ||
| Subcutaneous Defibrillation Electrodes | 660 | ||
| Azygos Vein Defibrillation Coil | 660 | ||
| Coronary Sinus Coil | 660 | ||
| Upgrading Techniques | 660 | ||
| Cardiac Implantable Electronic Devices Connectivity | 661 | ||
| Securing Leads, Creating Pockets, and Closure | 662 | ||
| Epicardial Lead Placemanent Placement of Epicardial Electrodes | 665 | ||
| Epicardial Approach | 665 | ||
| Median Sternotomy Approach | 665 | ||
| Left Anterolateral Thoracotomy Approach | 665 | ||
| Subxiphoid Approach | 666 | ||
| Left Subcostal Approach | 666 | ||
| Thoracoscopic Approach | 667 | ||
| Cosmetic Approach to Device Implantation | 667 | ||
| Submuscular Pectoral Pocket | 668 | ||
| Special Considerations and Situations | 672 | ||
| Use of the Iliac Vein | 672 | ||
| Transiliac Implantable Cardioverter-Defibrillator Implantation | 673 | ||
| Use of the Jugular Vein | 673 | ||
| Alternatives to Radiography during Implantation | 674 | ||
| Repositioning of Electrodes | 675 | ||
| Alternatives to Transvenous Lead Placement | 675 | ||
| Misplacement of Lead in Left Ventricle | 679 | ||
| Selective Site Pacing | 680 | ||
| General Considerations | 680 | ||
| Anatomic Considerations | 681 | ||
| Right Atrium | 681 | ||
| Right Ventricle | 682 | ||
| Radiographic Anatomy | 683 | ||
| Atrial Septal Pacing | 684 | ||
| Right Ventricular Selective Site Pacing | 686 | ||
| Direct His Bundle Pacing | 687 | ||
| The Future of Selective Site Pacing | 688 | ||
| Immediate Postoperative Care | 688 | ||
| References | 689 | ||
| 27 Pacemaker and Implantable Cardioverter-Defibrillator Management in Children and Congenital Heart Disease | 692 | ||
| Pediatric Indications for Pacing | 692 | ||
| Sinus Node Dysfunction | 692 | ||
| Atrioventricular Node Dysfunction | 693 | ||
| Other Pacing Indications | 694 | ||
| Cardiac Resynchronization | 695 | ||
| Lead Implantation Technique | 695 | ||
| Epicardial Pacing | 697 | ||
| Other Considerations | 697 | ||
| Indications for Implantable Cardioverter-Defibrillator Implantation in Children and Adults with Congenital Heart Disease | 698 | ||
| Congenital Heart Disease | 699 | ||
| Patients with Inherited Arrhythmia Syndromes | 700 | ||
| Technical Considerations in Implantable Cardioverter-Defibrillator Implantation for Pediatric Patients and Patients with Congenital Heart Disease | 700 | ||
| Ventricular Fibrillation and “Defibrillation Testing” in Pediatrics | 701 | ||
| Approach to the Pediatric Patient with High Defibrillation Thresholds | 701 | ||
| Programming | 702 | ||
| Implantable Cardioverter-Defibrillator Programming Suggestions | 703 | ||
| Lead Complications | 704 | ||
| Psychosocial Aspects | 706 | ||
| Summary | 706 | ||
| References | 707 | ||
| 28 Implantation of the Subcutaneous Implantable Cardioverter-Defibrillator | 709 | ||
| Identifying Candidates for Subcutaneous Implantable Cardioverter-Defibrillator Therapy | 709 | ||
| Patient Selection | 709 | ||
| Patient Assessment | 709 | ||
| General Considerations for Subcutaneous Implantable Cardioverter-Defibrillator Implantation | 709 | ||
| Personnel and Equipment | 709 | ||
| Planning of the Procedure | 710 | ||
| Preparation | 711 | ||
| Anesthesia | 711 | ||
| Patient Positioning | 711 | ||
| Incision Marking | 711 | ||
| Surgical Site Preparation | 712 | ||
| Implantation of the Subcutaneous Implantable Cardioverter-Defibrillator | 712 | ||
| Creating the Pocket | 712 | ||
| Lead Tunneling | 712 | ||
| Three-Incision Implantation Technique | 713 | ||
| Xiphoid-to-Superior Parasternal Tunneling | 713 | ||
| Two-Incision Implantation Technique | 714 | ||
| Placing the Device in the Pocket | 714 | ||
| Postoperative Care | 715 | ||
| Alternative Implant Positions | 715 | ||
| Submuscular Implantation | 715 | ||
| Sub-Serratus Anterior Position of the Can | 715 | ||
| Lead and Can Positions in Patients with Anatomic Variations | 715 | ||
| Troubleshooting | 715 | ||
| Device Extraction | 715 | ||
| Infection | 715 | ||
| Pocket Erosion | 716 | ||
| Defibrillation Threshold Testing Failure | 716 | ||
| Considerations for the Future | 717 | ||
| Conclusions | 717 | ||
| References | 717 | ||
| 29 Intraprocedural Assessment of Stimulation, Sensing, Detection, and Defibrillation | 718 | ||
| Principles Related to Stimulation | 718 | ||
| Physiology of Cardiac Pacing | 718 | ||
| Determining Optimal Lead Position | 718 | ||
| Imaging for Lead Placement | 718 | ||
| Lead Placement | 720 | ||
| Right Atrial Leads | 720 | ||
| Right Ventricular Leads | 720 | ||
| Left Ventricular Leads | 720 | ||
| Evaluation for Extracardiac Stimulation | 722 | ||
| Assessing for Current of Injury | 722 | ||
| Wavelet Size, Slew Rate, and Lead Impedance | 722 | ||
| Sensed Signals | 722 | ||
| Pacing Capture Thresholds | 722 | ||
| Lead Impedance | 722 | ||
| Slew Rates | 723 | ||
| Stimulation Threshold Testing and the Strength-Duration Curve | 723 | ||
| Wedensky Effect and Wedensky Facilitation | 724 | ||
| Bipolar and Unipolar Stimulation | 725 | ||
| Cathodal and Anodal Stimulation | 725 | ||
| Capture Latency and Exit Block | 726 | ||
| Principles Related to Sensing | 727 | ||
| Physiology of Intracardiac Sensing | 727 | ||
| Near-Field and Far-Field Signals | 728 | ||
| Unipolar, Integrated Bipolar, and True Bipolar Sensing | 728 | ||
| Approach to Undersensing | 728 | ||
| Approach to Oversensing | 729 | ||
| Lead Issues | 729 | ||
| Metabolic and Structural Factors | 730 | ||
| Electromagnetic Interference | 730 | ||
| Sensing in Cardiac Resynchronization Devices | 730 | ||
| Principles Related to Arrhythmia Detection and Defibrillation Threshold Testing | 730 | ||
| Overview of Detection and Arrhythmia Discriminators | 730 | ||
| Intraprocedural Defibrillation Testing | 734 | ||
| Assessment of Sensing | 734 | ||
| Assessment of Defibrillation Margin | 734 | ||
| Evolution of Implantable Cardioverter-Defibrillator Testing | 735 | ||
| When Defibrillation Testing Should Be Considered | 735 | ||
| Contraindications to Defibrillation Testing | 735 | ||
| To Test or Not to Test? | 735 | ||
| Performance of Defibrillation Testing | 736 | ||
| References | 736 | ||
| 30 Coronary Sinus Lead Implantation | 739 | ||
| Introduction | 739 | ||
| Left Ventricular Lead Position and Response | 739 | ||
| Newer Tools for Delivery of Coronary Venous Leads | 743 | ||
| Coronary Sinus Access Catheter | 745 | ||
| Telescoping Assist Catheter | 745 | ||
| Vein Selector | 746 | ||
| Inner Guide | 746 | ||
| Previous Approach to the Shape and Use of Inner Guides | 746 | ||
| New Approach to the Shape and Use of Delivery Guides | 749 | ||
| Left Ventricular Lead Implantation Using the Author-Designed Delivery System | 749 | ||
| Step-by-Step Summary | 749 | ||
| Left Ventricular Lead Implantation with the Worley Delivery System and Interventional Techniques | 752 | ||
| Details and Rationale | 752 | ||
| Prepare the Patient for the Use of Iodinated Contrast Material | 752 | ||
| Equipping and Setting up the Room | 752 | ||
| Collect Available Left Ventricular Lead Implantation Equipment and Review Its Use | 752 | ||
| Organize the Equipment to Be Readily Available in the Room | 752 | ||
| Assemble the “Always Used” Equipment on the Table before Starting | 752 | ||
| Pay Careful Attention to the Orientation of the Instrument Table during Various Stages of the Procedure | 752 | ||
| Approach to Contrast | 753 | ||
| Venous Access for Left Ventricular Lead Implantation | 753 | ||
| Preventing Restricted Catheter/Lead Movement | 755 | ||
| Separate Access for Each Lead | 755 | ||
| Axillary versus Subclavian Venous Access | 755 | ||
| Response to Subclavian Obstruction in Patient with Preexisting Leads | 755 | ||
| The Platform for Left Ventricular Lead Placement | 756 | ||
| Lumen Size | 756 | ||
| Catheter Shape | 757 | ||
| Cutting versus Peeling to Remove the Coronary Sinus Access Sheath | 758 | ||
| Coronary Sinus Access for Left Ventricular Lead Implantation | 759 | ||
| Contrast or Not for Coronary Sinus Cannulation? | 760 | ||
| Limitations of the Noncontrast Method | 760 | ||
| Limitation of the Contrast Method | 761 | ||
| Turning Failure Into Success With the Use of Contrast | 761 | ||
| Catheter Shape for Coronary Sinus Cannulation | 761 | ||
| Catheter Shape and the Anatomy Surrounding the Coronary Sinus Ostium (Case Study 30-1) | 761 | ||
| How to Locate the Ostium of the Coronary Sinus With Contrast Injection System | 763 | ||
| Coronary Sinus Cannulation: A Two-Step Process with Contrast Injection | 764 | ||
| Step 1: Locating the Ostium of the Coronary Sinus | 764 | ||
| Anatomy Surrounding the Coronary Sinus Ostium as Defined by Contrast Injection | 765 | ||
| Coronary Sinus Venous Anatomy | 767 | ||
| Half-Strength versus Full-Strength Contrast Agent | 768 | ||
| Occlusive Coronary Sinus Venography (CASE STUDY 30-2) | 770 | ||
| Measures to Overcome Failure to Visualize the Coronary Venous Anatomy | 772 | ||
| Selective Injection of the Coronary Veins | 772 | ||
| Blind Draw Back Technique | 772 | ||
| Focused Location and Injection of the Anterior or Middle Cardiac Veins | 772 | ||
| Selective Injection for the Persistent Left Superior Vena Cava | 777 | ||
| Coronary Artery Injection with Venous-Phase Images | 777 | ||
| Basic Patterns of the Coronary Venous Anatomy | 777 | ||
| Size Distribution | 777 | ||
| Cannulation of the Difficult Coronary Sinus | 777 | ||
| Finding the Difficult Coronary Sinus Ostium | 777 | ||
| Anatomic Variants That Make It Difficult to Locate | 778 | ||
| Step 2: Advancing a Sheath or Guide into the Coronary Sinus | 778 | ||
| If the Sheath/Guide Is Difficult to Advance | 778 | ||
| Anchor Balloon Technique | 780 | ||
| 5 Follow-Up and Programming | 959 | ||
| 36 Timing Cycles of Implantable Devices | 961 | ||
| Pacing System Code | 961 | ||
| Pacing Modes | 961 | ||
| Single-Chamber Pacing Modes | 961 | ||
| Single-Chamber Asynchronous Pacing (AOO, VOO) | 961 | ||
| Single-Chamber Inhibited Pacing (AAI, VVI) | 961 | ||
| Single-Chamber Triggered Pacing (AAT, VVT) | 961 | ||
| Dual-Chamber Pacing Modes | 962 | ||
| Dual-Chamber Asynchronous Pacing (DOO) | 962 | ||
| Dual-Chamber Tracking Modes (DDD, VDD) | 963 | ||
| Dual-Chamber Modes Without Tracking (DDI, VDI, DVI) | 963 | ||
| Dual-Chamber Triggered Modes | 963 | ||
| Timing Cycles of Single- and Dual-Chamber Pacing | 963 | ||
| Single-Chamber Pacing | 964 | ||
| Lower Rate Interval | 964 | ||
| Refractory Period | 964 | ||
| Timing Cycles in Different Single-Chamber Pacing Modes | 965 | ||
| Single-Chamber Asynchronous Pacing (AOO, VOO) | 965 | ||
| Single-Chamber Inhibited Pacing (AAI, VVI) | 965 | ||
| Single-Chamber Rate Hysteresis | 965 | ||
| Dual-Chamber Pacing | 965 | ||
| Overview of Dual-Chamber Timing Cycles | 965 | ||
| Lower Rate Interval | 965 | ||
| Atrioventricular Interval and Ventriculoatrial Interval | 967 | ||
| Refractory Periods | 967 | ||
| Upper Rate Interval | 967 | ||
| Blanking and Refractory Periods | 968 | ||
| Confusing Terminology Regarding Blanking and Refractory Periods | 969 | ||
| Atrioventricular Interval | 970 | ||
| Atrioventricular Crosstalk and Ventricular Safety Pacing | 970 | ||
| Differential Atrioventricular Interval | 971 | ||
| Dynamic or Rate-Adaptive Atrioventricular Interval | 972 | ||
| Atrioventricular Interval Hysteresis | 972 | ||
| Timing Cycles in Different Dual-Chamber Pacing Modes | 973 | ||
| Lower Rate (Base Rate) Timing | 973 | ||
| Ventricular-Based Timing | 973 | ||
| Atrial-Based Timing | 973 | ||
| Comparison of Atrial-Based and Ventricular-Based Timing | 973 | ||
| Hybrid Timing | 973 | ||
| Dual-Chamber Rate Hysteresis | 975 | ||
| Upper Rate Behavior | 975 | ||
| Sensor-Driven or Rate-Adaptive Pacing | 978 | ||
| Hemodynamics of Exercise and Basis for Rate-Adaptive Pacing | 978 | ||
| Timing Cycles of Sensor-Driven Pacing | 978 | ||
| Sensor Parameters | 978 | ||
| Rate-Adaptive Algorithms | 979 | ||
| Device Algorithms and Specific Features | 979 | ||
| Algorithms for Detection of, and Response to, Atrial Tachyarrhythmias (Mode Switching) | 979 | ||
| Timing Cycles for Mode Switching | 979 | ||
| Atrial Sensitivity | 979 | ||
| Comparison of Mode-Switching Algorithms | 980 | ||
| Ventricular Rate Control | 981 | ||
| Detection of Rapid Regular Atrial Tachyarrhythmias (Atrial Flutter) | 983 | ||
| Mode Switch Episodes Versus Atrial Tachycardia/Atrial Fibrillation Episodes | 983 | ||
| Algorithms for Prevention of Atrial Tachyarrhythmias | 985 | ||
| Algorithms for Prevention of Atrial Fibrillation by Pacing | 985 | ||
| Prevention of Pacing in the Atrial Vulnerable Period | 985 | ||
| Algorithms to Minimize Ventricular Pacing | 989 | ||
| Dynamic Atrioventricular Interval Prolongation (Atrioventricular Hysteresis) | 989 | ||
| Atrioventricular Mode Switch (Atrial Pacing to Dual-Chamber Pacing) | 989 | ||
| Algorithms for Rate Adjustment | 992 | ||
| Algorithms to Promote Transient Rapid Pacing (for Neurally-Mediated Syncope) | 992 | ||
| Algorithms to Promote Intrinsic Heart Rate | 992 | ||
| Noncircadian algorithms. | 992 | ||
| Circadian algorithms. | 997 | ||
| Algorithms to Prevent Sudden Variations in Rate | 999 | ||
| Prevention of Beat-Beat Variations in Rate | 999 | ||
| Tracking modes. | 999 | ||
| Nontracking modes (algorithms for regularization of ventricular rate in AF). | 999 | ||
| Rate Adjustment During Mode Switch | 1000 | ||
| Rate Regularization at the Upper Rate Limit | 1000 | ||
| Pacemaker-Mediated Atrioventricular Dyssynchronous Rhythms | 1000 | ||
| Classic Pacemaker-Mediated Tachycardia | 1000 | ||
| Algorithms for Prevention, Detection, and Termination of Pacemaker-Mediated Tachycardia | 1002 | ||
| Other Pacemaker Reentrant Tachycardias | 1002 | ||
| Repetitive Nonreentrant Ventriculoatrial Synchrony | 1002 | ||
| Response of Dual-Chamber Devices to Premature Ventricular Complexes | 1008 | ||
| Timing Cycles of Biventricular Pacing | 1008 | ||
| Goals of Biventricular Pacing | 1008 | ||
| Pacing, Sensing, and Timing | 1008 | ||
| Pacing | 1008 | ||
| Sensing | 1008 | ||
| Timing | 1010 | ||
| Timing Cycles | 1010 | ||
| Atrioventricular Interval and Interventricular (V-V) Interval | 1010 | ||
| Interventricular delay. | 1010 | ||
| Sensing within the AVI and the interventricular interval. | 1010 | ||
| Blanking and Refractory Periods | 1011 | ||
| Cross-chamber (atrial/ventricular). | 1011 | ||
| Same chamber. | 1011 | ||
| Interventricular refractory period. | 1011 | ||
| Double counting and triple counting in CRT devices. | 1012 | ||
| Lower Rate Interval and Lower Rate Timing | 1012 | ||
| Upper Rate Interval and Upper Rate Behavior | 1013 | ||
| TARP and iTARP | 1013 | ||
| Features to Promote Biventricular Pacing | 1014 | ||
| Suppression of Intrinsic Conduction/Response to Intrinsic Conduction | 1014 | ||
| Dynamic adaptation of A-V and V-V intervals. | 1014 | ||
| Triggered ventricular pacing. | 1014 | ||
| Biventricular pacing during atrial tachyarrhythmias. | 1017 | ||
| Prevention of Loss of Atrial Tracking (and Restoration of Tracking) | 1020 | ||
| Features to Prevent Pacing in the Ventricular Vulnerable Period | 1020 | ||
| Left Ventricular Protection Period | 1020 | ||
| Pacemaker-Mediated Atrioventricular Dyssynchronous Rhythms in Cardiac Resynchronization Therapy Devices | 1020 | ||
| Timing Cycles of Implantable Cardioverter-Defibrillators | 1020 | ||
| Blanking and Refractory Periods in Implantable Cardioverter-Defibrillators | 1021 | ||
| Ventricular Channel | 1021 | ||
| Atrial Channel | 1022 | ||
| Interaction between Pacing and Ventricular Tachyarrhythmia Detection | 1022 | ||
| Upper Limit of Pacing Versus Lower Limit of Ventricular Tachycardia Detection | 1022 | ||
| Conflict Between Pacing Parameters and Ventricular Tachyarrhythmia Detection | 1023 | ||
| Features to Promote Ventricular Tachyarrhythmia Detection | 1023 | ||
| Arrhythmia unhiding. | 1025 | ||
| Shortening of the atrioventricular delay. | 1025 | ||
| Bradycardia Functions Following Ventricular Tachycardia Detection and during/after Therapy for Ventricular Tachycardia/Ventricular Tachycardia Fibrillation | 1025 | ||
| Response to External Influences | 1025 | ||
| Noise Response | 1025 | ||
| Electrical Reset (Power-on Reset) | 1027 | ||
| Magnet Response | 1027 | ||
| References | 1030 | ||
| 37 Pacemaker Programming and Troubleshooting | 1031 | ||
| Pacemaker Programming | 1031 | ||
| Pacing Mode | 1031 | ||
| DDD(R) | 1031 | ||
| DDI(R) | 1031 | ||
| ADI(R) | 1031 | ||
| VDD | 1031 | ||
| VDI(R) | 1031 | ||
| AAI(R) | 1031 | ||
| VVI(R) | 1034 | ||
| VVT | 1034 | ||
| VOO or DOO | 1034 | ||
| ODO or OVO or OAO | 1034 | ||
| OOO | 1034 | ||
| Baseline and Upper Rates | 1034 | ||
| Rate Response | 1034 | ||
| Pacing Output | 1034 | ||
| Sensitivity | 1036 | ||
| Atrioventricular Delay | 1036 | ||
| Pacemaker Troubleshooting | 1037 | ||
| Electrocardiograms in Patients with Pacemakers | 1037 | ||
| Pacing Pulse Artifacts | 1037 | ||
| Paced P-Wave Morphology | 1038 | ||
| Paced QRS Morphology | 1038 | ||
| Event Markers and Intracardiac Electrograms | 1038 | ||
| Failure to Pace (Nonpacing) | 1040 | ||
| Failure to Capture (Noncapture) | 1042 | ||
| Oversensing | 1044 | ||
| Far-Field R-Wave Oversensing | 1044 | ||
| Far-Field P-Wave Oversensing | 1045 | ||
| Near-Field Oversensing | 1046 | ||
| T-Wave Oversensing | 1046 | ||
| Myopotential Oversensing | 1046 | ||
| Oversensing of Nonphysiologic Signals | 1046 | ||
| Consequences and Management of Oversensing | 1048 | ||
| Failure to Sense (Undersensing) | 1051 | ||
| Specific Pacemaker Issues | 1053 | ||
| Crosstalk | 1053 | ||
| Pacemaker-Mediated Tachycardia | 1054 | ||
| Endless-loop tachycardia. | 1055 | ||
| Prerequisites. | 1055 | ||
| Detection and termination. | 1055 | ||
| Prevention. | 1056 | ||
| Atrial arrhythmias. | 1057 | ||
| Myopotential tracking. | 1058 | ||
| Sensor-driven tachycardia. | 1059 | ||
| Runaway pacemaker. | 1059 | ||
| Cross-Stimulation | 1059 | ||
| Repetitive Nonreentrant Ventriculoatrial Synchronous Rhythm | 1059 | ||
| Systematic Pacemaker Electrocardiogram/Electrogram Interpretation | 1060 | ||
| Conclusion | 1062 | ||
| References | 1062 | ||
| 38 Implantable Cardioverter-Defibrillator Programming and Troubleshooting | 1064 | ||
| General Principles | 1064 | ||
| Initial Evaluation and Tools | 1064 | ||
| Clinical History | 1064 | ||
| Physical Examination | 1064 | ||
| Electrocardiographic Recordings | 1065 | ||
| Device Telemetry | 1065 | ||
| Radiographic Evidence | 1067 | ||
| Presentations | 1072 | ||
| Multiple Shocks | 1072 | ||
| Failure to Convert Ventricular Tachycardia or Ventricular Fibrillation | 1083 | ||
| Failure to Detect Ventricular Tachycardia or Ventricular Fibrillation | 1083 | ||
| Problems with Pacing | 1086 | ||
| Other Issues | 1086 | ||
| Summary | 1087 | ||
| References | 1087 | ||
| 39 Cardiac Resynchronization Therapy Programming and Troubleshooting | 1090 | ||
| Introduction | 1090 | ||
| Cardiac Resynchronization Therapy Programming | 1090 | ||
| General Principles on Cardiac Resynchronization Therapy Programming | 1090 | ||
| Minimize Right Atrial Pacing | 1090 | ||
| Program Appropriate AV and VV Delays | 1090 | ||
| Program Adequate Pacing Output | 1090 | ||
| Program Higher Tracking Rates | 1090 | ||
| Appropriate Programming of Postventricular Atrial Refractory Period and Associated Algorithms | 1090 | ||
| Avoid Interruption of Cardiac Resynchronization Therapy Due to Arrhythmias | 1090 | ||
| Consider Algorithms to Promote Cardiac Resynchronization Therapy | 1090 | ||
| Recognize Anodal Capture on Electrocardiogram as a Reason for Nonresponse | 1090 | ||
| Strategies to Deal With Phrenic Nerve Capture | 1091 | ||
| Understand Optimization Algorithms, Outcomes, and Applicability to Individual Patients | 1091 | ||
| Device Manufacturer–Specific Cardiac Resynchronization Therapy Features | 1091 | ||
| Medtronic-Specific Cardiac Resynchronization Therapy Features | 1091 | ||
| Adaptive CRT. | 1091 | ||
| Multipolar LV pacing leads with additional LV pacing vectors. | 1092 | ||
| Ventricular-sense response. | 1093 | ||
| Conducted AF response. | 1094 | ||
| Atrial tracking recovery. | 1094 | ||
| Ventricular sense episodes. | 1096 | ||
| St. Jude Medical–Specific Cardiac Resynchronization Therapy Features | 1096 | ||
| Quick opt. | 1096 | ||
| Multipolar LV pacing leads with additional LV pacing vectors. | 1096 | ||
| RV-LV conduction time measurement. | 1096 | ||
| Trigger pacing. | 1096 | ||
| Negative AV/PV hysteresis. | 1096 | ||
| Boston Scientific Cardiac Resynchronization Therapy–Related Specific Features | 1096 | ||
| Smart delay. | 1096 | ||
| RV-LV delay. | 1096 | ||
| Multipolar LV pacing with additional LV pacing vectors. | 1097 | ||
| Ventricular rate regulation. | 1097 | ||
| BiV triggered pacing. | 1097 | ||
| LV sensing and protection periods. | 1097 | ||
| Tracking preference. | 1097 | ||
| Sorin-Related Specific Features | 1097 | ||
| Multiple LV pacing vectors. | 1097 | ||
| VV delay. | 1097 | ||
| SonR (endocardial acceleration sensor) hemodynamic optimization. | 1101 | ||
| Biotronik Devices: Cardiac Resynchronization Therapy–Related Features | 1101 | ||
| Multiple LV pacing vectors. | 1101 | ||
| LV pacing protection. | 1101 | ||
| Triggered LV pacing. | 1101 | ||
| VV delay. | 1101 | ||
| Negative AV hysteresis. | 1101 | ||
| Cardiac Resynchronization Therapy Troubleshooting | 1101 | ||
| Pacing Malfunction | 1103 | ||
| Noncapture | 1103 | ||
| Elevated Pacing Threshold | 1106 | ||
| Autocapture Failure | 1107 | ||
| Diaphragmatic stimulation. | 1108 | ||
| Anodal stimulation. | 1110 | ||
| Sensing Abnormality | 1111 | ||
| Double-Counting | 1111 | ||
| Oversensing | 1112 | ||
| Undersensing | 1112 | ||
| Generator | 1112 | ||
| Electromagnetic Interference | 1113 | ||
| Radiation Effect | 1113 | ||
| Proarrhythmia | 1114 | ||
| Cardiac Resynchronization Therapy Device and Other Cardiac Device Interaction | 1114 | ||
| Recognition and Management of Poor Response to Cardiac Resynchronization Therapy | 1116 | ||
| Pre-Cardiac Resynchronization Therapy Implant: Patient Selection | 1116 | ||
| Cardiomyopathy and Scar Burden | 1116 | ||
| Cardiac Resynchronization Therapy Implant: Optimal Left Ventricular Lead Position | 1118 | ||
| Postcardiac Resynchronization Therapy Management | 1122 | ||
| Inadequate Biventricular Pacing | 1122 | ||
| Cardiac Resynchronization Therapy Programming | 1122 | ||
| Atrial Fibrillation | 1122 | ||
| Premature Contractions | 1123 | ||
| AV and VV Programming | 1127 | ||
| Echo-guided optimization. | 1127 | ||
| Impedance cardiography. | 1129 | ||
| Finger photoplethysmography (FPPG). | 1129 | ||
| Acoustic cardiography. | 1129 | ||
| Electrocardiography. | 1129 | ||
| References | 1131 | ||
| 40 Follow-Up of Cardiac Implantable Electronic Devices—Remote Monitoring and in Person | 1133 | ||
| Monitoring Goals | 1133 | ||
| In-Person Monitoring | 1133 | ||
| Remote Technologies | 1133 | ||
| Transtelephonic Monitoring Without Interrogation | 1133 | ||
| Modern Systems | 1134 | ||
| Remote Management | 1135 | ||
| Clinical Applications | 1135 | ||
| Outpatient Clinic Workload Reduction and Optimization | 1135 | ||
| Device Managment | 1136 | ||
| Lead and Device Performance | 1136 | ||
| Advisories | 1142 | ||
| Disease Management | 1142 | ||
| Arrhythmias | 1142 | ||
| Atrial Fibrillation | 1142 | ||
| Ventricular Arrhythmias | 1145 | ||
| Heart Failure | 1145 | ||
| Implementing Remote Monitoring | 1145 | ||
| Device Clinic | 1149 | ||
| The Organizational Model | 1150 | ||
| Role and Responsibilities of the Patient | 1153 | ||
| Patient Acceptance and Satisfaction | 1153 | ||
| Economics | 1153 | ||
| Data Management | 1154 | ||
| Regulatory Issues | 1155 | ||
| Medicolegal Issues | 1155 | ||
| Summary | 1155 | ||
| References | 1156 | ||
| 41 Perioperative and Periprocedural Management, Electromagnetic Interference, and Cardiac Implantable Electronic Devices | 1158 | ||
| Considerations for Patients with Cardiac Implantable Electronic Devices Undergoing Surgical OR Invasive Procedures | 1158 | ||
| Clinical Status Affecting Arrhythmic Risk OR Device Function | 1158 | ||
| Electromagnetic Interference | 1158 | ||
| Oversensing | 1158 | ||
| Device Reset | 1159 | ||
| Damage to the Lead-Tissue Interface | 1159 | ||
| Battery Life | 1159 | ||
| Changes in Programming | 1159 | ||
| Physical Damage to the Cardiac Implantable Electronic Device Related to Surgical Procedures | 1159 | ||
| Preoperative Evaluation of the Patient with a Cardiac Implantable Electronic Device OR Arrhythmias | 1159 | ||
| Role of the Electrophysiology/ Cardiology Team | 1159 | ||
| Role of the Anesthesiology/Surgical Team | 1161 | ||
| Reprogramming Versus Magnet Use | 1162 | ||
| Reprogramming the Cardiac Implantable Electronic Device | 1162 | ||
| Magnet Response | 1162 | ||
| No Reprogramming OR Magnet Use | 1164 | ||
| Subcutaneous Implantable Cardioverter-Defibrillator | 1164 | ||
| Novel Pacemakers | 1165 | ||
| Implantable Loop Recorders | 1166 | ||
| Emergency Procedures | 1166 | ||
| Intraoperative Management of the Patient with a Cardiac Implantable Electronic Device | 1166 | ||
| Intraoperative Monitoring | 1166 | ||
| Central Venous Catheter Placement and Cardiac Implantable Electronic Device Leads | 1166 | ||
| Location of the Electrosurgical Return Patch | 1167 | ||
| Postoperative Management of the Patient with a Cardiac Implantable Electronic Device | 1167 | ||
| Mechanism of Specific EMI Sources and Risk to the Cardiac Implantable Electronic Device | 1167 | ||
| Electrosurgical Energy | 1167 | ||
| Direct Current Cardioversion | 1168 | ||
| Radiofrequency Ablation | 1168 | ||
| Diagnostic Radiation | 1168 | ||
| Therapeutic Radiation | 1169 | ||
| Electroconvulsive Therapy | 1170 | ||
| Transurethral Resection of the Prostate/Transurethral Needle Ablation | 1170 | ||
| Colonoscopy/Gastroscopy | 1170 | ||
| Ocular Procedures | 1170 | ||
| Magnetic Drapes | 1170 | ||
| Tissue Expanders with Magnets | 1170 | ||
| Transcutaneous Electrical Nerve Stimulation/Spinal Cord Stimulators | 1170 | ||
| Radiofrequency Identification Devices | 1170 | ||
| Electromyography and Nerve Conduction Velocity Studies | 1170 | ||
| Lithotripsy | 1171 | ||
| Argon Plasma Coagulation | 1171 | ||
| Procedures with No Risk | 1171 | ||
| Electromagnetic Interference in the Nonmedical Environment | 1171 | ||
| Cellular Telephones and Other Home Electronics | 1171 | ||
| Industrial Equipment and Occupational Exposures | 1171 | ||
| Security Systems | 1172 | ||
| Scuba Diving and Hyperbaric Oxygen | 1172 | ||
| Conclusion | 1172 | ||
| References | 1173 | ||
| 42 Managing Advisories of Cardiac Implantable Electronic Devices | 1175 | ||
| Introduction | 1175 | ||
| Device Performance | 1175 | ||
| Types of Advisories | 1175 | ||
| Review of Device Advisories | 1176 | ||
| Generator-Associated Device Advisories | 1176 | ||
| Lead-Associated Advisories | 1178 | ||
| The Sprint Fidelis Lead Advisory | 1181 | ||
| The Riata Lead Advisory | 1182 | ||
| Approach to the Patient with an Advisory | 1185 | ||
| Lead Advisory Versus Generator Advisory | 1187 | ||
| Current Surveillance Mechanisms | 1187 | ||
| Conclusion | 1189 | ||
| References | 1189 | ||
| 43 Establishing and Managing a Device Clinic and Database | 1191 | ||
| Clinics for the Follow-Up of Cardiovascular Implantable Electronic Devices | 1191 | ||
| Increased Cardiovascular Implantable Electronic Device Follow-Up Volume | 1191 | ||
| Goal of Cardiovascular Implantable Electronic Device Follow-Up | 1191 | ||
| Personnel Involved in Cardiovascular Implantable Electronic Device Follow-Up | 1191 | ||
| Paradigms for Cardiovascular Implantable Electronic Device Follow-Up Including Remote Monitoring | 1192 | ||
| Organization of a Pacemaker Follow-Up (in-Person) | 1193 | ||
| Organization of an Implantable Cardioverter-Defibrilltor Follow-Up (in-Person) | 1193 | ||
| Organization of the Follow-Up of a Cardiac Resynchronization Therapy Device (CRT-P or CRT-D) | 1195 | ||
| Organization of Remote Follow-Up for Cardiovascular Implantable Electronic Devices | 1195 | ||
| Cardiovascular Implantable Electronic Device Database Integration | 1196 | ||
| Implementation, Health Economics and Reimbursement | 1197 | ||
| References | 1199 | ||
| 44 Social and Ethical Principles of Device Therapy | 1201 | ||
| The Ethics of Cardiac Implantable Electronic Device Reuse | 1201 | ||
| Disparities in Access to Cardiac Implantable Electronic Devices | 1201 | ||
| Donations to Improve Access to Cardiac Implantable Electronic Device Therapy | 1201 | ||
| Potential Sources of Reused Devices | 1201 | ||
| Support for Cardiac Implantable Electronic Device Reuse on Humanitarian Grounds | 1202 | ||
| Evidence in Favor of Safety and Efficacy of Cardiac Implantable Electronic Device Reuse | 1202 | ||
| Legal Obstacles, Regulatory Considerations, and Solutions | 1203 | ||
| Ethical Considerations of Cardiac Implantable Electronic Device Reuse | 1203 | ||
| Responsibilities of the Reprocessor | 1205 | ||
| Conclusions | 1205 | ||
| The Ethics of Cardiac Implantable Electronic Device Deactivation in Terminally Ill Patients | 1206 | ||
| Ethical and Legal Foundations of End-of-Life Care and Applications to Cardiac Implantable Electronic Devices | 1206 | ||
| Cardiac Implantable Electronic Device Function Near the Time of Death | 1206 | ||
| Views on Cardiac Implantable Electronic Device Deactivation | 1207 | ||
| Heart Rhythm Society Consensus Statement of 2010 | 1207 | ||
| The Ethics of Deactivating Cardiac Implantable Electronic Device Therapies | 1207 | ||
| Physician Agency | 1208 | ||
| Discussing the Role of Cardiac Implantable Electronic Device Therapy with Patients | 1208 | ||
| Logistics of Cardiac Implantable Electronic Device Activation | 1208 | ||
| Device Deactivation Plan | 1209 | ||
| Reprogramming the Cardiac Implantable Electronic Device | 1209 | ||
| Inpatient Care Settings | 1209 | ||
| Patients at Home or Outside of Inpatient Medical Facilities | 1209 | ||
| Pediatric Patients | 1209 | ||
| Conclusions | 1209 | ||
| References | 1210 | ||
| Index | 1211 | ||
| A | 1211 | ||
| B | 1213 | ||
| C | 1214 | ||
| D | 1217 | ||
| E | 1218 | ||
| F | 1219 | ||
| G | 1220 | ||
| H | 1220 | ||
| I | 1221 | ||
| J | 1222 | ||
| K | 1222 | ||
| L | 1222 | ||
| M | 1224 | ||
| N | 1224 | ||
| O | 1225 | ||
| P | 1225 | ||
| Q | 1227 | ||
| R | 1227 | ||
| S | 1228 | ||
| T | 1230 | ||
| U | 1231 | ||
| V | 1231 | ||
| W | 1232 | ||
| X | 1232 | ||
| Z | 1232 | ||
| Inside Back Cover | ibc1 |