Additional Information
Book Details
Abstract
Unique in the field, Surgical Implantation of Cardiac Rhythm Devices provides complete, easy-to-follow guidance for safe, effective surgical implantation of pacemakers, ICDs, and other devices. Beginning with surgical anatomy and surgical principles, expert authors provide thorough coverage of surgical technique and procedures – everything from sutures to special circumstances and complications. Detailed, high-quality illustrations show you exactly how to proceed, and each procedure includes an accompanying video clip online.
- Outlines relevant anatomic structures and landmarks, as well as various types of sutures and instruments.
- Provides authoritative, detailed guidance on transvenous lead placement, including novel or alternative placements, as well as implantation of subcutaneous ICDs.
- Covers tools and techniques, anesthesia, radiation safety, pitfalls and complications, tips and pearls, patient preparation, postoperative patient management, and follow-up care.
- Offers expert coverage of pediatric considerations and other special circumstances.
- Allows you to view surgical procedures and relevant anatomy in video clips online, as well as through extensive, high-quality illustrations in the text.
- Ideal for EP fellows, practicing electrophysiologists, and cardiologists who perform surgical procedures to implant pacemakers, ICDs, and other devices.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| IFC | ES1 | ||
| Surgical Implantation of Cardiac Rhythm Devices | i | ||
| Surgical Implantation of Cardiac Rhythm Devices | iii | ||
| Copyright | iv | ||
| Dedication | v | ||
| Contributors | vi | ||
| Preface | viii | ||
| Contents | ix | ||
| Video Contents | x | ||
| 1 - Development of Cardiac Implantable Electrical Devices | 1 | ||
| Introduction | 1 | ||
| Where Did It Start? | 1 | ||
| Birth of the Pacemaker | 1 | ||
| Battery Technology | 4 | ||
| Programmable Pulse Generators | 4 | ||
| Auto-Programmability | 6 | ||
| Data Logging and Telemetry | 6 | ||
| Necessity Is the Mother of Invention | 6 | ||
| Defibrillation and the Development of Implantable Defibrillators | 6 | ||
| Progress in Cardiac Implantable Devices in the Twenty-First Century | 8 | ||
| Cardiac Pacing for Heart Failure | 8 | ||
| Technological Advancements in Cardiac Resynchronization Therapy | 8 | ||
| Transthoracic Impedance Measurements for Heart Failure Monitoring | 9 | ||
| Advancements in CIED Programming: Options and Best Programming | 9 | ||
| Rate Drop/Sudden Bradycardia Response | 9 | ||
| Advanced Sensor Technology | 9 | ||
| Avoidance of Right Ventricular Pacing | 9 | ||
| Avoiding Inappropriate and Unnecessary Implantable Cardioverter-Defibrillator Shocks | 9 | ||
| Revolutionary Technologies | 10 | ||
| Leadless Pacing | 10 | ||
| Subcutaneous Implantable Cardioverter-Defibrillator | 10 | ||
| MRI-Conditional Pacemakers and Implantable Cardioverter-Defibrillators | 10 | ||
| Final Thoughts and an Eye Into the Future | 11 | ||
| Acknowledgment | 11 | ||
| References | 11 | ||
| 2 - Surgical Anatomy for the Implanting Physician | 13 | ||
| Introduction | 13 | ||
| External Anatomic Landmarks | 13 | ||
| Skin | 13 | ||
| Breast Tissue | 17 | ||
| Skeletal Anatomy | 18 | ||
| Musculature | 24 | ||
| Venous Vasculature | 31 | ||
| Venous Anomalies | 35 | ||
| Heart | 35 | ||
| Right Atrium | 36 | ||
| Clinical Correlations | 41 | ||
| Right Ventricle and Tricuspid Valve | 45 | ||
| Clinical Correlations | 45 | ||
| Left Atrium, Left Ventricle, and Mitral and Aortic Valves | 50 | ||
| Left Ventricle and Mitral and Aortic Valves | 52 | ||
| Conduction System | 53 | ||
| Clinical Correlations | 54 | ||
| Venous Anatomy Including the Coronary Sinus | 54 | ||
| Clinical Correlations | 55 | ||
| Acknowledgment | 57 | ||
| References | 57 | ||
| 3 - Surgical Techniques and Tools | 59 | ||
| Introduction | 59 | ||
| Surgical Leadership | 59 | ||
| Surgical/Procedural Safety Checklist | 59 | ||
| Instruments | 60 | ||
| Instruments for Cutting | 60 | ||
| Instruments for Grasping | 60 | ||
| Instruments for Retracting | 62 | ||
| Instruments for Clamping | 63 | ||
| Instruments for Suturing | 63 | ||
| Electrocautery | 65 | ||
| Plasma Knife | 67 | ||
| Suture Materials and Needles | 68 | ||
| Suture Characteristics | 68 | ||
| Suture Needles | 69 | ||
| Hemostasis | 69 | ||
| Knot Tying | 69 | ||
| Knots | 69 | ||
| Suturing and Wound Closure | 71 | ||
| Body Mechanics | 71 | ||
| Holding the Needle Driver | 72 | ||
| Loading the Needle | 73 | ||
| Suturing | 73 | ||
| Common Suturing Techniques | 73 | ||
| Goals for Wound Closure | 74 | ||
| Wound Healing | 76 | ||
| References | 80 | ||
| 4 - Anesthesia for Interventional Cardiology | 81 | ||
| Introduction | 81 | ||
| Preoperative Evaluation | 81 | ||
| Key Points in the Preoperative Evaluation | 81 | ||
| History | 81 | ||
| Review of Systems | 81 | ||
| Physical Examination | 82 | ||
| Preoperative Considerations | 82 | ||
| Selecting the Appropriate Anesthesia Management | 82 | ||
| Relevant Definitions | 82 | ||
| Sedation | 82 | ||
| General Anesthesia | 82 | ||
| Regional Anesthesia | 83 | ||
| Identifying High-Risk Patients | 83 | ||
| Additional Risk Factors to Consider in Planning Sedation for Procedures | 84 | ||
| Patient Factors | 84 | ||
| Environmental Factors | 86 | ||
| Procedural Factors | 86 | ||
| Intraoperative Care | 86 | ||
| Guidelines for Non–Operating Room Anesthesia | 86 | ||
| Environment | 86 | ||
| Anesthesia Equipment | 86 | ||
| Equipment for Transport to Postanesthesia Care Unit or Intensive Care Unit | 86 | ||
| Intraoperative Monitoring | 86 | ||
| Standard Monitors for Non–Operating Room Anesthesia5 | 86 | ||
| Assessment of Ventilation | 87 | ||
| Additional Monitoring | 87 | ||
| Moderate Sedation | 87 | ||
| Risks and Complications | 87 | ||
| Training Requirements for Moderate Sedation for Nonanesthesia Clinicians (MDs, PAs, and ARNPs) | 87 | ||
| Medications for Sedation and Anesthesia | 87 | ||
| Minimal Sedation | 87 | ||
| Moderate Sedation | 88 | ||
| Deep Sedation, Monitored Anesthesia Care, and General Anesthesia | 88 | ||
| Benzodiazepines | 88 | ||
| Drug Interactions | 88 | ||
| Pharmacodynamics | 88 | ||
| Reversal | 88 | ||
| Propofol | 88 | ||
| 5 - Radiation Safety | 98 | ||
| Basic Radiation Terminology | 98 | ||
| Patient Risk From Radiation Exposure | 99 | ||
| Risk to Laboratory Personnel From Radiation Exposure | 99 | ||
| Minimizing and Optimizing X-Ray Exposure to Patients and Staff | 100 | ||
| Equipment Operation | 100 | ||
| Protective Shielding and Personal Equipment | 101 | ||
| Fluoro-less Device Insertion | 103 | ||
| Cardiac Resynchronization Therapy | 103 | ||
| Summary | 103 | ||
| References | 103 | ||
| 6 - Patient Preparation | 105 | ||
| Introduction | 105 | ||
| Patient Identification | 105 | ||
| Patient Positioning | 105 | ||
| Placement of Monitoring Leads | 106 | ||
| Placement of Electrocautery Grounding Pad | 106 | ||
| Placement of Defibrillator Patches | 107 | ||
| Restraints | 107 | ||
| Respiratory Monitoring | 107 | ||
| Moderate Sedation | 108 | ||
| Scrub Antiseptics | 109 | ||
| Surgical Field Preparation | 109 | ||
| Scrubbing and Gowning | 109 | ||
| Preparation of the Patient | 112 | ||
| Summary | 115 | ||
| References | 115 | ||
| 7 - Cardiac Implantable Electronic Device Surgical Implant | 116 | ||
| Introduction | 116 | ||
| Preprocedure Planning for a New CIED Implant | 116 | ||
| Patient Position, Prepping, and Draping | 120 | ||
| Performing the Procedure | 120 | ||
| Incision and Pocket Choices | 120 | ||
| Forming the Incision and Pocket | 122 | ||
| Subpectoral Pocket | 126 | ||
| Vessel Choices | 129 | ||
| Finishing the Procedure | 130 | ||
| Securing the Leads | 130 | ||
| Generator and Lead Attachment | 130 | ||
| Closing the Pocket | 132 | ||
| Pulse Generator Replacement Procedures | 133 | ||
| Patient Evaluation Specific to Pulse Generator Replacements | 134 | ||
| Anticoagulation | 135 | ||
| Performing the Generator Replacement Procedure | 135 | ||
| Incision and Dissection | 135 | ||
| Special Considerations | 139 | ||
| Subcutaneous Implantable Defibrillator Generator Replacements | 139 | ||
| Generator Replacements in Patients With a Subpectoral Pocket | 139 | ||
| Pocket Revisions | 140 | ||
| Situations Requiring Lead Tunneling | 140 | ||
| Acknowledgment | 142 | ||
| References | 142 | ||
| 8 - Transvenous Lead Placement | 143 | ||
| Introduction | 143 | ||
| Venous Access | 143 | ||
| Subclavian Vein Approach | 143 | ||
| Axillary Vein Approach | 147 | ||
| Cephalic Vein Approach | 150 | ||
| Venous Anomaly | 152 | ||
| Venous Obstruction | 152 | ||
| Venous Access During Lead Revision | 153 | ||
| Techniques to Minimize Complications | 154 | ||
| Lead Positioning | 155 | ||
| Right Ventricular Lead Placement | 155 | ||
| Right Ventricular Apical Versus Right Ventricular Septal Location | 158 | ||
| Right Ventricular Lead Selection | 158 | ||
| When the Right Ventricular Lead Is Not in the Right Ventricle | 158 | ||
| Right Ventricular Lead Perforation | 158 | ||
| Atrial Lead Placement | 159 | ||
| Atrial Lead Selection | 161 | ||
| Left Ventricular Lead Placement | 161 | ||
| Locating the Coronary Sinus Os | 161 | ||
| Visualizing Coronary Venous Anatomy | 163 | ||
| Lead Selection and Placement of the Left Ventricular Lead | 163 | ||
| Left Ventricular Lead Location | 166 | ||
| Left Ventricular Guide Catheter Removal | 167 | ||
| Coronary Sinus Dissection | 167 | ||
| Phrenic Nerve Stimulation | 167 | ||
| Lead Placement in Nonstandard Cases | 167 | ||
| Lead Placement in Right-Sided Implants | 167 | ||
| Lead Placement in Upgrade Cases | 168 | ||
| Acknowledgment | 170 | ||
| References | 170 | ||
| 9 - Considerations for Novel or Alternative Lead Placement | 173 | ||
| Introduction | 173 | ||
| Considerations for Alternative Shocking-Coil Placement | 173 | ||
| Azygos Vein Lead Placement | 173 | ||
| Subcutaneous Shocking-Coil Placement | 174 | ||
| Considerations for Alternative Pacing Lead Placement | 174 | ||
| Permanent Pacing Leads Implanted Through the Jugular Vein | 175 | ||
| Permanent Pacing Leads Implanted Through the Femoral Vein | 175 | ||
| Temporary-Permanent Transvenous Leads | 175 | ||
| Epicardial Pacing Leads | 175 | ||
| Infectious Endocarditis | 176 | ||
| End-Stage Renal Disease | 176 | ||
| Adult Congenital Heart Disease | 177 | ||
| Tricuspid Valve Surgery | 177 | ||
| Patients With Intracardiac Shunts | 177 | ||
| Technical Features of Epicardial Lead Placement | 177 | ||
| Leadless Pacing | 179 | ||
| References | 180 | ||
| 10 - Implanting the Subcutaneous Implantable Cardioverter-Defibrillator | 181 | ||
| Introduction | 181 | ||
| Indications | 181 | ||
| Preparation: Electrocardiographic Screening | 181 | ||
| Operative Strategy | 181 | ||
| Anesthesia | 181 | ||
| Patient Preparation | 182 | ||
| Surgical Instruments | 183 | ||
| Operative Technique | 183 | ||
| Generator Placement | 184 | ||
| Lead Placement | 186 | ||
| Three-Incision Technique | 186 | ||
| Two-Incision Technique | 189 | ||
| Closure | 190 | ||
| Additional Considerations | 191 | ||
| Unusual Anatomic Presentations | 191 | ||
| Periprocedural Evaluation and Defibrillation Testing | 191 | ||
| Programming | 191 | ||
| Conclusion | 192 | ||
| References | 192 | ||
| 11 - Device Implantation in Pediatrics and Congenital Heart Disease | 193 | ||
| Introduction | 193 | ||
| Loop Recorders | 193 | ||
| Pacemaker Implantation | 193 | ||
| Implantable Cardioverter-Defibrillator Implantation | 195 | ||
| Pacemaker and Implantable Cardioverter-Defibrillator Implantation in Congenital Heart Disease | 195 | ||
| Pacemaker Implantation | 196 | ||
| Pacing in Specific Anatomic Variants | 196 | ||
| Implantable Cardioverter-Defibrillator Implantation | 197 | ||
| Cardiac Resynchronization Therapy via Biventricular or Multisite Pacing | 199 | ||
| Cardiac Resynchronization Therapy for the Systemic Left Ventricle | 200 | ||
| Cardiac Resynchronization Therapy for the Subpulmonary Right Ventricle | 201 | ||
| Cardiac Resynchronization Therapy for the Systemic Right Ventricle | 201 | ||
| Cardiac Resynchronization Therapy for the Single Ventricle | 202 | ||
| Lead Extraction, Venous Occlusions, and Intracardiac Shunts in Pediatrics and Congenital Heart Disease | 202 | ||
| Conclusions | 203 | ||
| References | 203 | ||
| 12 - Special Circumstances and Obstacles | 207 | ||
| Introduction | 207 | ||
| Prior Median Sternotomy | 207 | ||
| Obesity | 207 | ||
| Anorexia/Cachexia | 207 | ||
| Muscular Chest | 208 | ||
| Alterations in Breast Tissue | 208 | ||
| Pendulous Breasts | 208 | ||
| Breast Augmentation | 209 | ||
| Breast Reduction | 209 | ||
| Mastectomy | 211 | ||
| Indwelling Central Lines | 211 | ||
| Dialysis Fistulas | 211 | ||
| Prior Clavicular Fracture | 211 | ||
| Tracheostomy | 211 | ||
| Chest Irradiation | 211 | ||
| Vascular Stenosis and Obstruction | 211 | ||
| Keloids | 213 | ||
| Summary | 213 | ||
| References | 213 | ||
| 13 - Pitfalls and Complications | 214 | ||
| Introduction | 214 | ||
| Lead Malfunction or Dislodgement | 214 | ||
| Hematomas and Bleeding | 214 | ||
| Pneumothorax and Its Variants | 217 | ||
| Venous Access and Obstruction | 217 | ||
| Infections | 218 | ||
| Perforation | 220 | ||
| Death | 220 | ||
| Summary and Quality Improvement | 221 | ||
| References | 221 | ||
| 14 - Prevention, Evaluation, and Management of Cardiac Rhythm Device Infections | 223 | ||
| Introduction | 223 | ||
| Epidemiology | 223 | ||
| Risk Factors | 223 | ||
| Patient and Procedural Risk Factors | 224 | ||
| Organism Virulence Factors | 224 | ||
| CIED Influence on Infection | 224 | ||
| Prevention | 224 | ||
| Antibiotics | 224 | ||
| Skin Preparation | 225 | ||
| Hematoma and Anticoagulation | 226 | ||
| Microbiology | 226 | ||
| Presentation | 226 | ||
| Diagnostic Evaluation | 227 | ||
| Laboratory Testing | 227 | ||
| Imaging | 228 | ||
| Management | 228 | ||
| CIED and Lead Extraction | 229 | ||
| Open Surgical Approach | 230 | ||
| Long-Term Antibiotics | 230 | ||
| Postoperative Management | 231 | ||
| Antibiotics | 231 | ||
| Reimplantation | 232 | ||
| Prognosis After CIED Infection | 232 | ||
| Conclusion | 233 | ||
| References | 233 | ||
| 15 - Postoperative Management | 237 | ||
| Introduction | 237 | ||
| Postoperative Management Specific to CIED Type and Indications | 237 | ||
| Immediate Postoperative Care | 238 | ||
| Postoperative Recovery Unit to Hospital Discharge | 238 | ||
| Specific Testing | 239 | ||
| Chest Radiograph | 239 | ||
| Electrocardiogram | 240 | ||
| Routine Laboratory Testing | 240 | ||
| Device Interrogation | 241 | ||
| Wound Care | 241 | ||
| Activity | 242 | ||
| Diet/Nutrition | 243 | ||
| Venous Thromboembolism Prophylaxis | 243 | ||
| Antibiotic Prophylaxis | 243 | ||
| Pain Control | 243 | ||
| Discharge Planning | 244 | ||
| Overnight Observation | 244 | ||
| Same-Day Discharge | 244 | ||
| First Follow-up Clinic Visit | 244 | ||
| First Year After CIED Implantation | 247 | ||
| Summary | 248 | ||
| References | 248 | ||
| Index | 249 | ||
| A | 249 | ||
| B | 249 | ||
| C | 249 | ||
| D | 250 | ||
| E | 250 | ||
| F | 250 | ||
| G | 250 | ||
| H | 250 | ||
| I | 250 | ||
| J | 251 | ||
| K | 251 | ||
| L | 251 | ||
| M | 251 | ||
| N | 251 | ||
| O | 251 | ||
| P | 251 | ||
| Q | 252 | ||
| R | 252 | ||
| S | 252 | ||
| T | 253 | ||
| U | 253 | ||
| V | 253 | ||
| W | 253 | ||
| X | 253 | ||
| Z | 253 | ||
| IBC | ES2 |