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HE IMPLANTABLE CARDIOVERTER DEFIBRILLATOR, or T"lCD," is arguably the most technologically challenging type of therapy that physicians utilize today. At the same time, engineers who design ICDs are being called upon by clinicians to extend even further the technological envelope in quest of building the "ideal" device. To the extent, however, that physicians who utilize ICDs are not sufficiently comfortable with or familiar with the engineering principles that guide ICD function, the full clinical potential of even an ideal device will not be realized. In comple mentary fashion, engineers require as full an appreciation as possi ble of the real world "boundary conditions" and clinical impact of various ICD features, if the latter are truly to be perfected. This book is intended to serve as an educational tool to foster mutual understanding and communication among physicians, engineers, and other professionals involved in ICD therapy, with the ultimate purpose of enhancing patient care. The highly varied backgrounds of such a diverse audience posed obvious challenges in the preparation of this volume. Given the overwhelmingly greater involvement of clinicians in the day-to day management and follow-up of ICD recipients, we gave high priority to the presentation of oftentimes complex yet relevant engi neering concepts in a manner that could be understandable to most clinicians.
This new edition provides up-to-date comprehensive coverage of the rapidly evolving field of clinical cardiac electrophysiology. It is designed for physicians, cardiologists, cardiac electrophysiologists, and allied professionals practising or learning the speciality of clinical cardiac electrophysiology. This textbook - written entirely by two practising authorities in the field - offers a cohesive and comprehensive summary of the principles and practice of clinical cardiac electrophysiology. The authors emphasize the clinical approach to the patient and provide a fundamental, yet thorough, discussion of the primary therapeutic modalities used today in a state-of-the-art electrophysiology laboratory, including the latest pharmacotherapy options, catheter ablation treatment, and the newest implantable devices. The authors provide the reader with a concise, organized discussion of the management of patients with benign to life-threatening arrhythmias using the newest concepts, equipment, and techniques of diagnostic and therapeutic electrophysiology.
Implantable defibrillators as originally conceived by Michel Mirowski were limited to the detection and automatic termination of ventricular fibrillation. In the original "AID" device, the detection algoritlun sought to distinguish sinus rhytlun from ventricular fibrillation by identifying the "more sinusoidal waveform of ventricular fibrillation. " The therapeutic intervention was elicited only once deadly polymorphic rhythms had developed. It was rapidly learned, however, that ventricular fibrillation is usually preceded by ventricular tachycardia. Mirowski recognized the pivotal importance of developing algoritllms based on heart rate. Ventricular tachycardia detection allowed the successful development of interventions for the termination of ventricular tachyarrhythmias before they degenerated into ventricular fibrillation. Current device therapy no longer confines itself to tlle termination of chaotic rhythms but seeks to prevent them. Diagnostic algorithms moved upward along the chain of events leading to catastrophic rhytlulls. Rate smoothing algorithms were developed to prevent postextrasystolic pauses from triggering ventricular and atrial tachyarrhytlmlias. Beyond the renaissance of ectopy-centered strategies, long-term prevention received increasing attention. Multisite pacing therapies provided by "Arrhythmia Management Devices" were designed to reduce the "arrhytlunia burden" and optimize the synergy of cardiac contraction and relaxation. Clinical evidence now suggests that atrial fibrillation prevention by pacing is feasible and tllat biventricular pacing may be of benefit in selected patients with heart failure. However, these applications of device therapy that generally require ventricular defibrillation backup remain investigational and were not considered in this book.
This 3rd edition presents cutting-edge standards of pacing and defibrillation to keep you at the forefront of this rapidly expanding field. You'll find coverage of all the new devices and management strategies you need to solve a full range of clinical problems using today's best approaches. Written by world authorities on pacing and devices for cardiac care, this new full-color 3rd edition is the more practical than ever! Addresses the management of patients with a broad range of conditions, including sinus node disease, carotid sinus hypersensitivity, tachyarrhythmias, heart failure, and more. Details cardiac pacing in pediatric patients. Illustrates vital concepts and techniques with over 745 x-rays and figures. Explains how to approach pacemaker generator changes. Reviews fundamental concepts such as how to pace the heart and how leads, power sources, programmers, and electronic circuitry work. Contains a new chapter on resynchronization trials. Offers technical information on both new and old devices to help you make the correct choice for every patient. Provides new material on implantation, with key updates to all aspects of this challenging clinical area.
This brilliant and highly practical book provides a case-based introduction and primer to the practice of ICD therapy. It contains a huge number of images and includes real-world patient histories. The reader is able to gain extensive practical knowledge of the practice of ICD therapy with the use of these case reports. These concentrate on the skills necessary to increase specialist knowledge of defibrillator therapy practice.
Critical care medicine is a dynamic and exciting arena where complex pathophysiologic states require extensive knowledge and up-to-date clinical information. An extensive kno- edge of basic pathophysiology, as well as awareness of the appropriate diagnostic tests and treatments that are used to optimize care in the critically ill is essential. Since our frst edition 7 years ago, new information crucial to the care and understanding of the critically ill patient has rapidly accumulated. Because this knowledge base crosses many different disciplines, a comprehensive multidisciplinary approach presenting the information is essential, similar to the multidisciplinary approach that is used to care for the critically ill patient. We have strived to provide this content in an easily digestible format that uses a variety of teaching tools to facilitate understanding of the presented concepts and to enhance information retention. To meet the demand to provide comprehensive and diverse education in order to und- stand the pathogenesis and optimum care of a variety of critical illnesses, we have subst- tially revised the prior topics in the frst edition with updated information. We have also markedly expanded the number of topics covered to include acute lung injury and the acute respiratory distress syndrome, an expanded discussion of the physiology and operation of mechanical ventilation, obstetrical care in the ICU, neurosurgical emergencies, acute co- nary syndromes, cardiac arrhythmias, role of whole body rehabilitation in the ICU, ethical conduct of human research in the ICU, and nursing care of the ICU patient.
This second editionis a ground-breaking clinical text with a strong emphasis on rigorous evidence. Leaders in the field discuss best practice in the light of systematic reviews and randomised control trials, and how best to treat where the information is less clear. Case histories provide intriguing discussions on how to apply the evidence in real life situations. Evidence-based Cardiology also includes free access to the latest evidence, which is automatically posted on a companion website.
Consisting of 13 chapters, this book is uniformly written to provide sensible, matter-of-fact methods for understanding and caring for patients with permanent pacemakers, ICDs and CRT systems. Now improved and updated, including a new chapter on programming and optimization of CRT devices, this second edition presents a large amount of information in an easily digestible form. Cardiac Pacing and Defibrillation offers sensible, matter-of-fact methods for understanding and caring for patients, making everyday clinical encounters easier and more productive. Readers will appreciate the knowledge and experience shared by the authors of this book.
Cardiac Pacing and ICDs, 6e is the ideal resource for clinicians who need an accessible, clinically-focused guide to cardiac pacemakers, ICDs and CRTs. Completely updated, and now with larger full-color images throughout, this new sixth edition offers thorough coverage of essential topics like: Indications for both temporary and permanent pacing Pacing hemodynamics explained in clinically relevant terms with simple algorithms for mode selection and device programming Tips and Tricks for implantation and removal of devices and left ventricular leads Evaluation and management of pacemaker and ICD device malfunctions MRI safety and how to follow patients with devices Remote follow up and more Thoroughly revised and redone to provide more tables, charts and figures explaining devices Cardiac Pacing and ICDs, 6e presents all aspects of pacing in an intuitive, easy-to-use way: chapters proceed from pacing basics and indications through initial patient presentation, device implementation, trouble-shooting, and long-term follow-up – an approach that mirrors the clinician’s course of action in treating and managing patients. Itis the perfect reference for cardiology and electrophysiology fellows, general clinical cardiologists, and electrophysiologists who want a clear-headed, authoritative overview of current devices and best practices for their use treating heart rhythm abnormalities. It will also be of great use to those studying for the IHRBE Examination in Devices, and individuals in this field who care for patients with implantable devices at all levels.
Pacing and defibrillation have become the leading therapeutic treatments of heart rhythm disorders, including bradycardia and tachycardia. The success of these therapies is largely due to centuries of scientific inquiry into the fundamental mechanisms of bioelectric phenomena in the heart. History of successful development of bioelectric therapies includes development of experimental and theoretical methodologies, novel bioengineering approaches, and state-of-the-art clinical implantable device therapies. The purpose of this book is to present a uniform thematic collection of reviews written by the leading basic and applied scientists working in basic bioengineering research laboratories, who have contributed to the development of current understanding of the fundamental mechanisms of pacing and electrophysiology, and who are at the leading edge of further developments in electrotherapy. The book will start from the historic overview of the subject, including the development of the pacemaker and defibrillator, evolution of theories of cardiac arrhythmias and experimental methods used in the field over the centuries. Leading experts in the field will write these chapters. The second part of the book will focus on rigorous treatment of the fundamental theory of interaction between electric field and cardiac cell, tissue, and organ. Chapters will be written by top notch scientists, who made critically important contributions to the development of these theories. Part 3 will provide summary of several decades of research involving electrode recordings and multielectrode mapping of ventricular fibrillation and defibrillation in humans and animal models of arrhythmias. Part 4 will present new insights into defibrillation gained due to the advent of optical imaging technology, which permitted to map defibrillation without overwhelming shock-induced artifacts present in electrode recordings. Part 5 will provide rigorous overview of the methodologies, which made research of physiological and engineering aspects of electrotherapy possible. And finally, part 6 will present possible future of implantable devices and electrotherapy in the treatment of cardiac rhythm disorders.