Cardiac Defibrillation

Sudden cardiac death and ventricular arrhythmia play a prominent role in mortality in our era. One of the biggest milestones in the therapy of ventricular arrhythmias was the invention of cardiac defibrillation. There were several important developments in the last decades, making nowadays automated external and internal defibrillators widely available. However, the rapid evolution and high differentiation of available options presents a challenge to be kept "up-to-date". With this book, we would like to review the actual guidelines and give practical advices concerning of indications in cardiomyopathy patients, possible contraindications and complications, the perioperative management including anticoagulation and antibiotics, and the programming and follow-up of defibrillator devices. Cover......Page 1 Cardiac Defibrillation......Page 2 ©......Page 3 Contents......Page 5 Preface......Page 7 Section 1 External Cardiac Defibrillation......Page 9 2.1. History......Page 11 2.3. Waveforms and its importance......Page 12 2.4. Cardioversion and defibrillation......Page 13 3.1. Definition and basic AED components......Page 14 3.2.1. Energy levels......Page 16 3.2.3. Others factors affecting defibrillation success......Page 17 3.5.1. Basic steps......Page 18 3.5.3. AED use in pediatric and adolescent population......Page 20 3.6.1. AED use training......Page 21 3.6.2. Public access defibrillation......Page 22 3.7.1. Definition and indications......Page 23 3.7.2. How a WCD works......Page 24 3.7.3. Efficacy of WCD and other aspects......Page 25 4. Conclusions......Page 26 References......Page 27 Section 2 Principals of Internal Cardiac Defibrillation......Page 35 2. Geometry and pathogenesis of ventricular fibrillation......Page 37 3. Rotors and heart geometry......Page 38 4. Geometry and defibrillation......Page 39 5. Geometry and lead positioning for cardiac defibrillation......Page 41 5.1. Clinical aspects of right ventricular lead positioning for defibrillation......Page 42 6. Electrode configurations for subcutaneous ICDs......Page 45 References......Page 47 Section 3 Worth Knowing About Indication, Long-Term Benefit, Challenges, and Monitoring of ICD Therapy......Page 51 1. Introduction......Page 53 2. Clinical parameters......Page 54 3. Primary prevention trials......Page 55 4. ECG measurements......Page 56 5. Autonomic variables......Page 57 7. Electrophysiological testing......Page 58 10. Conclusion......Page 59 References......Page 60 1. Introduction......Page 67 2. Sudden cardiac death......Page 68 4. Secondary SCD prevention......Page 69 5. Primary SCD prevention......Page 70 5.1. Limiations of studies......Page 71 5.2. SCD risk predictors......Page 73 5.3. Comorbidity......Page 74 5.4. Age......Page 75 5.5. Gender......Page 76 Author details......Page 77 References......Page 78 1. Introduction......Page 87 2.1. Secondary prevention trials......Page 88 2.2. Primary prevention trials......Page 91 3.1. Lead failure......Page 94 3.3. Risk of ICD generator replacement......Page 95 Author details......Page 96 References......Page 97 2.1. Type of transmissions......Page 101 2.2. Technology of transmission......Page 102 2.3. Types of alerts......Page 104 3.1. Physicians......Page 105 3.2. Patients......Page 106 3.3. Health economics......Page 107 3.5. Reimbursement......Page 108 Author details......Page 109 References......Page 110 Section 4 ICD Implantation Procedure......Page 115 1.2. Antiplatelet therapy......Page 117 1.3. Oral anticoagulants......Page 118 1.4. Conclusion / recommendation......Page 120 2.1. Introduction......Page 122 3. Conclusion / recommendation......Page 124 References......Page 125 2. DFT concept......Page 129 3. Performing DFT testing......Page 130 4. Management of high DFT......Page 132 5. The arguments for and against performing DFT testing......Page 134 6. Conclusion......Page 136 References......Page 137 Section 5 Tipps and Tricks in ICD Programming......Page 143 3. VT/VF zone......Page 145 4. Inappropriate ICD therapy......Page 147 5. Detection Time (DT) or Number of Interval Detection (NID)......Page 149 6. Discrimination SVT/VT......Page 152 8. Sudden onset......Page 153 9. Timer......Page 155 10. Morphology criteria......Page 156 11. SVT/VT discrimination algorithms in single chamber devices......Page 157 12. SVT/VT discrimination algorithms in dual chamber devices......Page 159 13. Tachy/Sinus ratio......Page 160 14. Decision making for single or dual chamber ICD......Page 161 Author details......Page 165 References......Page 166 1.1. Anti-tachycardia pacing......Page 169 2. Pacing to discriminate between atrial tachycardia and re-entrant SVT......Page 171 3. Pitfalls in interpreting the VAAV/VAV response......Page 174 4. Limitations......Page 175 5. The post pacing interval after ATP as discrimination tool......Page 178 6. General considerations when approaching device based tracings......Page 182 References......Page 184 Implantable Cardioverter-Defibrillators in Sudden Cardiac Death Prevention: What Guidelines Don't Tell