Ebook Cardiac pacemakers and resynchronization step-by-step (2e): Part 1

Part 1 book “Cardiac pacemakers and resynchronization step-by-step” has contents: Recording pacemaker activity, fundamentals of electricity, ventricular stimulation, automatic mode switching, putomatic mode switching, pacemaker interference, pemote pacemaker monitoring,… àn other contents.

Trang 1

P1: OTE/PGN P2: OTE/PGN QC: OTE/PGN T1: OTE

BLBK303-FM BLBK303-Barold June 2, 2010 17:11 Trim: 276mm×219mm Printer Name: Yet to Come

i

Trang 2

Cardiac Pacemakers and Resynchronization

Step-by-Step

A N I L L U S T R A T E D G U I D E

i

Cardiac Pacemakers and Resynchronization Step-by-Step: An Illustrated Guide, Second Edition

S Serge Barold, Roland X Stroobandt and Alfons F Sinnaeve

Trang 3

Companion Website

With this book you are given free access to a companion resources site:

www.wiley.com/go/barold/cardiac

The website includes more than 300 images taken from this book

You are free to download these images and use them for your own presentations to students∗

How to access the website:

Look under the label below to see your access code.

Go to www,wiley.com/go/barold/cardiac and enter the code when prompted.

∗Please note that these images are for your own use for study and instruction If you are using these images in a presentation, the reference to the book should always be displayed along with the image See website for full copyright information.

ii

Trang 4

Cardiac Pacemakers and Resynchronization Step-by-Step

AN ILLUSTRATED GUIDE

Second Edition

S Serge Barold

MD, FRACP, FACP, FACC, FESC, FHRS

University of South Florida and Florida Heart Rhythm InstituteTampa, Florida, USA

Roland X Stroobandt

MD, PhD

Professor of MedicineHeart Center, Department of ElectrophysiologyUniversity Hospital, Ghent

Ghent, Belgium

Alfons F Sinnaeve ing., MSc

Professor Emeritus of Electronic EngineeringTechnical University KHBO, Department of ElectronicsOostende, Belgium

A John Wiley & Sons, Ltd., Publication

iii

Trang 5

This edition first published 2010, C 2010 by S Serge Barold, Roland X Stroobandt, and Alfons

F Sinnaeve Blackwell Publishing was acquired by John Wiley & Sons in February 2007 Blackwell’s publishing program has been merged with Wiley’s global Scientific, Technical and Medical business to form Wiley-Blackwell.

All rights reserved No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by the UK Copyright, Designs and Patents Act

1988, without the prior permission of the publisher.

Wiley also publishes its books in a variety of electronic formats Some content that appears in print may not be available in electronic books.

Designations used by companies to distinguish their products are often claimed as trademarks All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners The publisher is not associated with any product or vendor mentioned in this book This publication is designed to provide accurate and authoritative information in regard to the subject matter covered It is sold on the understanding that the publisher is not engaged in rendering professional services.

If professional advice or other expert assistance is required, the services of a competent professional should be sought.

The contents of this work are intended to further general scientific research, understanding, and discussion only and are not intended and should not be relied upon as recommending or promoting a specific method, diagnosis, or treatment by physicians for any particular patient The publisher and the author make no representations or warranties with respect to the accuracy or completeness of the contents of this work and specifically disclaim all warranties, including without limitation any implied warranties of fitness for a particular purpose In view of ongoing research, equipment modifications, changes in governmental regulations, and the constant flow of information relating to the use of medicines, equipment, and devices, the reader is urged to review and evaluate the information provided in the package insert or instructions for each medicine, equipment, or device for, among other things, any changes in the instructions or indication of usage and for added warnings and precautions Readers should consult with a specialist where appropriate The fact that an organization or Website is referred to in this work as a citation and/or a potential source of further information does not mean that the author or the publisher endorses the information the organization or Website may provide or recommendations it may make Further, readers should be aware that Internet Websites listed in this work may have changed or disappeared between when this work was written and when it is read No warranty may be created or extended by any promotional statements for this work Neither the publisher nor the author shall be liable for any damages arising herefrom.

Library of Congress Cataloging-in-Publication Data

Barold, S Serge.

Cardiac pacemakers and resynchronization therapy step-by-step : an illustrated guide / S Serge Barold, Roland X Stroobandt, Alfons F Sinnaeve – 2nd ed.

p ; cm.

Rev ed of: Cardiac pacemakers step-by-step c2004.

Includes bibliographical references and index.

ISBN: 9781405186360

A catalogue record for this book is available from the British Library.

Set in 9.5/12 pt Palatino by Aptara R Inc., New Delhi, India Printed and bound in Singapore

1 2010

iv

Trang 6

v

Contents

Preface to the first edition, vii Preface to the second edition, viii Abbreviations, ix

Color Plate Section

What is a pacemaker?, 1 Recording pacemaker activity, 2 Fundamentals of electricity, 10 Ventricular stimulation, 19 Pacing leads, 33

Sensing – basic concepts, 40 Sensing – advanced concepts, 58 Basic pacemaker electrocardiography, 71 Other single chamber pacemakers, 83 DDD pacemakers – basic functions, 86 DDD pacemakers – upper rate response, 107 Atrioventricular interval, 123

Retrograde ventriculoatrial synchrony in dual chamber pacemakers, 128

All dual chamber pacemakers function in the DDD mode, 141

Types of lower rate timing, 159 Atrial capture, 166

Automatic mode switching, 176 Pacemaker radiography, 191 Oversensing, 196

Troubleshooting, 201 Pacemaker hemodynamics and rate-adaptive pacing, 214

Pacemaker tachycardias – Part 1, 242 Pacemaker tachycardias – Part 2, 248 Treatment of tachycardia, 252 Pacemaker interference, 256 Pacemaker follow-up, 263 Remote pacemaker monitoring, 308 Special functions, 315

Biventricular pacing and cardiac resynchronization, 320 Conclusion, 354

Text: Overview of cardiac pacing and cardiac resynchronization

Cardiac pacing, 357

Implantation, 357 Basic function, 357

Power source, 357 Rate or interval?, 358 Single chamber pacemakers, 358 Basic electricity, 360

Chronic pacing threshold and safety margin, 360 Sensing, 362

Polarity: unipolar versus bipolar pacing and sensing, 363

Ventricular fusion and pseudofusion beats, 363 Operational characteristics of a simple DDD pacemaker, 363

Crosstalk and crosstalk intervals, 367 Increasing complexity: our simple DDD pacemaker grows to nine intervals, 367 Upper rate response of DDD pacemakers, 368 Lower rate timing of dual chamber

pacemakers, 369 Phantom programming, 369 Programmability of lower rate, 369 Endless loop tachycardia, 371 Repetitive non-reentrant VA synchrony: the cousin of endless loop tachycardia, 372 Types of dual chamber pacemakers, 373 Overdrive suppression and the underlying rhythm, 374

Pacemaker hemodynamics, 374 Rate-adaptive pacemakers, 375 The pacemaker stimulus, 376 Magnet mode, 376

Normal QRS patterns during right ventricular pacing, 377

Left ventricular endocardial pacing, 378 Manifestations of myocardial infarction in the paced rhythm, 378

Cardiac memory, 379 Pacemaker alternans, 380 Complications of pacemakers, 380 Non-electrical complications, 380 Electrical complications, 383 Automatic mode switching, 390 Minimizing right ventricular pacing, 392 Effect of drugs and electrolyte imbalance, 394 Magnet application, 395

Capture verification algorithms, 395 Keeping good records, 397

Factors influencing pacemaker longevity, 397

Trang 7

vi

Pacemaker follow-up, 398 The pacemaker as an implantable Holter system, 400

Special functions of pacemakers, 404

Cardiac resynchronization (CRT), 405

CRT hemodynamics, 405 CRT with only left ventricular pacing, 405 New York Heart Association class I and II patients with left bundle branch block and depressed left ventricular function, 406 Right bundle branch block, 406

CRT in patients with a narrow QRS complex, 406

Impact of CRT, 407 Alternative routes to left ventricular pacing, 408

What is a CRT responder?, 408 Complications of CRT implantation, 408 Impact of comorbidities, 409

Programming of CRT devices, 409 Atrial fibrillation and atrial tachyarrhythmia, 420 Congestive heart failure after CRT, 420

Trang 8

vii

Preface to the first edition

The impetus for writing this book came from our servations that many healthcare professionals and young physicians working in emergency rooms, in- tensive and coronary care units were unable to inter- pret simple pacemaker electrocardiograms correctly.

ob-Over the years we also heard many complaints from beginners in the field of cardiac pacing that virtu- ally all, if not all, the available books are too compli- cated and almost impossible to understand Indeed, the ever-changing progress in electrical stimulation makes cardiac pacing a moving target Therefore we decided to take up the challenge and write a book for beginners equipped with only a rudimentary knowledge of electrocardiography and no knowledge of cardiac pacing whatsoever Because many individuals first see the pacemaker patient after implantation, the book contains little about indications for pacing and implantation techniques The book starts with basic concepts and progressively covers more advanced aspects of cardiac pacing including troubleshooting and follow-up.

As one picture is worth a thousand words, this book tries to avoid unnecessary text and focuses on visual learning We undertook this project with the premise that learning cardiac pacing should be en- joyable Cardiac pacing is a logical discipline and should be fun and easy to learn with the carefully crafted illustrations in this book The artwork is simple for easy comprehension Many of the plates are self-explanatory and the text in the appendix only intends to provide further details and a comprehen- sive overview.

Many of the images used to create the illustrations

in this book are taken from CorelDraw and Corel Mega Gallery clipart collections.

We are grateful to Charlie Hamlyn of Blackwell Publishing and Tom Fryer of Sparks for their superb work in the production of this book.

S Serge Barold Roland X Stroobandt Alfons F Sinnaeve

Trang 9

The first edition of the book has been well received all over the world and translated into Japanese, Chi- nese and Polish The same format has been retained

in the second edition because of its wide ity and the frequent positive feedback that it facili- tates learning and understanding Many new plates were added A few plates were upgraded and a few were deleted when the message was no longer rel- evant We have reviewed the advances in cardiac pacing over the last seven years and introduced an important new presentation on cardiac resynchronization, which is a rapidly growing field The in- corporation of many suggestions from readers has also contributed to the increased size of the second

popular-edition For example, the latter now includes an panded text (including a large section on cardiac resynchronization), a discussion of indications, and

ex-a list of pertinent references As before, we omitted the technical details of pacemaker implantation and lead extraction We are grateful to Thomas V Hart- man, Kate Newell, and Cathryn Gates from Wiley- Blackwell Publishing for their outstanding work in the production of this book.

S Serge Barold Roland X Stroobandt Alfons F Sinnaeve

Trang 10

AHA American Heart Association AHR atrial high rate

AMS automatic mode switching

AP atrial paced event APC atrial premature complex

AR atrial event sensed in the refractory

period

AS atrial sensed event

AT atrial tachycardia ATP antitachycardia pacing ATR atrial tachycardia response

AV atrioventricular AVE atrioventricular extension AVI atrioventricular interval (also called

AV delay) AVI-U atrioventricular interval, unblanked BiV biventricular

BLR basic lower rate BOL beginning-of-life

BP biventricular paced event

BP blood pressure bpm beats per minute

device and defibrillator

CS coronary sinus CSNRT corrected sinus node recovery time

CT computed tomography ECG electrocardiogram EGM electrogram ELT endless loop tachycardia EMI electromagnetic interference EOL end-of-life

EOS end-of-service

ER evoked response ERI elective replacement indicator ERT elective replacement time ESCI escape interval

ESCR escape rate FARI filtered atrial rate interval FCC Federal Communications Commission HCM hypertrophic cardiomyopathy

HF heart failure

HR heart rate HRS Heart Rhythm Society HRV heart-rate variability

HV His–ventricular

I current (in amps, A) IACD intraatrial conduction delay ICD implantable cardioverter-defibrillator

IV interventricular

LA left atrium LBBB left bundle branch block LBT listen before talk LRI lower rate interval LRL lower rate limit

LV left ventricle LVEF left ventricular ejection fraction LVESV left ventricular end-systolic volume LVOT left ventricular outflow tract

mEq milliequivalent

MI myocardial infarction MICS Medical Implant Communications

System MRI magnetic resonance imaging

PMT pacemaker-mediated tachycardia

Trang 11

x

ppm pacing per minute

PR peripheral resistance PVAB postventricular atrial blanking period PVARP postventricular atrial refractory period PVARP-U postventricular atrial refractory period,

unblanked PVC premature ventricular complex

(= VPC) PVE premature ventricular event pVRP ventricular refractory period after

pacing

R resistance (in ohms, )

RA right atrium RAM random-access memory RBBB right bundle branch block

RF radiofrequency RNRVAS repetitive non-reentrant VA

synchrony ROM read-only memory

RR respiratory rate RRT recommended replacement time

RV right ventricle RVA right ventricular apex RVOT right ventricular outflow tract SAI spontaneous atrial interval SAR spontaneous atrial rate SAS synchronous atrial stimulation sAVI AV interval after a sensed event SDI sensor-driven interval

SDR sensor-driven rate SND sinus node dysfunction

sVRP ventricular refractory period after

sensing SVT supraventricular tachycardia TARP total atrial refractory period TCL tachycardia cycle length TDI tissue Doppler imaging TEE transesophageal echocardiography

TV tidal volume

U voltage (in volts, V) URI upper rate interval URL upper rate limit

VP ventricular paced event VPC ventricular premature complex VPI ventricular paced interval VPR ventricular paced rate

VR ventricular event sensed in the

refractory period VRP ventricular refractory period VRP-U ventricular refractory period,

Trang 12

part-Ia BLBK303-Barold-fig March 9, 2010 9:42 Trim: 276mm×219mm Printer Name: Yet to Come

1

Trang 13

2

Trang 14

3

Trang 15

4

Trang 16

5

Trang 17

6

Trang 18

7

Trang 19

8

Trang 20

9

Trang 21

10

Trang 22

11

Trang 23

12

Trang 24

13

Trang 25

14

Trang 26

15

Trang 27

16

Trang 28

17

Trang 29

18

Trang 30

19

Trang 31

20

Trang 32

part-Ib BLBK303-Barold-fig March 9, 2010 7:31 Trim: 276mm×219mm Printer Name: Yet to Come

21

Trang 33

22

Trang 34

23

Trang 35

24

Trang 36

25

Trang 37

26

Trang 38

27

Trang 39

28

Trang 40

29

Định dạng
Số trang	211
Dung lượng	24,32 MB