Ebook Implantable cardioverter - Defibrillators step by step: Part 1

(BQ) Part 1 book Implantable cardioverter - Defibrillators step by step includes: Cardiac tachyarrhythmias, indications, ICD hardware battery, capacitors and leads, ICD implantation, sensing and detection, SVT/VT discrimination, troubleshooting, follow-up of ICDs,...

Implantable Cardioverter-Defibrillators Step by Step

A N I L L U S T R A T E D G U I D E9781405186384_1_pre.qxd 10/27/08 3:33 PM Page i

Implantable Cardioverter-Defibrillators Step by Step: An Illustrated Guide Roland X Stroobandt, S Serge Barold and Alfons F Sinnaeve

© 2009 R.X Stroobandt, S.S Barold and A.F Sinnaeve ISBN: 978-1-405-18638-4

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presenta-Implantable Cardioverter- Defibrillators Step by Step

AN ILLUSTRATED GUIDE

Roland X Stroobandt

MD, PhD

Professor of MedicineHeart Center, University Hospital Ghent, BelgiumDepartment of Cardiology, A.Z Damiaan Hospital, Ostend, Belgium

S Serge Barold

MD, FRACP, FACP, FACC, FESC, FHRS

Clinical Professor of Medicine,University of South Florida Cardiology Division,Tampa General Hospital, Tampa, Florida, USA

Alfons F Sinnaeve

Ing, MSc

Professor Emeritus of Electronic EngineeringTechnical University KHBO, Department of Electronics,Ostend, Belgium

A John Wiley & Sons, Ltd., Publication9781405186384_1_pre.qxd 10/27/08 3:33 PM Page iii

This edition first published 2009, © 2009 R.X Stroobandt, S.S Barold and A.F SinnaeveBlackwell 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.

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Library of Congress Cataloging-in-Publication Data

Stroobandt, R (Roland)Implantable cardioverter-defibrillators step by step : an illustrated guide / Roland X Stroobandt, S Serge Barold, Alfons F Sinnaeve

[DNLM: 1 Defibrillators, Implantable—Handbooks 2 Tachycardia, Ventricular—therapy—Handbooks

3 Death, Sudden, Cardiac—prevention & control—Handbooks 4 Ventricular Fibrillation—therapy—Handbooks

WG 39 S924i 2009]

RC684.E4S74 2009617.4’120645—dc22

2008033369ISBN: 9781405186384

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

Set in 9.5/12pt palatino by Graphicraft Limited, Hong KongPrinted in Singapore by Markono Print Media Pte, Ltd

1 20099781405186384_1_pre.qxd 10/27/08 3:33 PM Page iv

4 ICD implantation 67

5 Sensing and detection 90

6 SVT/VT discrimination 112

7 ICD therapies 144

8 ICD timing cycles 168

9 Complications of ICD therapy 176

4 ICD implantation and lead systems 349

5 Sensing and detection of ventricular tachycardia/fibrillation 354

6 SVT/VT discrimination 357

7 ICD therapies 360

8 Timing cycles of ICDs 367

9 Complications of ICD therapy 368

14 Appendix B: American College

of Cardiology/American Heart Association / Heart Rhythm Society:

2008 Guidelines for ICD and CRT 406

v

Contents

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vi Preface

Implantable Cardioverter-Defibrillators Step By Step

is the logical sequel to our first book, Cardiac

Pacemakers Step by Step, published in 2004 The

pacemaker book should obviously be studied before starting this book because pacing constitutes an integral part of the function of an implantable cardioverter-defibrillator (ICD) The original pace- maker book was so well received that we decided to keep the same format In addition, 65 carefully selected ICD recordings have been included.

As one picture is worth a thousand words, we have tried to avoid unnecessary text and focused

on visual learning Many of the figures are explanatory and the text in the appendix provides a summary of the field The relevant figures are cited

self-in the appended text This arrangement promotes learning as an enjoyable and fun experience.

We have discussed the electrophysiologic aspects

of ICD implantation but omitted a description of the standard surgical implantation procedures, which are well described elsewhere Furthermore, the major ICD trials are mentioned only briefly to avoid reduplication of the abundant literature on the subject Barring these two issues, which might have rendered the work unwieldy, the book provides a comprehensive review of the basic and clinical

aspects of ICD therapy A section on cardiac chronization was added because most patients with such devices also receive an ICD The rapid evolution of technology made our task a moving target, with the continual need to upgrade some of the material Despite our efforts, it is possible that some dated material might have escaped our atten- tion, and we apologize for this.

resyn-We have discussed only the devices from the three US manufacturers as models, merely for the sake of convenience We are well aware that manu- facturers outside of the United States produce excel- lent devices Although a full description of non-US ICDs is beyond the scope of the book, such ICDs share many characteristics with US devices so that the book will be universally applicable to the clinical evaluation of all devices regardless of their origin.

We are particularly indebted to representatives

of Medtronic Inc., St Jude Medical and Boston Scientific for helping and guiding us with this project However, we remain responsible for any mistakes related to ICD technology.

Roland X Stroobandt

S Serge Barold Alfons F Sinnaeve

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Acknowledgments

Carsten Israel MD (Frankfurt, Germany), Michael

O Sweeney MD (Boston, MA), Bengt Herweg MD (Tampa, FL), and representatives from Medtronic Inc., Boston Scientific and St Jude Medical kindly provided a number of tracings.

Figure 13.381 was reproduced with permission from Mehdirad A, Fredman C, Bierman K, Barold

SS AV interval-dependent crosstalk Pacing Clin Electrophysiol 2008;31:232–4.

Figure 13.36 was reproduced with permission from Stroobandt R, Hagers Y, Provenier F, Van Belle

Y, Hamerlijnck R, Barold SS Silent lead malfunction detected only during defibrillator replacement.

Pacing Clin Electrophysiol 2006;29:67–9.

Figure 13.44 was reproduced with permission from Sung RJ, Lauer MR (eds) Implantable cardioverter-defibrillator therapy In: Fundamental Approaches to the Management of Cardiac Arrhythmias Dordrecht, The Netherlands: Kluwer Academic Publishers, 2000:287–416.

Parts of the following guideline were reproduced

by permission of the American Heart Association.

Zipes DP, Camm AJ, Borggrefe M, Buxton AE, Chaitman B, Fromer M, Gregoratos G, Klein G, Moss AJ, Myerburg RJ, Priori SG, Quinones MA, Roden DM, Silka MJ, Tracy C, Smith SC Jr, Jacobs

AK, Adams CD, Antman EM, Anderson JL, Hunt

SA, Halperin JL, Nishimura R, Ornato JP, Page

RL, Riegel B, Priori SG, Blanc JJ, Budaj A, Camm

AJ, Dean V, Deckers JW, Despres C, Dickstein

K, Lekakis J, McGregor K, Metra M, Morais J, Osterspey A, Tamargo JL, Zamorano JL ACC/

AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Death—Executive Summary:

A Report of the American College of Cardiology/

American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With

Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death) Developed in collabora- tion With the European Heart Rhythm Association and the Heart Rhythm Society J Am Coll Cardiol.

2006;48:e247-346.

Epstein AE, DiMarco JP, Ellenbogen KA, Estes

NA 3rd, Freedman RA, Gettes LS, Gillinov AM, Gregoratos G, Hammill SC, Hayes DL, Hlatky

MA, Newby LK, Page RL, Schoenfeld MH, Silka MJ, Stevenson LW, Sweeney MO, Smith SC Jr, Jacobs

AK, Adams CD, Anderson JL, Buller CE, Creager

MA, Ettinger SM, Faxon DP, Halperin JL, Hiratzka

LF, Hunt SA, Krumholz HM, Kushner FG, Lytle

BW, Nishimura RA, Ornato JP, Page RL, Riegel

B, Tarkington LG, Yancy CW; American College

of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee

to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices); American Association for Thoracic Surgery; Society of Thoracic Surgeons.

ACC/AHA/HRS 2008 Guidelines for Based Therapy of Cardiac Rhythm Abnormalities:

Device-a report of the AmericDevice-an College of CDevice-ardiology/

American Heart Association Task Force on tice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices) developed in collabora- tion with the American Association for Thoracic Surgery and Society of Thoracic Surgeons J Am Coll Cardiol 2008;51:e1-62.

Prac-The authors would also like to thank the nurses and technicians: Veerle De Meyer, Myriam Peleman, Rudy Colpaert, Guy De Cocker of the University Hospital, Ghent, Belgium, and Filiep Vandenbulcke

of the A.Z Damiaan Hospital, Ostend, Belgium, for their dedicated care of ICD patients and ability to recognize the teaching value of a number of record- ings included in this book.

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Introduction

Sudden cardiac death remains a major public health problem and accounts for 450 000 deaths annu- ally in the United States and 400 000 in Europe.

Michel Mirowski began developing an implantable defibrillator in the mid-1960s The first automatic defibrillator was finally implanted in a human patient in 1980 The device presently known as an implantable cardioverter-defibrillator (ICD) has proven effective in preventing sudden cardiac death Since 1980, technologic advances in device therapy including miniaturization, improved leads, optimal waveforms and transvenous implantation have revolutionized the treatment of malignant ven- tricular tachyarrhythmias and sudden cardiac death.

These advances have made ICDs easier and safer to implant and better accepted by patients and physi- cians Thus, ICDs have evolved from a treatment

of last resort to the gold standard for patients at high risk for life-threatening ventricular arrhythmias.

Recent advances include dual-chamber ICDs, additional therapy for atrial arrhythmias, and ICDs combined with biventricular pacing for selected heart failure patients Device-based monitoring of contemporary ICDs can also record data unrelated

to arrhythmias such as activity and the status of lung fluid in patients with congestive heart failure.

Finally, ICDs provide health benefits with efficiency comparable to other well-accepted forms of health care such as renal dialysis.

The ICD does not prevent arrhythmias from occurring, and it is sometimes likened to having a miniature ambulance crew inside the chest Shock delivery is the final step in a cascade of events beginning with arrhythmia detection The device can detect ventricular tachyarrhythmias, determine whether they should be converted to a normal rhythm with a shock or rapid ventricular pacing, and then administer therapy After successful treat- ment, the device must recognize the nontachycardic rhythm and reset the therapy sequences for the next event Afterwards, the device keeps a complete record of what it has done An ICD also gives bradycardia and post-shock bradycardia support like a conventional pacemaker.

Cardioversion and defibrillation are both forms

of high-energy therapy or shocks If the patient is conscious at the time of a shock, it is painful and usually described as feeling like a kick in the chest.

Patients should be advised of this in advance Their families should be advised that someone touching them is not harmed if the ICD discharges.

ICDs are multiprogrammable devices capable of delivering therapy for ventricular tachyarrhythmias

in the form of high-energy defibrillation shocks, low-energy (cardioversion) shocks or antitachy- cardia pacing, and conventional pacing therapy for bradyarrhythmias (Fig 0.01) Today’s devices have

a longevity of about 5–7 years, depending on shock and pacing frequency.

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Figure 0.01

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Figure 1.00

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Implantable Cardioverter-Defibrillators Step by Step: An Illustrated Guide Roland X Stroobandt, S Serge Barold and Alfons F Sinnaeve

© 2009 R.X Stroobandt, S.S Barold and A.F Sinnaeve ISBN: 978-1-405-18638-4

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Figure 2.00

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Implantable Cardioverter-Defibrillators Step by Step: An Illustrated Guide Roland X Stroobandt, S Serge Barold and Alfons F Sinnaeve

© 2009 R.X Stroobandt, S.S Barold and A.F Sinnaeve ISBN: 978-1-405-18638-4

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