Advances in Antiarrhythmic Drug Therapy, An Issue of Cardiac Electrophysiology Clinics

Amin Al-Ahmad, Paul Wang

Description

Implantable cardioverter-defibrillators (ICDs) are electronic devices installed in the chest to prevent sudden death caused by abnormally fast heart rhythms. Cardiac electrophysiologists are the physicians usually responsible for implanting and maintaining these devices. The technology for ICDs is rapidly evolving, and the articles in this issue will help electrophysiologists to keep up to date with the current generation of ICDs, including selection of patients who are appropriate for the device, monitoring patients after the device is implanted, and troubleshooting problems with the device.

Sujets

• Médecine
• Spécialités médicales
• Medical
• Cardiology

Informations

• Publié par: Saunders
• Date de parution: 28 septembre 2011
• Nombre de lectures: 0
• EAN13: 9781455712052
• Langue: English
• Poids de l'ouvrage: 2 Mo

Extrait

Advances in ICD Therapy , Vol. 3, No. 3, September 2011
ISSN: 1877-9182
doi: 10.1016/S1877-9182(11)00069-4

Contributors
Cardiac Electrophysiology Clinics
Advances in ICD Therapy
GUEST EDITOR: Paul Wang, MD
Amin Al-Ahmad, MD
CONSULTING EDITOR: Ranjan K. Thakur, MD, MPH, MBA, FHRS
Andrea Natale, MD, FACC, FHRS
ISSN  1877-9182
Volume 3 • Number 3 • September 2011

Advances in ICD Therapy , Vol. 3, No. 3, September 2011
ISSN: 1877-9182
doi: 10.1016/S1877-9182(11)00070-0

Contents
Cover
Contributors
Forthcoming Issues
Advances in ICD Therapy: “Ripples of the Past”
Advances in ICD Therapy
Indications for a Wearable Cardioverter-Defibrillator
Implantable Cardioverter–Defibrillator Therapy in Pediatric Patients and Congenital Heart Disease
ICD Lead Extraction
Strategies to Reduce ICD Shocks: The Role of Supraventricular Tachycardia–Ventricular Tachycardia Discriminators
Complications of ICD Generator Change and Implantations
Total Subcutaneous Defibrillators: The Current Status and Future Prospect of a New Technology
Lead Fracture: Incidence, Diagnosis and Preventing Inappropriate ICD Therapy
Cost-effectiveness of Implantable Cardioverter-Defibrillators and Cardiac Resynchronization Therapy
Unusual ICD Access
Caring for the Heart and Mind in ICD Patients
Advances in Remote Monitoring of Implantable Cardiac Devices
Defibrillation Threshold: Testing, Upper Limit of Vulnerability, and Methods for Reduction
Reducing ICD Shocks for Ventricular Arrhythmias
New Developments in ICD Leads and ICD Lead Configurations
Index
Advances in ICD Therapy , Vol. 3, No. 3, September 2011
ISSN: 1877-9182
doi: 10.1016/S1877-9182(11)00071-2

Forthcoming Issues
Advances in ICD Therapy , Vol. 3, No. 3, September 2011
ISSN: 1877-9182
doi: 10.1016/j.ccep.2011.07.004

Foreword
Advances in ICD Therapy: “Ripples of the Past”

Ranjan K. Thakur, MD, MPH, MBA, FHRS ,
Thoracic and Cardiovascular Institute, 405 West Greenlawn, Suite 400, Lansing, MI 48910, USA
E-mail address: [e-mail]
E-mail address: [e-mail]

Andrea Natale, MD, FHRS ,
Texas Cardiac Arrhythmia Institute, Center for Atrial Fibrillation at St David’s Medical Center, 1015 East 32nd Street, Suite 516, Austin, TX 78705, USA
E-mail address: [e-mail]
E-mail address: [e-mail]

Ranjan K. Thakur, MD, MPH, MBA, FHRS, Consulting Editor
Andrea Natale, MD, FHRS, Consulting Editor
To appreciate the advances in ICD therapy, it’s important to reflect on the past and ask the question, “advances from what?” Today’s advances owe their origins to the proverbial pebble dropped in the pond many years ago.
In 1956 Paul Zoll used alternating current defibrillation on post-heart surgery patients and in 1960 Bernard Lown introduced the first DC current defibrillator. While Mirowski and Mower were trying to develop an implantable defibrillator in the 1960s, it is the height of irony that it was Bernard Lown, who was the most vocal opponent advancing the charge (pun intended) that “…implanted defibrillator system represents an imperfect solution in search of a plausible and practical application.” 1 While this establishment view slowed the development of the ICD, it could not stall it for it was championed by indomitable individuals.
In 1985 the FDA approved the first automatic implanted defibrillator. To qualify for an implant, the patient had to survive two episodes of cardiac arrest; contrast that to primary prevention widely practiced today. The initial implanted device envisioned by Mirowski and Mower was a nonthoracotomy device, which delivered the energy via a transducer-tipped catheter, sensing pulsatile pressure, introduced through a peripheral vein into the right ventricle. Technological challenges prevented intracardiac defibrillation in the early years, and the first approved system was implanted by cardiac surgeons, used epicardial patches, and required a thoracotomy for implantation. Transvenous, nonthoracotomy defibrillation became possible a few years later, as shown by Bardy et al, and the implant procedures could be done by electrophysiologists. Innumerable advances, small and large, have occurred since 1985.
Despite these advances, both clinical and technological challenges remain. So, we congratulate Drs Wang and Al-Ahmad for their superb editing of this issue of the Cardiac Electrophysiology Clinics focused on “Advances in ICD Therapy.” They have selected topics that are relevant to today’s technology and clinical practice and they have followed the ripples a little further to glimpse into the future.

Reference

   1. B. Lown, P. Axelrod. Implanted Standby Defibrillators. Circulation . 1972;46:637-639.
Advances in ICD Therapy , Vol. 3, No. 3, September 2011
ISSN: 1877-9182
doi: 10.1016/j.ccep.2011.07.005

Preface
Advances in ICD Therapy

Paul J. Wang, MD ,
Department of Medicine, Stanford Arrhythmia Service and Cardiac Electrophysiology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305-5233, USA
E-mail address: [e-mail]
E-mail address: [e-mail]

Amin Al-Ahmad, MD ,
Department of Medicine, Stanford University School of Medicine, 300 Pasteur Dr H2146 MC 5233, Stanford, CA 94305-5233, USA
E-mail address: [e-mail]
E-mail address: [e-mail]

Paul J. Wang, MD, Guest Editor
Amin Al-Ahmad, MD, Guest Editor
We are honored and privileged to serve as editors for this volume on advances in ICD therapy. Since the introduction of the first transvenous ICD systems, there have been numerous advances that have made significant improvements in ICD performance and safety. We have invited experts in the field to discuss many of these important developments.
Drs Dewland, Olgin, and Lee lead off the issue with a discussion of the indications for a novel technology, the wearable cardioverter defibrillator. Drs Hill and Dubin then discuss the role of the implantable cardioverter defibrillator in pediatric patients and patients with congenital heart disease. Drs Maytin and Epstein provide a thorough overview of the indications, techniques, and outcomes of ICD lead extraction.
Drs Gard and Friedman review the role of supraventricular tachycardia–ventricular tachycardia discriminators to reduce ICD shocks. Drs Prutkin and Poole discuss the topic of complications of ICD generator change and implantations. Drs Refaat and Saba introduce a new technology, the subcutaneous defibrillator.
Drs Koneru, Kaszala, Huizar, and Ellenbogen focus on the topic of ICD lead fracture and review its incidence, diagnosis, and strategies to prevent inappropriate ICD therapy. Drs Freeman, Ullal, and Turakhia review the analysis of cost effectiveness of implantable cardioverter defibrillators and cardiac resynchronization therapy. Dr Rea provides insights into novel and unusual methods for ICD lead access.
Drs Ford, Cutitta, Woodrow, Kirian, and Sears discuss caring for the heart and mind in ICD patients. Drs Varma and Wilkoff focus on important advances in the remote monitoring of implantable cardiac devices. Drs Hsia, Chia, and Evans discuss the testing of the upper limit of vulnerability and methods of assessing defibrillation threshold. Drs Schoenhard and Zei review methods of reducing ICD shocks for ventricular arrhythmias. Dr Wang discusses new developments in ICD leads and ICD lead configurations.
The articles in this issue are designed to highlight the advances in ICDs and how they may translate into improved outcomes and care of patients with ICDs.
Advances in ICD Therapy , Vol. 3, No. 3, September 2011
ISSN: 1877-9182
doi: 10.1016/j.ccep.2011.05.001

Indications for a Wearable Cardioverter-Defibrillator

Thomas A. Dewland, MD a , Jeffrey E. Olgin, MD b , Byron K. Lee, MD, MAS b , *
a Division of Cardiology, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143-0103, USA
b Electrophysiology and Arrhythmia Service, Division of Cardiology, University of California, San Francisco, 500 Parnassus Avenue, San Francisco, CA 94143-1354, USA
* Corresponding author. Electrophysiology and Arrhythmia Service, Division of Cardiology, University of California, San Francisco, 500 Parnassus Avenue, Box 1354, MU 429, San Francisco, CA 94143-1354.
E-mail address: [e-mail]

Abstract
The wearable cardioverter-defibrillator (WCD) is an alternative antiarrhythmic device that provides continuous cardiac monitoring and defibrillation capabilities through a noninvasive electrode-based system. Although the WCD has been shown to be highly effective at restoration of sinus rhythm in patients with a ventricular tachyarrhythmia, randomized trials using the WCD in patient populations at elevated risk for arrhythmic death have not been reported. Clinical indications for WCD use are varied and continue to evolve as further experience with this relatively new technology emerges.

Keywords
• Wearable external defibrillator • Sudden cardiac arrest • Ventricular tachycardia • Fibrillation • Arrhythmia
Since the first description of ventricular fibrillation (VF) termination by means of an externally applied electric shock over half a century ago, 1 substantial progress has been made in the treatment of unstable tachyarrhythmias. The advent of microprocessor technology and improvements in battery storage have enabled the development of compact implantable devices capable of continuous cardiac rhythm monitoring and automated delivery of electrical energy to the myocardium. The modern implantable cardioverter-defibrillator (ICD) has evolved into an efficacious and widely used therapy for the treatment of patients who are at the highest risk for ventricular arrhythmias.
Heightened understanding and awareness of the public health burden imposed by sudden cardiac arrest (SCA) has paralleled advances in device-based antiarrhythmi