(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,...
9781405186384_1_pre.qxd 10/27/08 3:33 PM Page i Implantable Cardioverter-Defibrillators Step by Step AN ILLUSTRATED GUIDE 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 9781405186384_1_pre.qxd 10/27/08 3:33 PM Page ii Companion Website With this book you are given free access to a companion resources site www.wiley.com/go/icdstepbystep • The website includes over 150 images taken from this book • You are free to download these images and use them in your own presentations to students* How to access the website: • Look under the label on the front inside cover of the book to see your unique access code • Enter this code when prompted when you access the site *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 9781405186384_1_pre.qxd 10/27/08 3:33 PM Page iii Implantable CardioverterDefibrillators Step by Step AN ILLUSTRATED GUIDE Roland X Stroobandt MD, PhD Professor of Medicine Heart Center, University Hospital Ghent, Belgium Department 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 Engineering Technical University KHBO, Department of Electronics, Ostend, Belgium A John Wiley & Sons, Ltd., Publication 9781405186384_1_pre.qxd 10/27/08 3:33 PM Page iv This edition first published 2009, © 2009 R.X Stroobandt, S.S Barold and A.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 Registered office: John Wiley & Sons Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK Editorial offices: 9600 Garsington Road, Oxford, OX4 2DQ, UK The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK 111 River Street, Hoboken, NJ 07030-5774, USA For details of our global editorial offices, for customer services and for information about how to apply for permission to reuse the copyright material in this book please see our website at www.wiley.com/wiley-blackwell The right of the author to be identified as the author of this work has been asserted in accordance with the Copyright, Designs and Patents Act 1988 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 Stroobandt, R (Roland) Implantable cardioverter-defibrillators step by step : an illustrated guide / Roland X Stroobandt, S Serge Barold, Alfons F Sinnaeve p ; cm Sequel to: Cardiac pacemakers step by step / S Serge Barold, Roland X Stroobandt, Alfons F Sinnaeve c2004 ISBN 978-1-4051-8638-4 Implantable cardioverter-defibrillators—Handbooks, manuals, etc I Barold, S Serge II Sinnaeve, Alfons F III Barold, S Serge Cardiac pacemakers step by step IV Title [DNLM: Defibrillators, Implantable—Handbooks Tachycardia, Ventricular—therapy—Handbooks Death, Sudden, Cardiac—prevention & control—Handbooks Ventricular Fibrillation—therapy—Handbooks WG 39 S924i 2009] RC684.E4S74 2009 617.4’120645—dc22 2008033369 ISBN: 9781405186384 A catalogue record for this book is available from the British Library Set in 9.5/12pt palatino by Graphicraft Limited, Hong Kong Printed in Singapore by Markono Print Media Pte, Ltd 2009 9781405186384_1_pre.qxd 10/27/08 3:33 PM Page v Contents v 333 Preface vi Text Acknowledgments vii Cardiac tachyarrhythmias 333 Introduction ix Indications for ICD 337 Illustrations ICD hardware 342 ICD implantation and lead systems 349 Sensing and detection of ventricular tachycardia/fibrillation 354 SVT/VT discrimination 357 ICD therapies 360 Timing cycles of ICDs 367 Complications of ICD therapy 368 10 ICD follow-up 374 11 Troubleshooting 382 12 Cardiac resynchronization 388 13 Appendix A: American College of Cardiology/American Heart Association/European Society of Cardiology: 2006 Guidelines for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Death 400 Appendix B: American College of Cardiology/American Heart Association/Heart Rhythm Society: 2008 Guidelines for ICD and CRT 406 Index 409 Cardiac tachyarrhythmias Indications 21 ICD hardware 39 Battery, capacitors and leads 39 ICD implantation 67 Sensing and detection 90 SVT/VT discrimination 112 ICD therapies 144 ICD timing cycles 168 Complications of ICD therapy 176 10 Follow-up of ICDs 195 11 Troubleshooting 217 12 Special ICD functions and resynchronization therapy 229 13 ICD function with emphasis on stored electrograms 255 Representative examples to 65 260 14 9781405186384_1_pre.qxd vi 10/27/08 3:33 PM Page 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 pacemaker 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 selfexplanatory and the text in the appendix provides a summary of the field The relevant figures are cited 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 resynchronization 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 attention, and we apologize for this We have discussed only the devices from the three US manufacturers as models, merely for the sake of convenience We are well aware that manufacturers outside of the United States produce excellent 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 9781405186384_1_pre.qxd 10/27/08 3:33 PM Page vii 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– 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 vii Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death) Developed in collaboration 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 DeviceBased Therapy of Cardiac Rhythm Abnormalities: a report of the 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) developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons J Am Coll Cardiol 2008;51:e1-62 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 recordings included in this book 9781405186384_1_pre.qxd 10/27/08 3:33 PM Page ix Introduction Sudden cardiac death remains a major public health problem and accounts for 450 000 deaths annually 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 ventricular tachyarrhythmias and sudden cardiac death These advances have made ICDs easier and safer to implant and better accepted by patients and physicians 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 ix 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 treatment, 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 antitachycardia 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 9781405186384_1_pre.qxd 10/27/08 x Figure 0.01 3:33 PM Page x 9781405186384_4_010.qxd 10/27/08 4:02 PM Page 205 205 Figure 10.10 9781405186384_4_010.qxd 10/27/08 206 Figure 10.11 4:02 PM Page 206 9781405186384_4_010.qxd 10/27/08 4:02 PM Page 207 207 Figure 10.12 9781405186384_4_010.qxd 10/27/08 208 Figure 10.13 4:02 PM Page 208 9781405186384_4_010.qxd 10/27/08 4:02 PM Page 209 209 Figure 10.14 9781405186384_4_010.qxd 10/27/08 210 Figure 10.15 4:03 PM Page 210 9781405186384_4_010.qxd 10/27/08 4:03 PM Page 211 211 Figure 10.16 9781405186384_4_010.qxd 10/27/08 212 Figure 10.17 4:03 PM Page 212 9781405186384_4_010.qxd 10/27/08 4:03 PM Page 213 213 Figure 10.18 9781405186384_4_010.qxd 10/27/08 214 Figure 10.19 4:03 PM Page 214 9781405186384_4_010.qxd 10/27/08 4:03 PM Page 215 215 Figure 10.20 9781405186384_4_010.qxd 10/27/08 216 Figure 10.21 4:04 PM Page 216 9781405186384_4_011.qxd 10/27/08 3:56 PM Page 217 217 Figure 11.00 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 9781405186384_4_011.qxd 10/27/08 218 Figure 11.01 3:56 PM Page 218 9781405186384_4_011.qxd 10/27/08 3:56 PM Page 219 219 Figure 11.02 ... Page 11 11 Figure 1. 10 97 814 0 518 6384_4_0 01. qxd 10 /27/08 12 Figure 1. 11 3:46 PM Page 12 97 814 0 518 6384_4_0 01. qxd 10 /27/08 3:47 PM Page 13 13 Figure 1. 12 97 814 0 518 6384_4_0 01. qxd 10 /27/08 14 Figure 1. 13... Page 17 17 Figure 1. 16 97 814 0 518 6384_4_0 01. qxd 10 /27/08 18 Figure 1. 17 3:47 PM Page 18 97 814 0 518 6384_4_0 01. qxd 10 /27/08 3:47 PM Page 19 19 Figure 1. 18 97 814 0 518 6384_4_0 01. qxd 10 /27/08 20 Figure 1. 19... 14 Figure 1. 13 3:47 PM Page 14 97 814 0 518 6384_4_0 01. qxd 10 /27/08 3:47 PM Page 15 15 Figure 1. 14 97 814 0 518 6384_4_0 01. qxd 10 /27/08 16 Figure 1. 15 3:47 PM Page 16 97 814 0 518 6384_4_0 01. qxd 10 /27/08 3:47