Implantable Cardioverter Defibrillator Therapy

by Kroll, Mark W.; Lehmann, Michael H.

• ISBN13: 9780792343004
• ISBN10: 079234300X
• Format: Hardcover
• Copyright: 1996-11-30
• Publisher: Kluwer Academic Pub

Summary

The Implantable Cardioverter Defibrillator, or `ICD', is arguably the most technologically challenging type of therapy that physicians utilize today. At the same time, engineers who design ICDs are being called upon by clinicians to extend even further the technological envelope in the quest of building the `ideal' device. To the extent, however, that physicians who utilize ICDs are not sufficiently comfortable with, or familiar with, the engineering principles that guide ICD function, the full clinical potential of even an ideal device will not be realized. In complementary fashion, engineers require as full an appreciation as possible of the real world `boundary conditions' and clinical impact of various ICD features, if the latter are truly to be perfected. Implantable Cardioverter Defibrillator Therapy: The Engineering-Clinical Interface is intended to serve as an educational tool to foster mutual understanding and communication among physicians, engineers, and other professionals involved in ICD therapy, with the ultimate purpose of enhancing patient care.

Table of Contents

Preface

Sudden Cardiac Death

History of the ICD

The Electrophysiological Effects of Defibrillation Shocks

Defining the Defibrillation Dosage

The Defibrillation Threshold

Pathways for Defibrillation Current

The Defibrillation Waveform

The System

Leads for the ICD

The Battery

The High Voltage Capacitor

The Pulse Generator

High Power Circuitry

The Amplifier: Sensing the Depolarization

Tachyarrhythmia Detection

Anti-Tachycardia Pacing and Cardioversion

Implantation: Pre-Operative Evaluation to Discharge

ICD Infection Avoidance: Science, Art, Discipline

Safety Margins for Sensing and Detection: Programming Tradeoffs

Patient Followup Systems

Troubleshooting Suspected ICD Malfunction

Clinical Results

Sudden Death Despite ICD Therapy

Future Clinical Challenges

Glossary

Index

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