The Nuts And Bolts of Icd Therapy

by Kenny, Tom

• ISBN13: 9781405135115
• ISBN10: 1405135115
• Edition: 1st
• Format: Paperback
• Copyright: 2005-11-18
• Publisher: Wiley-Blackwell

Summary

THE NUTS AND BOLTS OF ICD THERAPY builds on the series commenced with THE NUTS AND BOLTS OF CARDIAC PACING and offers a systematic approach to ICD therapy for clinician-readers with no formal training in cardiac rhythm management devices or electrophysiology. While this audience includes nurses and technicians (who often handle most of the routine chores of follow-up visits) it may also include cardiology fellows, medical students, and physicians who are not electrophysiologists.ICD stands for implantable cardioverter-defibrillator. A decade of clinical studies have gradually expanded the indications for these devices from "therapy of last resort" in 1986 (Medicare only approved them in cardiac arrest survivors who did not respond to medication) to broadened criteria in 1991 and again in 1999. In fact, right now, Medicare is reviewing another significant expansion (proposed September 2004) of ICD indications that would allow the device to be implanted in patients with compromised left-ventricular function, even if there was no documented evidence of any rhythm disorder.In short, the number of ICD patients is increasing sharply, particularly in the U.S. The number of electrophysiologists-physicians who specialize in the electrical system of the heart-is not increasing as dramatically. The result is that more and more ICD patients are being treated by physicians and staffs with little or no ICD training.Few academic courses even address the subject. Most clinicians learn about ICDs from colleagues or from training programs offered by manufacturers.Summary"Most people who get an ICD will have the implant performed by an electrophysiologist. But after that, most of them return to their primary physician or cardiologist, who may have little or no experience in ICD therapy and no obvious way to go about learning the subject," commented Tom Kenny. He has developed and taught numerous manufacturer-sponsored courses on ICD therapy, and knows first-hand the incredible demand for the subject and the level of knowledge of the average clinician.In actual clinical practice, there are hundreds of thousands of ICD patients being cared for by non-specialists who may not know enough about the devices to assure that the patient is receiving appropriate therapy. This book is aimed at all levels of healthcare professionals (cardiologists, non-cardiologist physicians, fellows, physician''s assistants, nurses, technicians and others) who need to know about the devices in the patients they treat.Even clinicians far removed from the world of cardiac rhythm management (dentists, surgeons) encounter ICD patients in their practice and may have to make special accommodations for the device.This book will treat the subject in a medically sound, professional, but familiar, friendly style. It will build, concept on concept, the fundamentals of ICD therapy. It will cover basics but also build up to more advanced concepts, so that this book will also be a great reference tool for even clinicians experienced in the care of ICD patients.OverviewAn ICD is primarily an implantable defibrillator; it monitors the heart and delivers a powerful jolt of energy (officially called "therapy delivery" but more accurately depicted by the slang term "shock") when the device detects a dangerously rapid and irregular heart beat. Defibrillators aim to treat sudden cardiac arrest, one of the "top five" major killers in the industrialized world. In that area, they are remarkably successful: defibrillators have a 99 percent efficacy rate.One issue in ICD therapy is determining who gets them. As one medical book puts it, one of the first symptoms of sudden cardiac arrest is death. Many people die of the "electrical accident" in the heart that causes sudden cardiac arrest without even knowing they have the condition. Identifying patients at risk is an ongoing scientific quest that has recently exploded to show that many hundreds of thousands of people are probably at risk of sudden c

Author Biography

Thomas P. Kenny is the primary author of the book, he is the Vice President of Education for St. Jude Medical, a leader in cardiac rhythm management devices. As such, he has developed and collaborated on a wide variety of training and educational materials for physicians, fellows, physician assistants, nurses, and technicians. He is an outstanding presenter with more than 15 years' experience in the electrical management of cardiac rhythms and a thorough understanding of the industry, the key opinion leaders, and its developments over time. He will provide the structure and content of the material.

Mr. Kenny has experienced both sides of training for cardiac rhythm management devices: in his early years, in clinical practice, caring for such patients, and today, as an executive charged with training the many people who use St. Jude Medical products.

Jo Ann LeQuang has worked with Tom Kenny for over ten years and was most recently Director of Communications at St. Jude Medical. She now owns LeQ Medical Communications based in Angleton, Texas. Jo Ann writes a regular medical column for a local Texas paper, translated Berndt Luderitz's book A History of the Disorders of Cardiac Rhythm (from German into English, 1995), and writes regularly for HMP Publications (medical magazines, newsletters, journals).

Table of Contents

Preface	vii
Sudden cardiac death	1	(11)
The history of ICDs	12	(4)
The ICD system	16	(4)
Indications for ICD implantation	20	(6)
Implant procedures	26	(11)
Sensing	37	(6)
Arrhythmia detection	43	(7)
Arrhythmia therapy	50	(12)
SVT discrimination	62	(8)
Bradycardia pacing	70	(7)
Electrograms	77	(9)
Special features	86	(7)
Diagnostics	93	(13)
A systematic guide to ICD follow-up	106	(9)
Troubleshooting	115	(8)
Glossary	123	(14)
Index	137