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Part 1 book “Cardiac pacemakers and resynchronization step-by-step” has contents: Recording pacemaker activity, fundamentals of electricity, ventricular stimulation, automatic mode switching, putomatic mode switching, pacemaker interference, pemote pacemaker monitoring,… àn other contents.
P1: OTE/PGN P2: OTE/PGN BLBK303-FM BLBK303-Barold QC: OTE/PGN June 2, 2010 T1: OTE 17:11 Trim: 276mm×219mm Printer Name: Yet to Come i P1: OTE/PGN P2: OTE/PGN BLBK303-FM BLBK303-Barold QC: OTE/PGN June 2, 2010 T1: OTE 17:11 Trim: 276mm×219mm Printer Name: Yet to Come Cardiac Pacemakers and Resynchronization Step-by-Step AN ILLUSTRATED GUIDE Cardiac Pacemakers and Resynchronization Step-by-Step: An Illustrated Guide, Second Edition S Serge Barold, Roland X Stroobandt and Alfons F Sinnaeve © 2010 S Serge Barold, Roland X Stroobandt, and Alfons F Sinnaeve ISBN: 978-1-405-18636-0 i P1: OTE/PGN P2: OTE/PGN BLBK303-FM BLBK303-Barold QC: OTE/PGN June 2, 2010 T1: OTE 17:11 Trim: 276mm×219mm Printer Name: Yet to Come Companion Website With this book you are given free access to a companion resources site: www.wiley.com/go/barold/cardiac The website includes more than 300 images taken from this book You are free to download these images and use them for your own presentations to students∗ How to access the website: Look under the label below to see your access code Go to www,wiley.com/go/barold/cardiac and enter the code when prompted ∗ 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 ii P1: OTE/PGN P2: OTE/PGN BLBK303-FM BLBK303-Barold QC: OTE/PGN June 2, 2010 T1: OTE 17:11 Trim: 276mm×219mm Printer Name: Yet to Come Cardiac Pacemakers and Resynchronization Step-by-Step AN ILLUSTRATED GUIDE Second Edition S Serge Barold MD, FRACP, FACP, FACC, FESC, FHRS University of South Florida and Florida Heart Rhythm Institute Tampa, Florida, USA Roland X Stroobandt MD, PhD Professor of Medicine Heart Center, Department of Electrophysiology University Hospital, Ghent Ghent, Belgium Alfons F Sinnaeve ing., MSc Professor Emeritus of Electronic Engineering Technical University KHBO, Department of Electronics Oostende, Belgium A John Wiley & Sons, Ltd., Publication iii P1: OTE/PGN P2: OTE/PGN BLBK303-FM BLBK303-Barold QC: OTE/PGN June 2, 2010 T1: OTE 17:11 Trim: 276mm×219mm This edition first published 2010, F Sinnaeve C Printer Name: Yet to Come 2010 by S Serge Barold, Roland X Stroobandt, and Alfons 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 UK 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 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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 Barold, S Serge Cardiac pacemakers and resynchronization therapy step-by-step : an illustrated guide / S Serge Barold, Roland X Stroobandt, Alfons F Sinnaeve – 2nd ed p ; cm Rev ed of: Cardiac pacemakers step-by-step c2004 Includes bibliographical references and index ISBN 978-1-4051-8636-0 Cardiac pacemakers–Pictorial works I Stroobandt, R (Roland) II Sinnaeve, Alfons F III Barold, S Serge Cardiac pacemakers step-by-step IV Title [DNLM: Cardiac Pacing, Artificial–methods–Handbooks Pacemaker, Artificial–Handbooks Electrocardiography–methods–Handbooks WG 39 B264c 2010] RC684.P3B365 2010 617.4’120645–dc22 2010010756 ISBN: 9781405186360 A catalogue record for this book is available from the British Library Set in 9.5/12 pt Palatino by Aptara R Inc., New Delhi, India Printed and bound in Singapore 2010 iv P1: OTE/PGN P2: OTE/PGN BLBK303-FM BLBK303-Barold QC: OTE/PGN June 2, 2010 T1: OTE 17:11 Trim: 276mm×219mm Printer Name: Yet to Come Contents Preface to the first edition, vii Preface to the second edition, viii Abbreviations, ix Color Plate Section What is a pacemaker?, Recording pacemaker activity, Fundamentals of electricity, 10 Ventricular stimulation, 19 Pacing leads, 33 Sensing – basic concepts, 40 Sensing – advanced concepts, 58 Basic pacemaker electrocardiography, 71 Other single chamber pacemakers, 83 DDD pacemakers – basic functions, 86 DDD pacemakers – upper rate response, 107 Atrioventricular interval, 123 Retrograde ventriculoatrial synchrony in dual chamber pacemakers, 128 All dual chamber pacemakers function in the DDD mode, 141 Types of lower rate timing, 159 Atrial capture, 166 Automatic mode switching, 176 Pacemaker radiography, 191 Oversensing, 196 Troubleshooting, 201 Pacemaker hemodynamics and rate-adaptive pacing, 214 Pacemaker tachycardias – Part 1, 242 Pacemaker tachycardias – Part 2, 248 Treatment of tachycardia, 252 Pacemaker interference, 256 Pacemaker follow-up, 263 Remote pacemaker monitoring, 308 Special functions, 315 Biventricular pacing and cardiac resynchronization, 320 Conclusion, 354 Text: Overview of cardiac pacing and cardiac resynchronization Cardiac pacing, 357 Implantation, 357 Basic function, 357 v Power source, 357 Rate or interval?, 358 Single chamber pacemakers, 358 Basic electricity, 360 Chronic pacing threshold and safety margin, 360 Sensing, 362 Polarity: unipolar versus bipolar pacing and sensing, 363 Ventricular fusion and pseudofusion beats, 363 Operational characteristics of a simple DDD pacemaker, 363 Crosstalk and crosstalk intervals, 367 Increasing complexity: our simple DDD pacemaker grows to nine intervals, 367 Upper rate response of DDD pacemakers, 368 Lower rate timing of dual chamber pacemakers, 369 Phantom programming, 369 Programmability of lower rate, 369 Endless loop tachycardia, 371 Repetitive non-reentrant VA synchrony: the cousin of endless loop tachycardia, 372 Types of dual chamber pacemakers, 373 Overdrive suppression and the underlying rhythm, 374 Pacemaker hemodynamics, 374 Rate-adaptive pacemakers, 375 The pacemaker stimulus, 376 Magnet mode, 376 Normal QRS patterns during right ventricular pacing, 377 Left ventricular endocardial pacing, 378 Manifestations of myocardial infarction in the paced rhythm, 378 Cardiac memory, 379 Pacemaker alternans, 380 Complications of pacemakers, 380 Non-electrical complications, 380 Electrical complications, 383 Automatic mode switching, 390 Minimizing right ventricular pacing, 392 Effect of drugs and electrolyte imbalance, 394 Magnet application, 395 Capture verification algorithms, 395 Keeping good records, 397 Factors influencing pacemaker longevity, 397 P1: OTE/PGN P2: OTE/PGN BLBK303-FM BLBK303-Barold vi QC: OTE/PGN June 2, 2010 T1: OTE 17:11 Trim: 276mm×219mm Printer Name: Yet to Come Pacemaker follow-up, 398 The pacemaker as an implantable Holter system, 400 Special functions of pacemakers, 404 Cardiac resynchronization (CRT), 405 CRT hemodynamics, 405 CRT with only left ventricular pacing, 405 New York Heart Association class I and II patients with left bundle branch block and depressed left ventricular function, 406 Right bundle branch block, 406 CRT in patients with a narrow QRS complex, 406 Impact of CRT, 407 Alternative routes to left ventricular pacing, 408 What is a CRT responder?, 408 Complications of CRT implantation, 408 Impact of comorbidities, 409 Programming of CRT devices, 409 Atrial fibrillation and atrial tachyarrhythmia, 420 Congestive heart failure after CRT, 420 Arrhythmias after CRT, 422 Appendix: guidelines, 423 American guidelines for pacemaker implantation, 423 European guidelines for pacemaker implantation, 429 Commentary, 433 Further reading, 441 Index, 451 P1: OTE/PGN P2: OTE/PGN BLBK303-FM BLBK303-Barold QC: OTE/PGN June 2, 2010 T1: OTE 17:11 Trim: 276mm×219mm Printer Name: Yet to Come Preface to the first edition The impetus for writing this book came from our observations that many healthcare professionals and young physicians working in emergency rooms, intensive and coronary care units were unable to interpret simple pacemaker electrocardiograms correctly Over the years we also heard many complaints from beginners in the field of cardiac pacing that virtually all, if not all, the available books are too complicated and almost impossible to understand Indeed, the ever-changing progress in electrical stimulation makes cardiac pacing a moving target Therefore we decided to take up the challenge and write a book for beginners equipped with only a rudimentary knowledge of electrocardiography and no knowledge of cardiac pacing whatsoever Because many individuals first see the pacemaker patient after implantation, the book contains little about indications for pacing and implantation techniques The book starts with basic concepts and progressively covers more advanced aspects of cardiac pacing including troubleshooting and follow-up vii As one picture is worth a thousand words, this book tries to avoid unnecessary text and focuses on visual learning We undertook this project with the premise that learning cardiac pacing should be enjoyable Cardiac pacing is a logical discipline and should be fun and easy to learn with the carefully crafted illustrations in this book The artwork is simple for easy comprehension Many of the plates are self-explanatory and the text in the appendix only intends to provide further details and a comprehensive overview Many of the images used to create the illustrations in this book are taken from CorelDraw and Corel Mega Gallery clipart collections We are grateful to Charlie Hamlyn of Blackwell Publishing and Tom Fryer of Sparks for their superb work in the production of this book S Serge Barold Roland X Stroobandt Alfons F Sinnaeve P1: OTE/PGN P2: OTE/PGN BLBK303-FM BLBK303-Barold viii QC: OTE/PGN June 2, 2010 T1: OTE 17:11 Trim: 276mm×219mm Printer Name: Yet to Come Preface to the second edition The first edition of the book has been well received all over the world and translated into Japanese, Chinese and Polish The same format has been retained in the second edition because of its wide popularity and the frequent positive feedback that it facilitates learning and understanding Many new plates were added A few plates were upgraded and a few were deleted when the message was no longer relevant We have reviewed the advances in cardiac pacing over the last seven years and introduced an important new presentation on cardiac resynchronization, which is a rapidly growing field The incorporation of many suggestions from readers has also contributed to the increased size of the second edition For example, the latter now includes an expanded text (including a large section on cardiac resynchronization), a discussion of indications, and a list of pertinent references As before, we omitted the technical details of pacemaker implantation and lead extraction We are grateful to Thomas V Hartman, Kate Newell, and Cathryn Gates from WileyBlackwell Publishing for their outstanding work in the production of this book S Serge Barold Roland X Stroobandt Alfons F Sinnaeve P1: OTE/PGN P2: OTE/PGN BLBK303-FM BLBK303-Barold QC: OTE/PGN June 2, 2010 T1: OTE 17:11 Trim: 276mm×219mm Printer Name: Yet to Come Abbreviations A ACC AEGM AEI AF AFR Ah AH AHA AHR AMS AP APC AR As AS AT ATP ATR AV AVE AVI AVI-U BiV BLR BOL BP BP bpm BV C CAD CHF CO CRT CRT-D CS CSNRT CT ECG EGM ELT EMI EOL ampere American College of Cardiology atrial electrogram atrial escape interval atrial fibrillation atrial flutter response amperehour atrial–His American Heart Association atrial high rate automatic mode switching atrial paced event atrial premature complex atrial event sensed in the refractory period amperesecond atrial sensed event atrial tachycardia antitachycardia pacing atrial tachycardia response atrioventricular atrioventricular extension atrioventricular interval (also called AV delay) atrioventricular interval, unblanked biventricular basic lower rate beginning-of-life biventricular paced event blood pressure beats per minute biventricular coulomb coronary artery disease congestive heart failure cardiac ouput cardiac resynchronization therapy cardiac resynchronization therapy device and defibrillator coronary sinus corrected sinus node recovery time computed tomography electrocardiogram electrogram endless loop tachycardia electromagnetic interference end-of-life ix EOS ER ERI ERT ESCI ESCR FARI FCC HCM HF HR HRS HRV HV Hz I IACD ICD IV LA LBBB LBT LRI LRL LV LVEF LVESV LVOT A mA mEq MI MICS MRI ms MSDR MTR mV MV MVP NYHA OVI PAVB pAVI PM PMT end-of-service evoked response elective replacement indicator elective replacement time escape interval escape rate filtered atrial rate interval Federal Communications Commission hypertrophic cardiomyopathy heart failure heart rate Heart Rhythm Society heart-rate variability His–ventricular hertz current (in amps, A) intraatrial conduction delay implantable cardioverter-defibrillator interventricular left atrium left bundle branch block listen before talk lower rate interval lower rate limit left ventricle left ventricular ejection fraction left ventricular end-systolic volume left ventricular outflow tract microampere milliampere milliequivalent myocardial infarction Medical Implant Communications System magnetic resonance imaging millisecond maximum sensor-driven rate maximum tracking rate millivolt minute volume managed ventricular pacing New York Heart Association open ventricular interval postatrial ventricular blanking period AV interval after a paced event pacemaker pacemaker-mediated tachycardia P1: OTE/PGN part-Ij P2: OTE/PGN BLBK303-Barold-fig 186 QC: OTE/PGN March 9, 2010 T1: OTE 8:13 Trim: 276mm×219mm Printer Name: Yet to Come P1: OTE/PGN part-Ij P2: OTE/PGN BLBK303-Barold-fig QC: OTE/PGN March 9, 2010 T1: OTE 8:13 Trim: 276mm×219mm Printer Name: Yet to Come 187 P1: OTE/PGN part-Ij P2: OTE/PGN BLBK303-Barold-fig 188 QC: OTE/PGN March 9, 2010 T1: OTE 8:13 Trim: 276mm×219mm Printer Name: Yet to Come P1: OTE/PGN part-Ij P2: OTE/PGN BLBK303-Barold-fig QC: OTE/PGN March 9, 2010 T1: OTE 8:13 Trim: 276mm×219mm Printer Name: Yet to Come 189 P1: OTE/PGN part-Ij P2: OTE/PGN BLBK303-Barold-fig 190 QC: OTE/PGN March 9, 2010 T1: OTE 8:13 Trim: 276mm×219mm Printer Name: Yet to Come P1: OTE/PGN part-Ij P2: OTE/PGN BLBK303-Barold-fig QC: OTE/PGN March 9, 2010 T1: OTE 8:13 Trim: 276mm×219mm Printer Name: Yet to Come 191 Cardiac Pacemakers and Resynchronization Step-by-Step: An Illustrated Guide, Second Edition S Serge Barold, Roland X Stroobandt and Alfons F Sinnaeve © 2010 S Serge Barold, Roland X Stroobandt, and Alfons F Sinnaeve ISBN: 978-1-405-18636-0 P1: OTE/PGN part-Ij P2: OTE/PGN BLBK303-Barold-fig 192 QC: OTE/PGN March 9, 2010 T1: OTE 8:13 Trim: 276mm×219mm Printer Name: Yet to Come P1: OTE/PGN part-Ij P2: OTE/PGN BLBK303-Barold-fig QC: OTE/PGN March 9, 2010 T1: OTE 8:13 Trim: 276mm×219mm Printer Name: Yet to Come 193 P1: OTE/PGN part-Ij P2: OTE/PGN BLBK303-Barold-fig 194 QC: OTE/PGN March 9, 2010 T1: OTE 8:13 Trim: 276mm×219mm Printer Name: Yet to Come P1: OTE/PGN part-Ij P2: OTE/PGN BLBK303-Barold-fig QC: OTE/PGN March 9, 2010 T1: OTE 8:13 Trim: 276mm×219mm Printer Name: Yet to Come 195 P1: OTE/PGN part-Ij P2: OTE/PGN BLBK303-Barold-fig QC: OTE/PGN March 9, 2010 T1: OTE 8:13 Trim: 276mm×219mm Printer Name: Yet to Come 196 Cardiac Pacemakers and Resynchronization Step-by-Step: An Illustrated Guide, Second Edition S Serge Barold, Roland X Stroobandt and Alfons F Sinnaeve © 2010 S Serge Barold, Roland X Stroobandt, and Alfons F Sinnaeve ISBN: 978-1-405-18636-0 P1: OTE/PGN part-Ij P2: OTE/PGN BLBK303-Barold-fig QC: OTE/PGN March 9, 2010 T1: OTE 8:13 Trim: 276mm×219mm Printer Name: Yet to Come 197 P1: OTE/PGN part-Ij P2: OTE/PGN BLBK303-Barold-fig 198 QC: OTE/PGN March 9, 2010 T1: OTE 8:13 Trim: 276mm×219mm Printer Name: Yet to Come P1: OTE/PGN part-Ij P2: OTE/PGN BLBK303-Barold-fig QC: OTE/PGN March 9, 2010 T1: OTE 8:13 Trim: 276mm×219mm Printer Name: Yet to Come 199 P1: OTE/PGN part-Ik P2: OTE/PGN BLBK303-Barold-fig 200 QC: OTE/PGN March 9, 2010 T1: OTE 8:14 Trim: 276mm×219mm Printer Name: Yet to Come ...P1: OTE/PGN P2: OTE/PGN BLBK303-FM BLBK303-Barold QC: OTE/PGN June 2, 2 010 T1: OTE 17 :11 Trim: 276mm× 219 mm Printer Name: Yet to Come Cardiac Pacemakers and Resynchronization Step-by-Step. .. information ii P1: OTE/PGN P2: OTE/PGN BLBK303-FM BLBK303-Barold QC: OTE/PGN June 2, 2 010 T1: OTE 17 :11 Trim: 276mm× 219 mm Printer Name: Yet to Come Cardiac Pacemakers and Resynchronization Step-by-Step. .. GUIDE Cardiac Pacemakers and Resynchronization Step-by-Step: An Illustrated Guide, Second Edition S Serge Barold, Roland X Stroobandt and Alfons F Sinnaeve © 2 010 S Serge Barold, Roland X Stroobandt,