By David L. Hayes, Samuel J. Asirvatham, Paul A. Friedman

Including thirteen chapters, this publication is uniformly written to supply brilliant, matter-of-fact tools for figuring out and taking good care of sufferers with everlasting pacemakers, ICDs and CRT systems.Now more advantageous and up-to-date, together with a brand new bankruptcy on programming and optimization of CRT units, this moment variation offers a large number of details in an simply digestible shape. Cardiac Pacing and Defibrillation deals brilliant, matter-of-fact equipment for realizing and taking good care of sufferers, making daily medical encounters more straightforward and extra productive.Readers will enjoy the data and event shared via the authors of this booklet.

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Additional info for Cardiac Pacing and Defibrillation: A Clinical Approach

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117 All currently available commercial defibrillators use biphasic waveforms; a typical biphasic waveform is shown in Fig. 31C. Biphasic waveforms have numerous clinical advantages, all stemming from their improved defibrillation efficacy. 119 The improved efficacy of biphasic waveforms permits a greater tolerance in electrode positioning than that required for monophasic waveforms, facilitating the implanting procedure. 116,122,123 Simultaneously, advances in capacitor and battery technology have allowed for a reduction of pulse generator size.

Some devices do permit individualization of the pulse widths, based on the concept that individual variations in cellular time constants result in varying optimal pulse durations. 124,125 With few studies that specifically address this concept, individualized variation for optimization in patients with a high DFT requires further study. 0 0 5 10 15 20 Duration (ms) Fig. 32 Internal canine defibrillation threshold (peak current) plotted against waveform duration and tilt. Note important effect of tilt on threshold with this waveform.

Waveform modification if available with the generator Exchange the generator to a “high-output” device Exclude if possible drugs that increase the defibrillation threshold Add a superior vena cava coil Add a subcutaneous array or patch Move the generator to a left pectoral position if located on the right an adequate safety margin is not demonstrated. g. ]. If implantation criteria are still not met, some devices permit waveform pulse width adjustment (discussed below). Alternatively, a high-output device is used, leads are repositioned if it is thought that lead position can be improved, or an additional endovascular lead is added in systems that permit it.

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