Open Access Medical Books


Edited by Natalia Trayanova .

260 pages .
Open Access .

According to the American Heart Association, an overwhelming number of sudden cardiac deaths, estimated at about 400,000 per year, are thought to result from ventricular fibrillation, the most lethal of all cardiac rhythm disorders. Ventricular fibrillation is the breakdown of the organized electrical activity driving the heart's periodic pumping into disorganized self-sustained electrical activation patterns. A fibrillation episode results in the loss of cardiac outpu and, unless timely intervention takes place, death quickly ensues. Cardiac defibrillation, as achieved by the delivery of high-intensity electric shocks, is currently the only reliable treatment for ventricular fibrillation. Indeed, external defibrillators have long been used as standard therapy for ventricular fibrillation, and implantable cardioverter/defibrillators (ICDs) have been demonstrated to be an effective, lifesaving technology, superior to pharmacological therapy. Large, well-controlled prospective ICD trials have revolutionized the concept of sudden cardiac death prophylaxis. These studies have resulted in rapid growth of the patient populations for whom ICDs are indicated, with over 200,000 devices implanted every year throughout the world. In addition, over 100,000 external transthoracic defibrillators are installed in cardiac clinics, and a growing number of automatic external defibrillators are being used in public places and in households.
The increasingly large and diverse populations of patients with ICDs have exposed some of the limitations of this clinical technology. Although mean defibrillation thresholds typically range from 7 to 11J, ICDs are designed to provide up to 40J shocks. This is to accommodate the nearly 25% of patients, which have higher defibrillation thresholds, requiring programming of the ICD at near maximum output.
Clinical studies have recognized the desirability of reducing shock strength, and over 200 papers have been published in the last 10 years on the topic of defibrillation thresholds. Reducing shock strength remains a major challenge to clinical defibrillation.
Although ICD therapy has proved to be efficient and reliable in preventing sudden cardiac death, defibrillation is a traumatic experience. The therapy is painful and could be detrimental to cardiac function. Furthermore, clinical data from ICD trials have suggested that 6 out of 7 shocks delivered are classified as inadequate. Issues related to inappropriate and unnecessary shocks as well as patient risk stratification and post ICD cardiac rehabilitation are essential to the delivery of appropriate care to ICD recipients.

Additionally, certain special populations of patients are poorly served by current ICD technology. These include children and patients of small body size. Unique difficulties surround cardiac defibrillation in the pediatric population, including high rates of lead failure, frequent inappropriate therapy, and the mismatch of device and lead size to the body.
Many of the advances in defibrillation have been accomplished through the developments in hardware and software and by experimental trial and error. Further advances in the clinical procedure of defibrillation will require increased knowledge of the basic mechanisms by which the electric fields interact with heart tissue. Therefore, research on defibrillation mechanisms, particularly aimed at developing low-voltage defibrillation strategies, remains an important basic science topic.
The objective of this book is to present contemporary views on the challenges and implications of cardiac defibrillation, and specifically, on the subjects presented above. Basic science chapters elucidate questions such as lead configurations and the reasons by which a defibrillation shock fails. The chapters devoted to the challenges in the clinical procedure of defibrillation address issues related to inappropriate and unnecessary shocks, complications associated with the implantation of ICD devices, and the application of the therapy in pediatric patients and young adults. The book also examines the implications of defibrillation therapy, such as patient risk stratification, cardiac rehabilitation, and remote monitoring of patient with implantable devices.

Natalia Trayanova, PhD
Johns Hopkins University, MD, Baltimore



Part 1 Basic Mechanisms of Defibrillation .

 1 Mechanisms of Defibrillation Failure 3 Takashi Ashihara, Jason Constantino and Natalia A. Trayanova

 2 The Role of the Purkinje System in Defibrillation 11 Edward J Vigmond, Patrick M. Boyle and Makarand Deo

 3 Analysis of the Lead Sensitivity Distribution in Implantable Cardioverter Defibrillator 27 Jesús Requena-Carrión, Juho Väisänen, Jari Hyttinen and Juan J. Vinagre-Díaz

 4 Modeling Defibrillation 39 Gernot Plank and Natalia Trayanova

Part 2 Challenges in Clinical Defibrillation .

 5 What Can We Do Before Defibrillation? 61 Chunsheng Li, Shuo Wang and Junyuan Wu

 6 Pulmonary, Cardiovascular and Mechanical Complications of Implantable Cardioverter Defibrillators (ICDs) 71 Georgia Hardavella, Georgios Dionellis and Nikolaos Koulouris

 7 New Ways to Avoid Unnecessary and Inappropriate Shocks 81 Jorge Toquero, Victor Castro, Cristina Mitroi and Ignacio Fernández Lozano

 8 Cardiovascular Implantable Cardioverter Defibrillator-Related Complications: From Implant to Removal or Replacement: A Review 101 Mariana Parahuleva

 9 Expanding Applications of Defibrillators and Cardiac Resynchronization Therapy to Include Adult Congenital Heart Disease 117 K Michael, B Mayosi, J Morgan and G Veldtman

 10 Role of Automated External Defibrillators (AED) in Sports 133 Saqib Ghani and Sanjay Sharma

Part 3 Pediatric Defibrillation .

 11 Implantable-Cardioverter Defibrillator in Pediatric Population 147 María Algarra, Pablo Santiago, Luis Tercedor, Miguel Álvarez, Rocío Peñas, Francisca Valverde and Abdulreda Abdallah

 12 ICD Implantations in the Pediatric and Young Adult Population 167 Ten Harkel Arend DJ and Blom Nico A

 13 AED for Paediatric Use, Implications in the Design of Shock Advice Algorithms 183 Sofia Ruiz de Gauna, Jesus Ruiz, Unai Irusta and Elisabete Aramendi

Part 4 ICD Implications .

 14 Role of Implantable Cardioverter Defibrillators for Dialysis Patients 207 Marlies Ostermann

 15 Cardiac Rehabilitation for Patients with an Implantable Cardioverter Defibrillator 213 Alan Robert Denniss and Robert Zecchin

 16 ICDs and Risk Stratification in Magnetic Field Imaging 221 Dania Di Pietro Paolo, Tobias Toennis and Sergio Nicola Erne

 17 Remote Monitoring of Implantable Cardioverter-Defibrillator Therapy 235 MJ Pekka Raatikainen and Ulla-Maija Koivisto

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Published by: Unknown - Monday, May 13, 2013


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