Open Access Medical Books



Edited by Attila Roka .

298 pages .
Open Access .

Implantable cardiac pacemakers have been utilized for more than 50 years now. Continuous development transformed them from rudimentary, asynchronous pulse generators to sophisticated devices with advanced diagnostic and therapeutic capabilities. Implantable defibrillators and biventricular devices, treating malignant tachyarrhythmias and dyssynchrony, use a similar technology. As initial issues of bradycardia-related pacing got resolved, new issues have been recognized, such as the deleterious effects of chronic right ventricular pacing or high risk of complications due to utilization in a frail patient population.
Evidence-based practice guidelines were initially developed with a focus on indications and contraindications. Safe utilization of implantable antiarrhythmia devices begins with proper patient selection; implantation method and technique, device programming and follow up are also important aspects that determine the outcome. Lack of high quality data, which could guide these decisions, leads to large individual and geographical variations. Recently, expert consensus documents addressed several important topics, such as follow-up or end-of-life considerations, however, further research is still needed to provide a basis for a more uniform, safe therapy.
This book reviews several current issues and recent advances in pacemaker therapy. Improving safety of implantation is of utmost importance to decrease complications. Transvenous route became the standard approach for antiarrhythmic cardiac device implantation as it poses only a minimal burden to the patient. Cardiac resynchronization therapy can still be challenging from this approach due to highly variable individual anatomy – recently, interventional and minimally invasive surgical methods have been developed and studied in detail, with great success. Although the risk of severe periprocedural complications is low for pacemaker or defibrillator implants, there are still dreaded consequences, such as endocarditis or lead perforation, which may be lethal if not addressed in a timely and appropriate manner.
Transvenous lead extraction revolutionized management of these complications. Other common issues encountered during follow up include unnecessary right ventricular pacing and atrial fibrillation, with its potential to interact with device function. Several new algorithms have been introduced lately to address these issues – familiarity with these may prevent misinterpreting appropriate device function as malfunction.

Patients are frequently seen by multiple healthcare providers in various settings, and questions may arise whether the implanted device contributes to, or is responsible for the clinical presentation. As device-specific programmers are not always immediately available, routine diagnostic modalities, such as a 12-lead ECG should be evaluated first as these may often identify or rule out a potential issue.
Multiple ongoing research projects address potential applications related to implantable cardiac arrhythmia devices: studies on nonlinear cardiac dynamics, mobile telemonitoring and phrenic nerve stimulation in patients with diaphragmatic paralysis will be reviewed, displaying the potential of the technology beyond antibradycardia pacing.
I am extremely grateful to the international group of authors who contributed this book - their expertise clearly shows the worldwide abundance of pacemaker technology and thriving research activity in this field. I would like to also appreciate the help of the wonderful InTech editorial staff – Ms. Tanja Skorupan and Mr. Hrvoje Pecotic, who expertly guided us through the publication process. A special thanks to
my family – wife, Erika, and children, Fruzsina, Alice and Adam, who provided a supportive environment while working on this project.

Attila Roka MD, PhD
Hospital of St. Raphael, New Haven, CT,



Section 1 Novel Implantation Techniques .

 1 Techniques of Permanent Pacemaker Implantation 3 Majid Haghjoo

 2 Interventional and Minimally Invasive Surgical Techniques Facilitating Cardiac Resynchronization Therapy 13 Bela Merkely, Levente Molnar and Attila Roka

Section 2 Follow Up and Optimization of Device Function .

 3 Electrocardiographic Troubleshooting of Implanted Cardiac Electronic Devices 35 Attila Roka

 4 Strategies and Pacemaker Algorithms for Avoidance of Unnecessary Right Ventricular Stimulation 73 D. Bastian and K. Fessele

 5 Implanted Devices and Atrial Fibrillation 105 Federico Guerra, Michela Brambatti, Maria Vittoria Matassini and Alessandro Capucci

Section 3 Management of Complications .

 6 Complications of Pacemaker Implantation 131 Jeffrey L. Williams and Robert T. Stevenson

 7 Device-Related Endocarditis and Infected Leads Extraction: The Dark Side of The Moon 159 Michele Rossi, Giuseppe Musolino, Giuseppe Filiberto Serraino and Attilio Renzulli

 8 Mechanism and Management of Pacing Lead Related Cardiac Perforation 173 Sanjay Kumar, Haidar Yassin, Opesanmi Esan, Adam S. Budzikowski and John T. Kassotis

 9 Intravascular Lead Extractions: Tips and Tricks 189 Spyridon Koulouris and Sofia Metaxa

 10 Emergencies of Implantable Cardioverter Defibrillator 217 Baris Bugan

Section 4 Frontiers of Pacemaker Technology .

 11 Nonlinear Cardiac Dynamics 233 Charles L. Webber, Jr.

 12 Mobile and Wireless Technologies on Sphygmomanometers and Pulsimeters for Patients with Pacemakers and Those with Other Cardiovascular Diseases 247 Ching-Sung Wang and Teng-Wei Wang

 13 Phrenic Nerve Pacing: Current Concepts 269 Jorge F. Velazco, Shekhar Ghamande and Salim Surani

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Published by: Unknown - Tuesday, May 14, 2013