Chapter
In Memoriam—Dr Mark Allen Wood
CHAPTER 1: Indications for permanent and temporary cardiac pacing
Anatomy and physiology of the conduction system
Indications for permanent pacemakers
Indications for permanent pacing in sinus node dysfunction
Acquired atrioventricular block
Indications for permanent pacing in acquired AV block
Chronic bifascicular block
Indications for pacing in chronic bifascicular block
Indications for pacing in neurally-mediated syncope and hypersensitive carotid sinus syndrome
Idiopathic orthostatic hypotension
Specific conditions associated with cardiac conduction disease
Chronic neuromuscular disorders
Infiltrative and inflammatory disorders
Hypertrophic cardiomyopathy
Indications for permanent pacing for hypertrophic cardiomyopathy (adapted from guidelines published in 201146)
Pacing for systolic heart failure
Indications for pacing in heart failure and impaired LV systolic function
Pacing to prevent or terminate tachycardias
Indications for permanent pacing to prevent or terminate tachycardias
Pacing for children and adolescents (including all patients with congenital heart block)
Indications for permanent pacing in children and adolescents
Permanent pacing after the acute phase of myocardial infarction
Indications for permanent pacing following acute myocardial infarction
Pacing after cardiac surgery and transcatheter aortic valve implantation
Indications for temporary cardiac pacing
Acute myocardial infarction
Temporary pacing for procedural interventions
Other indications for temporary pacing
Temporary pacing for tachycardias
CHAPTER 2: Components of a pacing and ICD system: basic concepts of pacing
Electrophysiological considerations
Electrical excitability of the cardiac myocyte
Propagation of electrical stimuli
Bipolar versus unipolar sensing
Bipolar versus unipolar stimulation
Electrode–myocardial interface maturation
Time-dependent changes in sensing, impedance, and threshold
Considerations of time-dependent changes in the context of device programming
Impact of clinical variables on pacing threshold
Lead designs, materials, and functional characteristics
Monitoring, detecting, and reporting of lead malfunction and failure
Magnetic resonance compatible pacemakers and leads
Rate-adaptive pacing and other sensors
Dynamic AV and VV interval programming
Programming of pacemaker sensor algorithms
Choosing the right sensor
CHAPTER 3: Hemodynamics of cardiac pacing and pacing mode selection
Correction of bradycardia
Chronotropic incompetence and rate modulation
Chronotropic incompetence
Advantages and clinical benefits of rate modulation
Atrioventricular synchrony
Effects of optimal atrioventricular interval timing
Determination of optimal atrioventricular interval
Detrimental effects of right ventricular pacing
Strategies to minimize right ventricular pacing
Alternative site right ventricular pacing
Left ventricular pacing and cardiac resynchronization therapy
Suboptimal response to cardiac resynchronization therapy
Pacing in hypertrophic obstructive cardiomyopathy
CHAPTER 4: Temporary cardiac pacing
Cardiopulmonary resuscitation
Reversible causes of severe bradycardia
Temporary endocardial pacing
Temporary epicardial pacing
Temporary dual chamber pacing
Insertion of an endovascular temporary pacemaker
CHAPTER 5: Techniques of pacemaker implantation and removal
Assessment of the patient
Anticoagulants and antiplatelet agents
Subclavian vein anomalies
Patients at risk for asystole
Ventricular lead positioning
Epicardial lead placement
Revision of the implanted pacemaker system and pulse generator change
Post-procedure management
Complications of implantation
Complications of biventricular pacing
Accufix wire fragment retrieval
Extraction of coronary venous leads
Thoracotomy for lead extraction
Medicolegal aspects of implantation
CHAPTER 6: Pacemaker timing cycles and special features
Single or dual chamber asynchronous pacing (AOO, VOO, DOO)
Single chamber (atrial or ventricular) inhibited pacing (AAI, VVI)
Single chamber triggered mode (without inhibition) pacing (AAT, VVT)
Dual chamber pacing and sensing with inhibition and tracking (DDD)
Dual chamber pacing and sensing with inhibition but without tracking (DDI)
Ventricular pacing with inhibition and dual chamber sensing (VDI)
Atrioventricular sequential, ventricular inhibited pacing (DVI)
Ventricular pacing, dual chamber sensing with P-synchronous ventricular pacing and inhibition (VDD)
Blanking and refractory periods
Timing cycles based on pacing mode
Atrioventricular interval, cross-talk, and safety pacing
Ventriculoatrial interval (VAI)
Total and post-ventricular atrial refractory periods
Single chamber inhibited and rate-modulated pacing
Single chamber and dual chamber rate-modulated asynchronous pacing
Dual chamber rate-modulated pacing (DDDR, DDIR)
Comparison of atrial- and ventricular-based systems
Effects of ventricular- and atrial-based timing systems on rate-modulated pacing modes
Base rate during mode switch/fallback
Rate smoothing/stabilization
Rate-modulated pacing (sensor input to base rate pacing)
Algorithms to allow intrinsic sinus rate
Algorithms for cardioinhibitory neurogenic syncope
Algorithms for atrial arrhythmia detection and atrial pace/sense competition
2:1 Lock-in protection algorithm
Non-competitive atrial pacing
Atrial protection interval
Algorithms to prevent atrial fibrillation
Algorithms to minimize right ventricular pacing
Pacemaker-mediated tachycardia
Algorithms to prevent, identify, and terminate pacemaker-mediated tachycardia
Loss of biventricular pacing
CHAPTER 7: Evaluation, troubleshooting, and management of pacing system malfunctions
General considerations; approach to evaluate pacemaker function and malfunction
Differential diagnosis of device malfunction
Abnormalities in the mechanical components of a pacing system
Pulse generator hardware and software
Radiographic imaging of pacer systems
Electrocardiographic manifestations of pacer malfunction
Interpretation of the electrocardiogram
Interpretation of intracardiac electrograms
Undersensing; failure to sense
Oversensing cardiac signals
Oversensing non-cardiac signals
Pacing at an unexpected rate or sudden change in pacing rate
Pacemaker-mediated tachycardia and repetitive non–re-entrant ventriculoatrial synchrony
Analysis of stored device data
Event counters and histograms
Arrhythmia logbook and stored electrograms
CHAPTER 8: The implantable cardioverter–defibrillator
Indications and supporting evidence
High-risk patients who do not benefit from ICDs
Fibrillation and defibrillation
Vulnerable zone for shock-induced ventricular fibrillation and the upper limit of vulnerability
The high-voltage capacitor
Sensing, detection, and arrhythmia discrimination
Testing defibrillation efficacy at ICD implant
Implantation without assessing defibrillation efficacy
ICD therapy and programming
CHAPTER 9: Cardiac resynchronization therapy
Heart failure and mechanisms of cardiac resynchronization therapy
Indications and patient selection
Coronary sinus cannulation
Coronary vein navigation and left ventricular lead selection
Assessment of optimal left ventricular lead position
Management of difficulties in placing left ventricular leads (Table 9.4)
High left ventricular stimulation thresholds
Phrenic nerve stimulation
Complications related to left ventricular lead placement and management
Mild-to-moderate heart failure
Approach to CRT non-responders
Etiology of underlying cardiomyopathy
Left ventricular structure and scar burden
Optimal left ventricular lead position
Maximizing biventricular pacing
Algorithm to approach non-responders
CHAPTER 10: ICD follow-up and troubleshooting
Detecting clinical events
Defibrillation thresholds
Guidant/Boston Scientific
Pharmacological or catheter-based therapy
Electromagnetic interference
Failure to detect or treat sustained VT
CHAPTER 11: Follow-up of the patient with a CIED
Goals of CIED follow-up assessment
Immediate post-implantation period
The follow-up clinic and record keeping
Radiography and fluoroscopy
Programmers and telemetry
Implantable loop recorders
Frequency and mode of follow-up
Special situations encountered by the CIED patient
Electromagnetic interference
Perioperative (periprocedural) management
Patients nearing end of life or requesting withdrawal of therapy
Other clinical situations
Device advisories (alerts and recalls)
Cardiac Pacing and ICDs
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