The nuts and bolts of implantable device therapy : pacemakers

334 Pages·2015·16.52 MB·English

by  Kenny, Tom

The Nuts and Bolts
of Implantable
Device Therapy
Pacemakers
The Nuts
and Bolts
of Implantable
Device Therapy
Pacemakers
Tom Kenny,
FHRS, CCDS
Director of Education, PrepMD, Braintree, MA, USA
This edition first published 2015; © 2015 by John Wiley & Sons, Ltd.
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Library of Congress Cataloging-in-Publication Data
Kenny, Tom, 1954– , author.
The nuts and bolts of implantable device therapy pacemakers / Tom Kenny.
p. ; cm.
Includes index.
ISBN 978-1-118-67067-5 (pbk.)
I. Title.
[DNLM: 1. Cardiac Pacing, Artificial–methods. 2. Pacemaker, Artificial. WG 168]
RC684.P3
617.4′120645–dc23
2014027299
A catalogue record for this book is available from the British Library.
Cover images: © iStock.com/angelhel; © iStock.com/RASimon
Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not
be available in electronic books.
Set in 9.5/12pt Minion by SPi Publisher Services, Pondicherry, India
1 2015
Contents
Preface, vi 14 Single-chamber timing cycles, 153
Acknowledgments, vii 15 Introduction to dual-chamber
timing cycles, 169
1 Cardiovascular anatomy and physiology, 1
16 Dual-chamber timing cycles: the atrial
2 Cardiac conduction system, 15
channel, 179
3 The cardiac cycle and hemodynamics, 21
17 Dual-chamber timing cycles: the ventricular
4 Heart disease, 29 channel, 195
5 Cardiac medications related to cardiac 18 Paced eCg and egM analysis, 205
rhythm management devices, 37
19 Upper-rate behavior, 219
6 The basics of eCg and rhythm
20 Advanced dual-chamber timing, 233
interpretation, 48
21 Rate-responsive pacing, 242
7 Arrhythmia analysis, 58
8 electricity 101, 78 22 Special features, 260
9 Pacing 101, 84 23 Automatic capture algorithms, 278
10 Indications for pacing, 104 24 Pacemaker follow-up, 297
11 Pacemaker implantation, 116 25 Follow-up and troubleshooting, 310
12 C onnecting the leads to the pulse generator, 131 Key answer, 316
13 Pacemaker modes and codes, 140 Index, 320
v
Preface
Cardiac pacing has changed dramatically in the past break down some of the complexities of this cardiac
decades, and yet certain things have not changed at pacing. Cardiac pacing can seem overwhelmingly
all. While technology has advanced cardiac pacing complex because it involves the simultaneous inter-
to provide benefits to more and more patients while play of many different factors. Somebody once
streamlining device function and downsizing the told me that there are more than a million pos-
pulse generators, cardiac pacing is still a field that sible device parameter combinations available in
can be difficult to learn and slow to master. Those today’s most advanced pacemakers. So how does a
who become cardiac pacing specialists are those busy clinician find that one-in-a-million pacing
who take the time to learn the concepts, work sys- prescription? The number of options may have
tematically through follow-up, and listen carefully changed, but it is still about the basics. You find
to their patients. It has been more than three decades the right mode. The right rate. You program an AV
since I entered the cardiac rhythm management delay. You just work through the programming
field and two decades since I wrote my first work- one simple step at a time. For those willing to learn
book on pacing to assist those trying to learn the the concepts and approach things systematically,
field—and while everyone talks about how much cardiac pacing can be mastered.
cardiac pacing has changed in the past decades, it It has always been about the patient and how
strikes me how much has stayed the same. that patient interacts with the pacemaker. Our
After all, it is still about a battery, a wire in the patients come to the clinic—often nervous about
heart, and timing tiny electrical pulses to fire at their new “battery-powered” status—and expect
precisely the right split-second. It is still about to find in us clinicians both expertise and reas-
knowing rate and mode and being able to find a surance. I hope this book conveys my sentiment
pacing spike on an ECG. And it is still about that the greatest expert is one who not only
restoring as near-to-normal a cardiac rhythm as knows what to do but also knows how to talk
possible to our patients. warmly, frankly, and helpfully to each and every
For those embarking on a career in cardiac patient.
pacing or clinicians who just need to know more
about device-based cardiac rhythm management Tom Kenny
therapy, it is my hope that this book will help November 2014
vi
Acknowledgments
Nobody writes a book alone, even if there is just I owe a great debt to my publishers, who not only
one name on the front cover. First, I must acknowl- believed in this project but who went the extra mile
edge with deep gratitude my students, past and pre- to make it a reality.
sent, over the years. From these men and women I Third, I must thank my editor, Jo Ann LeQuang,
have learned a great deal about the kind of person who assisted in all of the work that goes into
who seeks a career in device-based therapy and turning a course into a manuscript. She worked
how to break down difficult concepts to make them with me on my very first workbook when I worked
not just understandable but logical. I think every in industry and she was a key contributor to this
time one of my students had an “ah-ha!” moment, project as well. I want to thank Matt O’Neal, Bob
I had one too! I hope that my instruction, my expla- Matioli, and all of the folks at PrepMD, where I
nations, my anecdotes, and my method of teaching work today, for their support and encouragement
serve you well in your future clinical work. I would with this project.
also like to thank my mentors that have taught Finally, I want to thank the many people who
me so much over the years. I know much of what encouraged me to write about cardiac pacing.
I know because of people like Orlando Maytin, No matter how much I teach this subject, lecture
Michael Chizner, Kathy King, Barbara Perra, and on it, or write about it—I still have a lot to say!
Eliot Ostrow. Thank you for sharing your clinical That shows the depth of this subject and also
expertise and sparking my interest in cardiology. my passion for it. It is my wish that this book not
Second, I want to thank my friends and family just informs future pacing experts but inspires
who supported me in the writing of this book. them as well.
vii
Answer key
Chapter 01 6 A
7 C
1 B
8 C
2 B
9 D
3 A
10 C
4 D
5 D
6 C Chapters 04
7 D
1 B
8 A
2 D
9 C
3 A
10 A
4 C
5 A
Chapter 02
6 C
7 D
1 D
8 A
2 A
9 C
3 B
10 B
4 A
5 D
6 C Chapter 05
7 C
8 C 1 B
9 A 2 A
10 D 3 C
4 D
5 A
Chapters 03
6 C
1 B 7 C
2 C 8 A
3 A 9 D
4 C 10 B
5 D
The Nuts and Bolts of Implantable Device Therapy Pacemakers, First Edition. Tom Kenny.
© 2015 John Wiley & Sons, Ltd. Published 2015 by John Wiley & Sons, Ltd.
316
Answer key 317
Chapter 06 Chapter 10
1 A 1 D
2 D 2 A
3 B 3 B
4 B 4 A
5 A 5 D
6 A 6 C
7 C 7 D
8 B 8 A
9 D 9 B
10 B 10 B
Chapter 07 Chapter 11
1 B 1 C
2 C 2 C
3 C 3 A
4 A 4 B
5 B 5 C
6 C 6 C
7 C 7 B
8 A 8 A
9 C 9 D
10 A 10 A
Chapter 08 Chapter 12
1 A 1 A
2 B 2 C
3 D 3 A
4 B 4 D
5 B 5 B
6 D 6 B
7 A 7 A
8 C 8 C
9 B 9 B
10 A 10 D
Chapter 09 Chapter 13
1 B 1 C
2 B 2 D
3 A 3 A
4 D 4 A
5 C 5 D
6 C 6 A
7 C 7 C
8 B 8 B
9 D 9 D
10 B 10 A
318 Answer key
Chapter 14 8 A
9 B
1 D
10 A
2 C
3 B
Chapter 18
4 B
5 B
1 B
6 A
2 C
7 C
3 B
8 D
4 D
9 D
5 C
10 A
6 A
7 C
8 D
Chapter 15
9 D
1 B 10 B
2 C
3 D Chapter 19
4 A
5 B 1 A
6 C 2 A
7 B 3 D
8 C 4 B
9 A 5 C
10 A 6 B
7 C
8 B
Chapter 16
9 C
10 B
1 B
2 D
3 A Chapter 20
4 D
1 C
5 C
2 A
6 B
3 B
7 A
4 C
8 C
5 C
9 B
6 A
10 D
7 B
8 D
Chapter 17 9 B
10 C
1 A
2 D
Chapter 21
3 C
4 A 1 B
5 C 2 C
6 C 3 C
7 D 4 D
Answer key 319
5 A 8 B
6 D 9 C
7 B 10 A
8 D
9 B
Chapter 24
10 A
1 B
2 B
Chapter 22
3 A
1 B 4 C
2 D 5 D
3 A 6 A
4 A 7 B
5 C 8 C
6 D 9 C
7 C 10 A
8 B
9 A
Chapter 25
10 A
1 D
2 A
Chapter 23
3 B
1 B 4 B
2 C 5 A
3 A 6 C
4 A 7 D
5 C 8 A
6 A 9 D
7 B 10 A