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Cardiac Pacing: A Physiological Approach
Asit Das
CHAPTER 1:
History of Pacemaker
CHAPTER 2:
Introduction to Physiological Pacing
INTRODUCTION
ADVERSE EFFECTS OF RV APICAL PACING
ELECTROCARDIOGRAPHIC CHANGES
MORPHOLOGICAL CHANGES
METABOLIC CHANGES
MECHANICAL
Impaired Pump Function
Mitral Regurgitation
Tethering
Interpapillary Muscle Activation Delay
Prolongation of Isovolumic Contraction Time
Annular Dilatation
Heart Failure
Atrial Fibrillation
Definition of a Physiological Pacemaker
Trials of Dual Chamber Pacemaker as Physiological Pacemaker
Strategies of Physiological Pacing
CHAPTER 3:
Managing Algorithm
INTRODUCTION
STRATEGIES OF REDUCING PACING BURDEN
AV SEARCH HYSTERESIS
MANAGED VENTRICULAR PACING (MVP)
VENTRICULAR INTRINSIC PREFERENCE (VIP)
AAIsafeR MODE
REVERSE MODE SWITCH (RHYTHMIQ MODE)
OUTCOME DATA
Advantages of MVP
Disadvantages of MVP
Advantages of VIP
Disadvantages of VIP
Strategies of Reducing Atrial Fibrillation Burden
Atrial Pacing to Prevent Atrial Fibrillation
Suppression of Triggers
Effect on Atrial Substrate Suppression of Compensatory Pause
Reducing Dispersion of Refractoriness Multi-Site Pacing
Reducing Dispersion of Refractoriness: Alternative Site Atrial Pacing
Atrial Pacing for Atrial Fibrillation Termination
Newer Pacing and Therapeutic Algorithms
OUTCOME DATA
CONCLUSION
CHAPTER 4:
Selective Site: Right Ventricular Septal Pacing
INTRODUCTION
ANATOMY
Electrical Activation Sequence
RV Apical vs RV Septal Pacing
RADIOLOGY
TOOLS AND TECHNIQUE
ELECTROCARDIOGRAPHIC CHARACTERISTICS
Mid-septum versus RVOT Septum
CARDIOMYOPATHY AND RV PACING
EVIDENCE
CONCLUSION
CHAPTER 5:
Selective Site: His Bundle Pacing
INTRODUCTION
ANATOMY
ELECTROCARDIOGRAPHIC CHARACTERISTICS
Pattern 1
Pattern 2
Pattern 3
INDICATIONS
Problems
IMPLANTATION
1st Step (Figs 5.3 and 5.4)
2nd Step
3rd Step
Outcome
CONCLUSION
CHAPTER 6:
Selective Site: Right Atrial Septal Pacing
INTRODUCTION
ANATOMY
ELECTROMECHANICS
IMPLANTATION
Bachmann’s Bundle or High Atrial Septal Pacing
Low atrial Septal Pacing
Electrocardiographic Characteristics
CONCLUSION
CHAPTER 7:
Case Discussion
CASE 1
CASE 2
CASE 3
CASE 4
CASE 5
CASE 6
CHAPTER 8:
Introduction to Cardiac Resynchronization Therapy
INTRODUCTION
INDICATION
New York Heart Association Class
QRS Duration
Left Ventricular Ejection Fraction
Class I
Class IIa
Class IIb
Electrical Activation Sequence
Mechanoenergetics
Assessment of Dyssynchrony
Echocardiographic Assessment
Atrioventricular Dyssynchrony (A Delay Between Atrial and Ventricular Contraction)
Interventricular Dyssynchrony
Intraventricular (or LV) Dyssynchrony
Others
Advanced Echocardiographic Assessment
Nonechocardiographic Assessment
Effects of Cardiac Resynchronization Therapy
Cardiac
Extracardiac
CHAPTER 9:
Role of Pre-procedure ECG Analysis
INTRODUCTION
ROLE OF SURFACE ECG
CASE 1 (FIG. 9.5)
CASE 2 (FIG. 9.6)
CHAPTER 10:
Anatomy of Coronary Sinus
INTRODUCTION
ANATOMY
VENOGRAPHY
OTHER IMAGING MODALITIES
TARGET VEIN AND TARGET SITE
CHAPTER 11:
Implantation Technique
INTRODUCTION
APPROACH
LEAD IMPLANTATION ORDER
PLACEMENT OF LV LEAD
BUDDY WIRE TECHNIQUE
RETROGRADE BUDDY WIRE TECHNIQUE
VENOPLASTY
ANCHOR BALLOON TECHNIQUE
ANTEGRADE SNARE TECHNIQUE
RETROGRADE SNARE TECHNIQUE
BALLOON-FACILITATED DELIVERY
PLACEMENT OF RV LEAD
ANATOMICAL INTER-LEAD DISTANCE
ELECTRICAL INTER-LEAD DISTANCE
ALTERNATIVE TECHNIQUES
EPICARDIAL PACING TECHNIQUES
Mini-thoracotomy
Video Assisted Thoracoscopy
Robotically Assisted Surgery
ENDOCARDIAL PACING TECHNIQUES
Transseptal Endocardial LV Lead Implantation
Trans-apical Endocardial LV Lead Implantation
Trans-arterial Endocardial LV Lead Implantation
CHAPTER 12:
Surface Electrocardiography: CRT Follow up
INTRODUCTION
ECG OF RIGHT VENTRICULAR PACING IN CRT
ECG of Left Ventricular Pacing from the Coronary Venous System
ECG Patterns and Follow-up of Biventricular Pacemakers
Biventricular Pacing with the RV Lead Located at the Apex
Biventricular Pacing with the RV lead in the Outflow Tract
CASE 1 (FIG. 12.8 TO 12.13)
CASE 2 (FIGS 12.14 TO 12.19)
CASE 3 (FIGS 12.20 TO 12.26)
CASE 4 (FIGS 12.28 TO 12.30)
CASE 5 (FIGS 12.31 TO 12.34)
CASE 6 (FIGS 12.35 TO 12.41)
FUSION
Configuration of the P wave
CHAPTER 13:
Optimizing Response
DEFINITION OF RESPONSE
Clinical
Echocardiographic
RESPONDERS AND SUPER-RESPONDERS
Non-responders
Atrial Fibrillation
Myocardial Ischemia
Medical Treatment
Evaluation and Interrogation of the CRT Device
Atrioventricular (AV)/Interventricular (VV) Delay Optimization
Left Ventricular Inflow Analysis
Left ventricular Outflow Analysis
Electrogram Analysis
Echocardiographic Assessment
CARDIAC ASSIST DEVICES
CHAPTER 14:
Newer Advances
MULTISITE AND MULTIPOINT LV PACING
Adaptive CRT Algorithm
INDEX
TOC
Index
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