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Implantable Defibrillator Therapy: A Clinical Guide (Paperback, Softcover reprint of the original 1st ed. 2002)
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Implantable Defibrillator Therapy: A Clinical Guide (Paperback, Softcover reprint of the original 1st ed. 2002)
Series: Developments in Cardiovascular Medicine, 244
Expected to ship within 10 - 15 working days
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Implantable defibrillators as originally conceived by Michel
Mirowski were limited to the detection and automatic termination of
ventricular fibrillation. In the original "AID" device, the
detection algoritlun sought to distinguish sinus rhytlun from
ventricular fibrillation by identifying the "more sinusoidal
waveform of ventricular fibrillation. " The therapeutic
intervention was elicited only once deadly polymorphic rhythms had
developed. It was rapidly learned, however, that ventricular
fibrillation is usually preceded by ventricular tachycardia.
Mirowski recognized the pivotal importance of developing
algoritllms based on heart rate. Ventricular tachycardia detection
allowed the successful development of interventions for the
termination of ventricular tachyarrhythmias before they degenerated
into ventricular fibrillation. Current device therapy no longer
confines itself to tlle termination of chaotic rhythms but seeks to
prevent them. Diagnostic algorithms moved upward along the chain of
events leading to catastrophic rhytlulls. Rate smoothing algorithms
were developed to prevent postextrasystolic pauses from triggering
ventricular and atrial tachyarrhytlmlias. Beyond the renaissance of
ectopy-centered strategies, long-term prevention received
increasing attention. Multisite pacing therapies provided by
"Arrhythmia Management Devices" were designed to reduce the
"arrhytlunia burden" and optimize the synergy of cardiac
contraction and relaxation. Clinical evidence now suggests that
atrial fibrillation prevention by pacing is feasible and tllat
biventricular pacing may be of benefit in selected patients with
heart failure. However, these applications of device therapy that
generally require ventricular defibrillation backup remain
investigational and were not considered in this book.
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