The Road to Successful CRT Implantation (eBook)

A Step-by-Step Approach

Daniel Gras, Angel R. León, Westvy G. Fisher (Autoren)

eBook Download: PDF

2008 | 1. Auflage
112 Seiten
John Wiley & Sons (Verlag)
978-0-470-75140-4 (ISBN)

Infos

Cardiac resynchronization therapy is a new therapy for advanced
heart failure patients. This therapy has been shown to improve
quality of life, exercise capacity, NYHA classification, and even
reverse the detrimental "reverse remodeling" that occurs in
advanced heart failure - in patients already receiving optimal
pharmacological therapy.

The typical patient has NYHA III/IV HF symptoms, a QRS > 120
ms, LVEDD > 55 mm, without any indication required for pacing.
The therapy is available in an ICD device, too. CRT has been shown
to be effective in patients with both ischemic and non-ischemic
cardiomyopathy.

The implant procedure is part of a learning curve. Many
physicians who already perform electrophysiology procedures, or
PPM, or ICD implants are the ideal implanter - but are surprised at
the challenges this implant presents. This book will help "flatten"
the learning curve for new physician implanting, and will provide a
"guide' for those who have already started implanting.

The success rate is about 90% - so after 10 years of
application, we have found that there are still patients who do not
get access to this great therapy because of the complexity of the
patient's anatomy, or physician skills.

The book is written by three authors with a great deal of
experience culminating in over 3000 cases between them.

This book is intended for cardiologists who currently implant
either or both pacemakers and cardioverter defibrillators with
cardiac resynchronization therapy (also called bi-ventricular
pacing), or plan to implant in the future. This book will be
extremely useful for the new cardiologist in training who is
learning to implant devices.

Autor

Gras, Daniel, MD, Nantes, France Fisher, Wes, MD, Chicago, USA Leon, Engel, MD, Atlanta, USA Abraham, William T, MD, Columbus, USA

Inhalt

Dedication.

Foreword.

General remarks.

1 How does ventricular dyssynchrony alter hemodynamic
function?.

2 What clinical benefits can we expect from CRT?.

3 How to select candidates for CRT.

4 Assessment of ventricular dyssynchrony by new
echocardiographic analyses.

5 What are the mechanisms of improvement during CRT?.

6 Clinical situations where CRT is unlikely to be of therapeutic
value.

7 Preimplantation checklist.

8 Right versus left-sided approach to implant the CRT
system.

9 Right ventricular pacing in CRT.

10 How to achieve reliable sensing and pacing of the right
atrium.

11 Is it safe to pace the left ventricle via a coronary sinus
tributary?.

12 Why perform a coronary sinus venogram before placement of
the.

left ventricular lead?.

13 Optimal LV lead positioning.

14 How to manage difficult coronary sinus cannulation.

15 How to avoid a dissection of the coronary sinus ostium.

16 How to overcome a myocardial bridge over the coronary
sinus.

17 What to do in the absence of a lateral branch on the
venogram.

18 How to manage high left ventricular pacing thresholds.

19 How to proceed in the presence of a complex coronary sinus
anatomy.

20 How to manage diminutive target coronary sinus
tributaries.

21 What to do when valves are in the way.

22 How to implant a CRT system in the presence of a left
superior vena cava.

23 Dilatation of the target cardiac vein by angioplasty
techniques.

24 Stenting for recurrent dislodgment of the left ventricular
lead.

25 Assessment of the electrical signal sensed by the left
ventricular lead.

26 How to avoid stimulating the left phrenic nerve.

27 Dye extravasation and venous perforation or dissection.

28 How to avoid a cardiac vein dissection by the balloon
catheter.

29 How to remove the guiding sheath using the slitting
technique.

30 Radiographic appearance of the final lead position of the CRT
system.

31 How to implant a CRT device in patients with chronic atrial
fibrillation.

32 Upgrading DDD pacing to CRT.

33 Upgrading a CRT to a CRT-ICD system.

34 Repositioning of a dislodged left ventricular lead.

35 How to implant a four-chamber CRT system.

36 How to implant a biventricular, double-left ventricular lead
CRT system.

37 Alternatives in left ventricular lead implant failures.

38 Left ventricular lead extraction.

39 Management of ventricular double counting in CRT.

40 Management of non-responders to CRT.

References.

Index.

Produkt-Details

• Erscheint lt. Verlag: 8.5.2008
• Vorwort: William T. Abraham
• Sprache: englisch
• Themenwelt: Medizin / Pharmazie ► Allgemeines / Lexika
• Themenwelt: Medizinische Fachgebiete ► Innere Medizin ► Kardiologie / Angiologie
• Schlagworte: electrophysiology • Elektrophysiologie • Medical Science • Medizin
• ISBN-10: 0-470-75140-1 / 0470751401
• ISBN-13: 978-0-470-75140-4 / 9780470751404