Applied Defibrillation Therapy

1. Introduction 9
1.1. Importance of sudden cardiac death 9
1.2. Historical development of ICD therapy 9
1.3. Standard functions of a defibrillator 12
1.4. Aims of ICD therapy 13
1.5. Alternative therapies 13
2. Guidelines and legal provisions 15
2.1. Indications for ICD therapy 15
2.1.1. Classes of indications according to the guidelines 15
2.1.2. Contraindications to and restrictions on ICD implantation 15
2.1.3. Diagnostic investigations and evaluation of arrhythmias 15
2.1.4. Value of risk stratification parameters 16
2.2. ICD indications by underlying cardiac disease 17
2.2.1. Coronary heart disease 17
2.2.2. Dilated cardiomyopathy (DCM) 19
2.2.3. Brugada syndrome 21
2.2.4. Hypertrophic cardiomyopathy (HCM) 23
2.2.5. Long QT syndrome 24
2.2.6. Short QT syndrome 25
2.2.7. Arrhythmogenic right ventricular cardiomyopathy (ARVC) 25
2.2.8. Catecholamine-induced polymorphic ventricular tachycardia 26
2.2.9. Noncompaction of the left ventricle 26
2.2.10. Cardiac resynchronisation therapy (CRT) 29
2.2.11. Other at-risk patients 31
3. ICD and Electrode Models 32
3.1. Special ICD functions 32
3.1.1. Preventive algorithms 32
3.1.2. Atrial antitachycardic therapies 32
3.1.3. VDD electrodes and ICDs 32
3.2. ICD electrodes 32
4. Implantation 43
4.1. Preparation for surgery 43
4.2. Electrode implantation 43
4.3. Implantation of the pulse generator 44
4.4. Postoperative care 48
4.5. Perioperative complications 48
4.6. Special implantation conditions 49
5. Programming 52
5.1. Detection thresholds 52
5.2. Detection interval 52
5.3. Inhibitory detection criteria 53
5.3.1. Interval-based additional criteria 53
5.3.2. Morphology-based additional criteria 55
5.4. Detection algorithms of dual-chamber ICDs 57
5.5. Redetection 59
5.6. ICD treatments 59
5.6.1. Antitachycardic stimulation (ATP) 59
5.6.2. Cardioversion and defibrillation 61
5.6.3. Programming of pacemaker function in ICDs 62
5.7. Special algorithms 63
5.7.1. Heart failure monitoring 63
6. Follow-up examinations 65
6.1. Intervention in case of frequent ICD treatments 67
6.2. Differentiation between appropriate and inappropriate treatments 68
6.3. Intervention in case of frequent inappropriate treatments 68
6.4. Interventions in case of frequent appropriate treatments 70
6.5. Possibilities of telemedicine 71
6.6. Infection of the ICD system 73
6.7. Electrode extraction 75
6.8. Electromagnetic interference 78
6.8.1. Non-medical electromagnetic interference 78
6.8.2. Electromagnetic interference in the medical setting 78
7. Psychosocial effects 80
8. Acronyms and abbreviations 81
8.1. Study acronyms 81
8.2. Abbreviations 81
9. References 83
Index 94