New PDF release: Cardiac Pacing and Defibrillation: A Clinical Approach
By David L. Hayes, Samuel J. Asirvatham, Paul A. Friedman
Inclusive of thirteen chapters, this ebook is uniformly written to supply good, matter-of-fact equipment for knowing and taking care of sufferers with everlasting pacemakers, ICDs and CRT systems.Now stronger and up-to-date, together with a brand new bankruptcy on programming and optimization of CRT units, this moment variation provides a large number of info in an simply digestible shape. Cardiac Pacing and Defibrillation deals good, matter-of-fact tools for knowing and taking care of sufferers, making daily medical encounters more uncomplicated and extra productive.Readers will savor the data and adventure shared through the authors of this booklet.
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Additional resources for Cardiac Pacing and Defibrillation: A Clinical Approach
5 CV2 Since the “tail” of the waveform in longer pulses (≥ 10 ms) refibrillates the ventricle (most likely accounting for the superiority of the ascending ramp seen by Schuder 115 et al. ), truncated waveforms have been used clinically. The classic monophasic truncated waveform is shown in Fig. 31B. The waveform is characterized by the initial voltage (Vi), the final voltage (Vf), and the pulse width or tilt. Tilt is an expression of the percentage decay of the initial voltage. The tilt of a waveform is a function of the size of the capacitor used, the resistance of the leads and tissues through which current passes, and the duration of the pulse.
26 Re-entrant ventricular tachycardia circuit. In (A), a circuit around a fixed scar is depicted by the arrow. The head of the arrow depicts the leading edge of the wavefront, and the body of the arrow back to the tail (colored gray) consists of tissue that is still refractory (since the wavefront has just propagated through it). ” For the arrow head to continue its course around the scar, an excitable gap must be present; if the wavefront encounters refractory tissue, it cannot proceed. In (B), a wavefront generated by an antitachycardia pacing impulse enters the excitable gap and terminates tachycardia.
In many commercially available devices, the only programmable option is the polarity. Therefore, if a patient undergoing implantable defibrillator insertion does not have an adequate defibrillation safety margin, a logical next step is reversal of polarity. If an adequate safety margin is still not met, a lead is often added (discussed below). Tilt or duration can also be modified as an alternative next step in systems that offer this feature. Lead system and defibrillation The most efficient lead system is one that evenly distributes the shock over the myocardium and minimizes the difference in potential between high-gradient and low-gradient zones.
Cardiac Pacing and Defibrillation: A Clinical Approach by David L. Hayes, Samuel J. Asirvatham, Paul A. Friedman