Table Of ContentCARDIAC DEFIBRILLATION
PREDICTION, PREVENTION
AND MANAGEMENT OF
CARDIOVASCULAR
ARRHYTHMIC EVENTS
Edited by Joyelle J. Harris
CARDIAC DEFIBRILLATION –
PREDICTION, PREVENTION
AND MANAGEMENT OF
CARDIOVASCULAR
ARRHYTHMIC EVENTS
Edited by Joyelle J. Harris
Cardiac Defibrillation – Prediction, Prevention and
Management of Cardiovascular Arrhythmic Events
Edited by Joyelle J. Harris
Copyright © 2015 Second Edition
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First published October, 2011, second - 2015
ISBN-10: 953-307-692-5
ISBN-13: 978-953-307-692-8
Contents
Preface IX
Part 1 Defibrillation Introduction and Assessments 1
Chapter 1 Implantable Cardioverter Defibrillators 3
Behzad Ghanavati
Chapter 2 Defibrillation Shock Amplitude, Location and Timing 19
Shimon Rosenheck
Chapter 3 Prognostic Significance of Implantable
Cardioverter-Defibrillator Shocks 41
Dan Blendea, Razvan Dadu and Craig McPherson
Chapter 4 Ventricular Tachyarrhythmias in Implantable
Cardioverter Defibrillator Recipients: Differences
Between Ischemic and Dilated Cardiomyopathies 53
Aldo Casaleggio, Tiziana Guidotto,
Vincenzo Malavasi and Paolo Rossi
Part 2 Prediction, Prevention, and
Management of Cardiovascular Events 67
Chapter 5 Prediction of Ventricular Arrhythmias
in Patients at Risk of Sudden Cardiac Death 69
K.H. Haugaa, J.P. Amlie and T. Edvardsen
Chapter 6 Prevention of Sudden Death –
Implantable Cardioverter Defibrillator
and/or Ventricular Radiofrequency Ablation 83
Andrea Colella, Marzia Giaccardi,
Antonella Sabatini, Alfredo Zuppiroli and Gian Franco Gensini
Chapter 7 Just in Time Support to Aide
Cardio-Pulmonary Resuscitation 105
Frank A. Drews and Paul M. Picciano
VI Contents
Chapter 8 Electrical Storm in the Era of
Implantable Cardioverter Defibrillators 131
David T. Huang and Darren Traub
Part 3 Applications and Clinical Relevance 147
Chapter 9 Ventricular Arrhythmias Due to
a Transient of Correctable Cause in
MADIT-II Patients: Prevalence and Clinical Relevance 149
Michela Casella, Pasquale Santangeli, Ghaliah Al-Mohani,
Antonio Dello Russo, Francesco Perna,
Stefano Bartoletti, Joseph Gallinghouse, Luigi Di Biase,
Andrea Natale and Claudio Tondo
Chapter 10 ICDs in Clinical Trials:
Assessment of the Effects of Omega-3
Polyunsaturated Fatty Acids from Fish Oils on
Ventricular Tachycardia and Ventricular Fibrillation 155
A. Mirrahimi, L. Chiavaroli, K. Srichaikul,
J.L. Sievenpiper, C.W.C. Kendall and D.J.A. Jenkins
Chapter 11 Application of the Bispectral Index (BIS)
During Deep Sedation for Patients with ICD Testing 163
Małgorzata Kuc, Maciej Kempa, Magdalena A.Wujtewicz,
Radosław Owczuk and Maria Wujtewicz
Preface
Throughout the world, approximately 23 million people suffer from heart failure each
year. Of all patients who experience heart failure, the mortality rate due to sudden
cardiac death (SCD) is between 28% and 68%. SCD is most often due to ventricular
tachycardia (VT) or ventricular fibrillation (VF). To alleviate SCD by VT and VF, one
effective and common treatment is the use of implanted cardioverter-defibrillators
(ICDs).
An ICD is a device that monitors the electrical activity of the user’s heart and delivers
an electrical shock upon detecting certain arrhythmias. While ICDs have decreased the
number of deaths due to sudden cardiac arrhythmic events, studies suggests that
patients with ICDs who receive shocks have a worse prognosis than similar patients
who do not receive shocks.
These poor projections for patients who receive shocks are spurred by several factors.
While the electrical shocks from ICDs save lives, they are also reported to be quite
painful. Therefore, patients who have experienced a shock tend to suffer from
psychological stress and a lower quality of life afterwards. Furthermore, about one
third of ICD patients will experience inappropriate or unnecessary shocks from their
ICDs. Inappropriate shocks have been linked to higher mortality rates in ICD patients.
Other research suggests that after patients receive a shock, heart failure tends to
progress more rapidly. Each of these factors highlights a gap in the body of knowledge
relevant to ICDs. Therefore, a significant amount of research and clinical studies are
needed to guarantee continued improvement for these devices.
One topic worthy of further exploration is the manner in which ICDs detect
arrhythmias. At present, many ICDs use timing to classify heart rhythms. As a result,
some safe rhythms are indistinguishable from life-threatening rhythms that have the
same timing. For example, sinus tachycardia (ST) arrhythmia is safe and occurs during
exercises in which the heart rate rises to about 120 beats per minute. On the other
hand, ventricular tachycardia (VT) arrhythmia is fatal and occurs at the same heart
rate. In spite of similar timing, ST and VT have different morphologies, suggesting that
additional detection mechanisms could help avoid unnecessary shocks in ICD
patients.
X Preface
Another question to consider is how defibrillators can be employed to protect low risk
patients from SCD. Patients who have a high risk of suffering from SCD are most
likely identified by healthcare professionals, and then they receive life-saving ICDs. As
a result, the majority of SCD victims are now low-risk patients because they remain
unidentified and thus unprotected. A suggested answer to this quandary is to increase
public access to defibrillators and to improve real-time, automated training on how to
use such devices.
More research could also be done to determine ways of preventing shocks in ICD
patients. For instance, examining the connection between diet, lifestyle, and
ventricular arrhythmias could lead to such prevention. Diets rich in fish oils have
shown promise in decreasing the risk of arrhythmatic cardiovascular events. However,
to date, only a few studies have examined the use of fish oils to prevent ICD discharge.
More studies could be done to increase this body of knowledge.
The chapters in this book explore the issues posed above in addition to discussing
methods for improving ICDs and answering critical questions about ICD technology.
The authors examine determinants for successful defibrillation and assess patients
who receive defibrillation. Special cases in ICD patients are also considered along with
clinical trials involving patients with defibrillators. The chapters presented herein
contain a comprehensive overview of prediction, prevention, and management of
cardiovascular events.
Joyelle J. Harris, Ph.D.
Exponent Failure Analysis Associates
Phoenix, Arizona
USA
