Cardiac Pacing and Electrophysiology : A Bridge to the 21st Century

In 1992, clinical cardiac electrophysiology became a recognized sub-speciality of the American Board of Internal Medicine. The formal recognition of this highly specialized and technical field of medicine represents the culmination of thirty years of remarkable scientific and intellectual discovery. Beginning in the 1950s, cardiologists realized that cardiac arrhythmias were the cause of significant morbidity and the sudden death of at least 350,000 patients every year in the United States alone. At that time the only tools available for analyzing abnormal heart rhythms were the standard EKG machine and careful deductive reasoning. During the early 1960s, cardiac pacemakers reflected the first foray in the electrical therapy of cardiac arrhythmias. Pacemakers were first implanted in order to control syncopal episodes related to bradycardic heart rhythms. Although crude and bulky devices, their utility was immediately obvious to physicians and patients alike. The recognition that electrical signals could be recorded from inside the heart and that the heart's rhythm could be controlled by the application of electrical energy began the era of clinical cardiac electrophysiology which was to follow. In the late 1960s and early 1970s and at the peak of the Vietnam conflict. a group of cardiologists with special training in cardiac electrophysiology were sequestered at the US Public Health Service Hospital at Staten Island. Front Matter....Pages i-xxi Front Matter....Pages 1-1 Equipment for the electrophysiology laboratory: possibilities and limitations....Pages 3-13 Vasovagal syncope: clinical presentation, classification and management....Pages 15-22 Classification of antiarrhythmic drugs in relation to mechanisms of arrhythmias....Pages 23-30 Electrophysiological characteristics in arrhythmogenic right ventricular dysplasia and dilated cardiomyopathies....Pages 31-40 Classification of death in patients under antiarrhythmic treatment....Pages 41-48 Heart rate variability....Pages 49-62 Heart rate variability and QT interval: their relationships with the cardiac frequency....Pages 63-72 Role of dynamic QT interval in Holter tapes to stratify risk in postmyocardial infarction patients....Pages 73-77 Heart rate variability in patients with angina pectoris....Pages 79-82 Time and frequency domain analysis of heart rate variability after myocardial infarction....Pages 83-91 Signal averaged ECG....Pages 93-115 Optimizing the predictive value of the signal-averaged ECG for serious arrhythmic events in the postinfarction period....Pages 117-124 Signal-averaged analysis of the P wave: possible applications in different settings....Pages 125-129 Late potentials during acute myocardial ischaemia....Pages 131-136 Radiofrequency catheter ablation in the treatment of supraventricular tachycardias....Pages 137-143 Anatomical versus electrophysiological approaches for ablation of the slow pathway in patients with AV nodal reentrant tachycardia....Pages 145-154 Front Matter....Pages 155-155 Cardiac pacing in Europe in 1992: a new survey....Pages 157-168 The myocardium-electrode interface at the cellular level....Pages 169-188 The myocardium-electrode interface at the macro level....Pages 189-201 Unipolar versus bipolar leads....Pages 203-207 Front Matter....Pages 155-155 Single Lead VDD pacing: an update....Pages 209-219 Substantial improvement of screw-in electrodes....Pages 221-226 Physiological cardiac pacing: an individual objective....Pages 227-250 Pacemaker syndrome during atrial-based pacing....Pages 251-267 Dual chamber pacemaker therapy in cardiomyopathy....Pages 269-279 DDD rate-responsive pacing: state of the art....Pages 281-287 Heart rate response based on changes in central venous oxygen saturation, minute ventilation and body activity....Pages 289-302 DDDR and atrial arrhythmia....Pages 303-308 Holter and pacemaker diagnostics....Pages 309-324 Clinical relevance of histograms in the follow-up of DDDR pacemakers....Pages 325-331 Holter and telemetry in pacemakers and ICDs: new developments....Pages 333-346 Automatic measure of the interface capacitor and the total cardiac impedance....Pages 347-353 Critical analysis of the different algorithms designed to protect the paced patient against atrial tachyarrhythmias in dual chamber pacing....Pages 355-362 Mode switching in DDDR pacing....Pages 363-370 Front Matter....Pages 371-371 Indication for ICD implantation and selection of patients: present and future....Pages 373-380 The optimum tilt for defibrillation....Pages 381-385 Cerebrovasomotor reactivity predicts tolerance to tiered therapy with implantable cardioverter-defibrillators....Pages 387-397 Clinical utility of telemetered electrograms in pacemakers and ICDs....Pages 399-410 High patient acceptance for implantable cardioverter/defibrillator (ICD): quality of life and patient acceptance....Pages 411-418 Cardiac pacing and electrophysiology: how much technology do we need?....Pages 419-422 Front Matter....Pages 371-371 Medical technology assessment and reimbursement policy of implantable devices in Belgium: possibilities and limitations for the future....Pages 423-430 Socioeconomic aspects of implantable devices: can we afford new technology?....Pages 431-437 Back Matter....Pages 439-441 This outstanding book covers all aspects of new developments in the field of basic electrophysiology, cardiac pacing, implantable defibrillators and socioeconomic aspects related to these topics. The section on electrophysiology provides a comprehensive overview of basic hardware equipment, sudden death, heart rate variability, signal averaged ECG, RF catheter ablation and clinical decision making. The section on pacing includes overviews on new lead developments, pacing in cardiomyopathy, as well as VVIR & DDIR pacing and automatic mode switching. Finally the section on implantable defibrillator provides a detailed view of clinical and technical aspects of third generation devices. All chapters have been written by world experts in their fields and each chapter is fully illustrated with tables, ECG recordings and black and white photographs. The book is highly recommended for nurses, technicians, bioengineers, cardiologists, cardiovascular surgeons, health authorities and for all who are involved in the field of pacing and electrophysiology