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By Vasken Dilsizian, Gerald M Pohost

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Extra resources for Cardiac CT, PET and MR

Example text

113 In some situations, the changes in ULV may not accurately reflect defibrillation efficacy. Since ULV may result in device testing with no VF induction, the R wave should be > 7 mV to insure adequate sensing of VF. 114 Because of the indirect nature of the ULV–DFT relationship and the large body of clinical and experimental data based on DFTs, ULV testing has only been adopted as routine clinical practice in a few centers. If future ICDs adopt automatic ULV testing (in which the device would scan the T wave and determine appropriate shock timing), this technique may become more widespread due to its ability to assess defibrillation efficacy without VF inductions in many patients and the possibility of automated testing by the ICD.

Over the range of clinically utilized capacitor size and biological tissue resistance in a given system, a change in energy up or down is reflected by a similar change in voltage and current. In practice, “energy” is the most commonly used term to indicate shock dose. Use of waveform theory in clinical practice The optimal biphasic waveform is specific to the device, lead, and patient. 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.

C H AP T E R 1 Clinically Relevant Basics of Pacing and Defibrillation 35 Fig. 38 Defibrillation thresholds with right-sided and left-sided cardioverterdefibrillator implantation of active can and cold can devices. Defibrillation threshold (DFT) is on ordinate, and side of placement and can type are on abscissa. 143 (From Friedman et al. 145 However, abdominal insertion is technically more challenging, requiring two incisions, lead tunneling, abdominal dissection (often necessitating surgical assistance), and general anesthesia.

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