Bruce L. Wilkoff

Implantable defibrillators as originally conceived by Michel Mirowski were limited to the detection and automatic termination of ventricular fibrillation. In the original "AID" device, the detection algoritlun sought to distinguish sinus rhytlun from ventricular fibrillation by identifying the "more sinusoidal waveform of ventricular fibrillation. " The therapeutic intervention was elicited only once deadly polymorphic rhythms had developed. It was rapidly learned, however, that ventricular fibrillation is usually preceded by ventricular tachycardia. Mirowski recognized the pivotal importance of developing algoritllms based on heart rate. Ventricular tachycardia detection allowed the successful development of interventions for the termination of ventricular tachyarrhythmias before they degenerated into ventricular fibrillation. Current device therapy no longer confines itself to tlle termination of chaotic rhythms but seeks to prevent them. Diagnostic algorithms moved upward along the chain of events leading to catastrophic rhytlulls. Rate smoothing algorithms were developed to prevent postextrasystolic pauses from triggering ventricular and atrial tachyarrhytlmlias. Beyond the renaissance of ectopy-centered strategies, long-term prevention received increasing attention. Multisite pacing therapies provided by "Arrhythmia Management Devices" were designed to reduce the "arrhytlunia burden" and optimize the synergy of cardiac contraction and relaxation. Clinical evidence now suggests that atrial fibrillation prevention by pacing is feasible and tllat biventricular pacing may be of benefit in selected patients with heart failure. However, these applications of device therapy that generally require ventricular defibrillation backup remain investigational and were not considered in this book.

Implantable defibrillators as originally conceived by Michel Mirowski were limited to the detection and automatic termination of ventricular fibrillation. In the original "AID" device, the detection algoritlun sought to distinguish sinus rhytlun from ventricular fibrillation by identifying the "more sinusoidal waveform of ventricular fibrillation. " The therapeutic intervention was elicited only once deadly polymorphic rhythms had developed. It was rapidly learned, however, that ventricular fibrillation is usually preceded by ventricular tachycardia. Mirowski recognized the pivotal importance of developing algoritllms based on heart rate. Ventricular tachycardia detection allowed the successful development of interventions for the termination of ventricular tachyarrhythmias before they degenerated into ventricular fibrillation. Current device therapy no longer confines itself to tlle termination of chaotic rhythms but seeks to prevent them. Diagnostic algorithms moved upward along the chain of events leading to catastrophic rhytlulls. Rate smoothing algorithms were developed to prevent postextrasystolic pauses from triggering ventricular and atrial tachyarrhytlmlias. Beyond the renaissance of ectopy-centered strategies, long-term prevention received increasing attention. Multisite pacing therapies provided by "Arrhythmia Management Devices" were designed to reduce the "arrhytlunia burden" and optimize the synergy of cardiac contraction and relaxation. Clinical evidence now suggests that atrial fibrillation prevention by pacing is feasible and tllat biventricular pacing may be of benefit in selected patients with heart failure. However, these applications of device therapy that generally require ventricular defibrillation backup remain investigational and were not considered in this book.

This issue of Cardiac Electrophysiology Clinics, edited by Drs. Noel G. Boyle and Bruce Wilkoff, will focus on Lead Management for Electrophysiologists. Topics include, but are not limited to, Overview of Lead Management; Vein Management; Electrode Management; Infection Management; Definitions and Metrics; Tensile Properties; TOOLS for Lead Extraction; Complications : Vascular, Cardiac, Thrombotic & Hemorrhage; Rescue; Outcomes & Registries; Reimplantation after Lead Removal; Venoplasty and Stenting; Palliation & Non Extraction Approaches; Surgical and Hybrid Extraction; Anesthesia Considerations for Lead Extraction; and Role of Imaging in Lead Extraction.

Your must-have bench reference for cardiac electrophysiology is now better than ever! Expert guidance from world authorities who contribute fresh perspectives on the challenging clinical area of cardiac electrophysiology. New focus on clinical relevance throughout, with reorganized content and 15 new chapters. New coverage of balloons, snares, venoplasty, spinal and neural stimulation, subcutaneous ICDs and leadless pacing, non-CS lead implantation, His-bundle pacing, and much more. New sections on cardiac anatomy and physiology and imaging of the heart, a new online chapter covering radiography of devices, and thought-provoking new information on the basic science of device implantation. State-of-the-art guidance on pacing for spinal and neural stimulation, computer simulation and modeling, biological pacemakers, perioperative and pre-procedural management of device patients, and much more. Greatly expanded online video library demonstrating key procedures and new technologies such as sub Q ICDs, implantation of non-coronary sinus left ventricular leads, the use of snares, and venoplasty of the subclavian and coronary sinus. More than 60 multimedia case presentations online covering a broad range of heart rhythm scenarios. Expert Consult eBook version included with purchase. This enhanced eBook experience allows you to search all of the text, figures, images, and references from the book on a variety of devices.