![]() ![]() The ventricles generate maximum efficiency when contracting simultaneously in systole. Image reproduced with permission from Boston Scientific This requires effective detection and discrimination of VT from other tachycardias.įig 1 Anti-Tachycardia Pacing (ATP) electrogram. Rapid pacing at a rate slightly faster than the VT aims to capture the ventricle, and leads to termination of the arrhythmia when pacing stops (Fig 1). One of the major advances in ICD technology has been the development of devices capable of detecting, and terminating VT, through the use of overdrive pacing. In these cases, it is important to provide primary or secondary prevention with a device capable of detecting, and hopefully successfully treating, VF or VT. There are specific patient populations who are at significantly higher risk of these arrhythmias, either because of prior documented episodes, or because of the underlying substrate of their cardiac disease. Ventricular Tachycardia (VT) arises from enhanced automaticity of an area of ventricular myocardium, often mediated by an ischaemic substrate. Conventional pacing is a very effective treatment for significant bradycardias. It is important to recognise that not all impaired conduction cause symptoms. Pathophysiologyĭisease or damage to any part of this conduction pathway may cause abnormalities on the ECG manifesting as bradycardia. This details the make and manufacturer of the leads and pulse generator, as well as the name and hospital of the implanting physician. Useful information about the nature of the device implanted can be found on the wallet-sized card carried by pacemaker patients. The terminology used can be disorientating to the non-specialist, but a basic understanding of the principles behind the devices makes appreciation of their impact on patients problems much simpler to understand. There are a wide variety of situations in which such implantable devices have a bearing on patient care, whether directly or indirectly.Īlthough the detailed assessment of such devices and situations can be complex, and frequently require highly specialised input, significant and useful information may be obtained from simple bedside tests within the emergency department (ED). Device therapy for heart failure (cardiac resynchronization therapy, or biventricular pacing).Device therapy for tachy-arrhythmias (automatic implantable cardio-defibrillators, or ICDs).Device therapy for brady-arrhythmias (conventional pacing).Although there is a wide degree of overlap, for the purposes of this session we will consider: Implantable devices in Cardiology is a term covering a variety of diagnostic and therapeutic modalities. ![]()
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