Developments In Cardiac Implantable Electronic Device Therapy How Can We Improve Clinical Implementation

The use of cardiac implantable electronic devices (CIEDs) has substantially increased in the last decades. They have a significant impact on reducing morbidity and mortality of patients suffering from cardiac arrhythmias and heart failure. Several developments of technical issues have appeared over recent years to improve safety and efficacy. However, their role in daily clinical practice is still unclear. For instance, different leadless technologies, such as leadless pacemakers, subcutaneous defibrillators or wearables are only partly or not included in the current guideline recommendations. There are also several attempts to improve clinical response to cardiac resynchronization therapy with multipoint or fusion optimized technologies, it is however not clear which patients really benefit from these. The same is true for novel conduction system pacing modalities: His-bundle pacing seems to be the most physiological but manually challenging compared to left bundle branch area pacing, which latter restores only the physiologic activation of the left ventricle but may be easier to perform. The classical indications for primary prophylactic ICD are also questioned based on some new study results, highlighting the need for an improved, more detailed and individual risk stratification for better patient selection. We have important but somehow controversial study results regarding preventive antibiotic therapy (incremental perioperative antibiotics vs antibiotic-eluting envelope) during CIED implantation. Lead extraction tools are also expanding but randomized controlled trials regarding the best approach are completely missing in this field. The importance of remote monitoring is also constantly growing, especially in the current pandemic times, the best way of patient selection needs however more research.

Heart failure affects over 5 million patients in the United States alone, and is a chronic and debilitating disease. While a number of pharmacologic therapies have shown varying degrees of effectiveness, many recent advances in the treatment of heart failure has focused on device based therapies. In Device Therapy in Heart Failure, William H. Maisel and a panel of authorities on the use and implementation of device based therapies provide a comprehensive overview of the current and developing technologies that are used to treat heart failure. Individual chapters provide an in-depth analysis of devices such as CRT’s and ICD’s, while broader topics such as the pathophysiology of heart failure and its current medical therapies are also discussed. Additional topics include Pacing and Defibrillation for Atrial Arrhythmias, Atrial Fibrillation Ablation, and Percutaneous Treatment of Coronary Artery Disease.

Cardiac Resynchronization Therapy continues to evolve at a rapidpace. Growing clinical experience and additional clinical trialsare resulting in changes in how patients are selected for CRT. This new edition of the successful Cardiac ResynchronizationTherapy builds on the strengths of the first edition, providingbasic knowledge as well as an up-to-date summary of new advances inCRT for heart failure. Fully updated to include information ontechnological advances, trouble shooting and recent key clinicaltrials, and with nine new chapters, this expanded text provides thelatest information, keeping the reader up-to-date with this rapidlyevolving field. The second edition of Cardiac Resynchronization Therapyis an essential addition to your collection.

Your must-have bench reference for cardiac electrophysiology is now better than ever! This globally recognized gold standard text provides a complete overview of clinical EP, with in-depth, expert information that helps you deliver superior clinical outcomes. In this updated 5th Edition, you’ll find all-new material on devices, techniques, trials, and much more – all designed to help you strengthen your skills in this fast-changing area and stay on the cutting edge of today’s most successful cardiac EP techniques. 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 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.

Electrical therapy of the heart has rapidly evolved over recent years with the development of the cardiac implantable defibrillator and the application of the cardiac resynchronization therapy to improve performance of the congestive failed heart. There is an impressive amount of literature produced to assess the efficacy and effectiveness of the electrical therapy. New technology is continuously introduced into the market for the treatment of electrical heart disease with optimized performance and implemented design, with approximately 600,000 new pacemakers implanted each year. Attention of the electrophysiology community has mainly focused on the biomedical aspects of electrical therapy, but the psychological, emotional, social and cognitive aspects of the implantable devices has been largely overlooked. Health-related quality of life (QoL) and, to a lesser extent, psychological disorders, i.e. anxiety and depression, have rarely been assessed as outcomes in clinical trials, and results are pointing towards the impact of the implantable devices on QoL and mental health not being direct but moderated and mediated by several biomedical as well as psychosocial variables. Furthermore, the cognitive effects of the implantable devices have rarely been assessed in empirical studies, although cognitive impairment is largely associated with the heart disorders that require implantation of an electrical device and cognitive benefits are strongly expected from the therapy. The aim of this book is to collect, appraise and condense the results of all empirical studies that have investigated, even marginally, the relationships between the implantable devices and any psychological, emotional, social and cognitive dimension. This book is a cornerstone for all involved in device utilization (physicians, nurses, technicians, industry representatives) that need to understand this topic.​