Electrotherapy Of The Heart

Since 1958, when the first cardiac pacing system was implanted, the exemplary collaboration between medicine and engineering has developed into an extremely successful therapy. The book highlights many of the recent and most important technological advances and shows the multidisciplinary nature of the technical task of pacemaker development which is based on the diverse components of physiology, electronics, physics, electrochemistry and the material sciences.

Pacing and defibrillation have become the leading therapeutic treatments of heart rhythm disorders, including bradycardia and tachycardia. The success of these therapies is largely due to centuries of scientific inquiry into the fundamental mechanisms of bioelectric phenomena in the heart. History of successful development of bioelectric therapies includes development of experimental and theoretical methodologies, novel bioengineering approaches, and state-of-the-art clinical implantable device therapies. The purpose of this book is to present a uniform thematic collection of reviews written by the leading basic and applied scientists working in basic bioengineering research laboratories, who have contributed to the development of current understanding of the fundamental mechanisms of pacing and electrophysiology, and who are at the leading edge of further developments in electrotherapy. The book will start from the historic overview of the subject, including the development of the pacemaker and defibrillator, evolution of theories of cardiac arrhythmias and experimental methods used in the field over the centuries. Leading experts in the field will write these chapters. The second part of the book will focus on rigorous treatment of the fundamental theory of interaction between electric field and cardiac cell, tissue, and organ. Chapters will be written by top notch scientists, who made critically important contributions to the development of these theories. Part 3 will provide summary of several decades of research involving electrode recordings and multielectrode mapping of ventricular fibrillation and defibrillation in humans and animal models of arrhythmias. Part 4 will present new insights into defibrillation gained due to the advent of optical imaging technology, which permitted to map defibrillation without overwhelming shock-induced artifacts present in electrode recordings. Part 5 will provide rigorous overview of the methodologies, which made research of physiological and engineering aspects of electrotherapy possible. And finally, part 6 will present possible future of implantable devices and electrotherapy in the treatment of cardiac rhythm disorders.

The introduction of permanent cardiac pacing in the late 1950s began the era of cardiac electrotherapy. In the 1980s, implantable cardioverter defibrillators (ICDs) were introduced. These advances created new challenges for cardiac implantable electronic devices (CIEDs). Right ventricular pacing was the primary breakthrough; however, over the years, it has become apparent that it can induce cardiac contraction dyssynchrony. Biventricular pacing allowed for the alleviation of dyssynchrony and improved the survival of patients with heart failure and bundle branch block. In recent decades, His bundle pacing has become a new strategy for physiological ventricular activation. However, the use of CIEDs carries several risks, e.g., complications related to transvenous leads. This led to the development of percutaneous lead extraction techniques as well as the introduction of a subcutaneous ICD (S-ICD) and leadless pacing. Technological evolution promises an exciting future in the development of cardiac electrotherapy. In this Special Issue, readers can find out about the clinical and hemodynamic aspects of right ventricular, His bundle, and biventricular pacing; ICD therapy; treatment of complications and technological advances in cardiac electrotherapy.

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