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==Pacemakers== | ==Pacemakers== | ||
[[Image:Paced2.gif|300px|right|thumb|Ventricular paced rhythm shows ventricular pacemaker spikes.]] | [[Image:Paced2.gif|300px|right|thumb|Ventricular paced rhythm shows ventricular pacemaker spikes.]] | ||
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==Implantable cardioverter defibrillators (ICD)== | ==Implantable cardioverter defibrillators (ICD)== | ||
[[Image:ICD_device.svg|right|300px|thumb|Schematic display of an ICD]] | [[Image:ICD_device.svg|right|300px|thumb|Schematic display of an ICD]] | ||
[[Image:Subcutaneous_ICD.svg|right|300px|thumb|A fully subcutaneous ICD (SQICD) has a can and lead that are placed subcutaneous but outside of the thorax. This type of ICD does not have te option to give anti-tachypacing or continuous pacemaker functionality, but can deliver a shock to cardiovert ventricular fibrillation.]] | |||
An ICD is a device that monitors heart rhythms. If it senses dangerous rhythms, it delivers shocks or anti-tachypacing (ATP) therapy. Many ICDs record the heart's electrical patterns when there is an abnormal heartbeat. | An ICD is a device that monitors heart rhythms. If it senses dangerous rhythms, it delivers shocks or anti-tachypacing (ATP) therapy. Many ICDs record the heart's electrical patterns when there is an abnormal heartbeat. | ||
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Patients do not meet the evidence based ICD implantation criteria if they have (1) a myocardial infarction within 40 days before ICD implantation; (2) newly diagnosed heart failure at the time of ICD implantation without prior therapy; (3) NYHA class IV symptoms of congestive heart failure. | Patients do not meet the evidence based ICD implantation criteria if they have (1) a myocardial infarction within 40 days before ICD implantation; (2) newly diagnosed heart failure at the time of ICD implantation without prior therapy; (3) NYHA class IV symptoms of congestive heart failure. | ||
A seperate chapter deals with a more complete list of [[ICD indications]] | |||
==Implantation== | ==Implantation== | ||
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*Right atrial lead | *Right atrial lead | ||
*Right ventricular lead | *Right ventricular lead | ||
*Left ventricular lead | *Left ventricular lead. The left ventricular lead is usually positioned in the coronary sinus, alternatively it can be positioned epicardially on the left ventricle (by a surgical procedure) or intracardially in the left ventricle (through a transseptal puncture). | ||
===Programming, follow up and complications=== | ===Programming, follow up and complications=== | ||
Programming should specifically aim at ensuring atrial-synchronous permanent biventricular pacing, by performing AV-interval optimization (echocardiography guided or using invasive haemodynamic measurments) and performing ventricular-ventricle (VV) interval optimization. Further programming, follow up and complications are similar to pacemakers and ICDs (see above). | Programming should specifically aim at ensuring atrial-synchronous permanent biventricular pacing, by performing AV-interval optimization (echocardiography guided or using invasive haemodynamic measurments) and performing ventricular-ventricle (VV) interval optimization. Further programming, follow up and complications are similar to pacemakers and ICDs (see above). | ||