1. The document discusses the basic principles and settings of cardiovascular implantable electronic devices (CIEDs), including pacemakers.
2. It covers topics such as pacing and sensing functions, parameters like lower and upper rates, pacing modes, and refractory and blanking periods.
3. The optimal settings aim to ensure cardiac pacing meets patients' needs while avoiding unnecessary pacing and maximizing battery longevity.
This document discusses indications for cardiac implantable electronic devices (CIEDs) such as pacemakers, cardiac resynchronization therapy (CRT), and implantable cardioverter defibrillators (ICDs) according to guidelines. It covers classifications of bradyarrhythmias and indications for pacing in various conditions such as persistent bradycardia. Indications for CRT and ICDs are also outlined based on left ventricular ejection fraction, heart failure class, and other factors. Current health insurance reimbursement policies in Taiwan for these devices are also summarized.
1. The document discusses the basic principles and settings of cardiovascular implantable electronic devices (CIEDs), including pacemakers.
2. It covers topics such as pacing and sensing functions, parameters like lower and upper rates, pacing modes, and refractory and blanking periods.
3. The optimal settings aim to ensure cardiac pacing meets patients' needs while avoiding unnecessary pacing and maximizing battery longevity.
This document discusses indications for cardiac implantable electronic devices (CIEDs) such as pacemakers, cardiac resynchronization therapy (CRT), and implantable cardioverter defibrillators (ICDs) according to guidelines. It covers classifications of bradyarrhythmias and indications for pacing in various conditions such as persistent bradycardia. Indications for CRT and ICDs are also outlined based on left ventricular ejection fraction, heart failure class, and other factors. Current health insurance reimbursement policies in Taiwan for these devices are also summarized.
植入性心臟電子儀器地基本原理與設定
This document discusses the basic principles and settings of implantable cardiac electronic devices. It covers topics such as voltage, current, impedance, pacing modes, detection zones, cardioversion, defibrillation, anti-tachycardia pacing, and challenges in reducing inappropriate therapies. Key points include an overview of Ohm's Law and its application to pacemakers, examples of different pacing modes like VVI and DDD, considerations for programming detection zones and therapy levels in ICDs, and the use of ATP to terminate VT episodes.
This document provides an overview of diagnosing myocardial infarction (MI) using electrocardiograms (ECGs). It discusses that an MI is best diagnosed using a 12-lead ECG rather than just a rhythm strip. The 12-lead ECG views the heart from 12 angles and can identify ST elevation in different regions to locate the MI. Anterior MIs involve leads V1-V4, lateral MIs involve leads I, aVL, V5-V6, and inferior MIs involve leads II, III, and aVF. The document walks through examples of anterior, lateral, inferior, and anterolateral MIs.
This document provides an overview of pacemaker ECG interpretations with the following aims:
1) To determine the pacing mode and whether it is functioning normally or abnormally.
2) To define any abnormalities present and differentiate between true malfunctions versus pseudo-malfunctions.
3) To recognize ECG patterns that may appear abnormal but are actually due to the normal operation of complex pacemaker algorithms.
It describes the types of pacemakers, electrodes, identification systems, sensing and pacing functions, modes of ventricular and atrial pacemakers, dual chamber pacemaker ECG patterns, pacemaker-mediated tachycardia, and takes away the importance of determining pacing mode and diagnosing normal versus abnormal function.
This document discusses ablation of atypical flutter. It begins with a case presentation and surface ECG of a patient with incessant tachycardia. It then provides an overview of typical and atypical flutter mechanisms, including CTI-dependent typical flutter and various non-CTI dependent circuits. It describes challenges ablating non-CTI dependent flutters and mapping algorithms. The document concludes with examples of ablation of different atypical flutter circuits, including incisional flutters.
Defibrilasyon ve defibrilatör 12 nisan 2015Hamit Işıkalp
Resusitasyonu günlük klinik çalışmalarında sık uygulamayan sağlık çalışanları için defibrilasyon ve defibrilatörler hakkında bir yansı. Tüm bilgileri yazılı olarak içermiyor. Eğitmenin anlatımı ile anlam kazanır.
A slide prepared for healthcare workers who do not use resuscitation skills in their everyday clinic life. About defibrillation, defibrillators. Does not include all the knowledge written. Must be used by the lecturer.
The document describes the electrocardiogram (ECG or EKG), which measures electrical activity of the heart. It notes that the ECG waveform consists of P waves from atrial depolarization, QRS complex from ventricular depolarization, and T waves from ventricular repolarization. It explains that the ECG represents both depolarization and repolarization waves generated by the heart during each heartbeat. It provides details on normal ECG intervals and how to analyze ECG rhythms.
This document provides an overview of stress echocardiography including objectives, indications, protocols, interpretation, and complications. Key points include: stress echo can evaluate CAD using exercise or pharmacologic stress with dobutamine; it has good sensitivity and specificity for CAD compared to nuclear imaging; and provides prognostic information on cardiac events. Interpretation focuses on changes in wall motion, ejection fraction, and detection of ischemia. Stress echo helps evaluate multiple conditions including viability, valvular disease, and cardiomyopathies.
Atrial tachycardias are an uncommon cause of supraventricular tachycardia, accounting for around 5-15% of cases depending on whether the patient has congenital heart defects. Atrial tachycardias can be focal, originating from a single site, or macroreentrant utilizing existing anatomical barriers; 3D mapping systems have improved localization of focal atrial tachycardia origins by providing better atrial anatomy visualization. Successful focal atrial tachycardia ablation is identified by termination of tachycardia within 10 seconds of beginning radiofrequency delivery and inability to reinduce tachycardia with drug provocation.
Cardiac arrhythmias and mapping techniquesSpringer
This document provides an overview of clinical cardiac electrophysiology. It discusses the history and development of the field, including the first recordings of intracardiac electrograms in the 1940s-1960s and the development of programmed electrical stimulation in the 1960s-1970s which allowed investigation of arrhythmia mechanisms. It describes the methodology used in electrophysiology studies, including equipment for recording cardiac activity and electrical stimulation, as well as study protocols for evaluating conduction intervals, refractory periods, and inducing/terminating arrhythmias. It outlines the diagnostic and therapeutic indications for electrophysiology studies in evaluating bradycardias, tachycardias, guiding catheter ablation and medical therapy, and risk stratification of conditions like WPW
IVUS may not be clinically warranted in all interventions, and should be seen as an adjunct to angiography. IVUS provides information about vessel morphology, plaque topography, and therapeutic outcomes that is often either equivocal or unavailable in angiographic images.
There are 3 situations in which IVUS has the most clinical utility:
Small vessel stenting: Studies have shown that post-stent restenosis rates are higher in small vessels. This is particularly true for vessels with diameters of 3.0mm or less, wherein small increases in stent diameter have been shown to significantly decrease the rate of restenosis. A study by Moussa et al showed that, as measured by IVUS, the incidence of restenosis has an inverse relationship to the post-procedure in-stent lumen CSA1.
In-Stent restenosis: In these cases, IVUS helps to determine whether the restenosis is due to inadequate stent deployment (underexpansion or incomplete apposition) due to intimal hyperplasia. IVUS will also help you select the proper device size for treatment of the stented area.
Difficult to assess lesions: At times, images of a lesion and the adjacent reference segment are often hazy. IVUS should be used to identify whether the angiographic appearance is due to dissection, thrombus, residual plaque, or is benign.
This document provides information about interpreting electrocardiograms (ECGs) for patients with dual chamber pacemakers. It lists the worldwide headquarters and contact information for Medtronic, the medical device company that produces pacemakers. The document aims to help physicians and medical professionals interpret ECG readings for patients with Medtronic dual chamber pacemakers implanted.
This document describes the electrocardiographic features of atrial flutter. It discusses:
- Typical atrial flutter involves a macroreentrant circuit around the tricuspid valve that rotates either clockwise or counterclockwise.
- Atypical flutter has a less well defined circuit and rate over 350 bpm.
- ECG shows sawtooth flutter waves at 250-350 bpm without isoelectric segments. The ventricular response is typically 2:1 but can be variable.
- Counterclockwise flutter has negative flutter waves in inferior leads and positive in V1. Clockwise is reversed.
- Right versus left atrial flutter can be distinguished by the polarity of flutter waves in V1
The document discusses newer advancements in heart failure device therapy. It summarizes that device therapies have greatly improved outcomes for heart failure patients. Some key devices discussed include implantable cardioverter defibrillators (ICDs) which reduce sudden cardiac death, cardiac resynchronization therapy which improves heart function, and left ventricular assist devices (LVADs) which are increasingly being used as long term support devices or as a destination therapy for end stage heart failure patients. The document provides details on the development, indications, benefits and risks of these various heart failure devices.
An ECG records the electrical activity of the heart over time using skin electrodes. It detects tiny electrical changes on the skin caused by heart muscle depolarization during each heartbeat. The standard ECG graph paper records the electrocardiogram and has calibrations for speed, amplitude, and time intervals. Proper patient positioning and electrode placement are important to obtain an accurate recording and avoid artifacts. Key aspects of ECG interpretation include heart rate, rhythm, electrical axis, and analyzing the P, QRS, and T waves. Common arrhythmias and abnormalities produce distinctive ECG patterns.
This document provides an overview of EKG waveforms and arrhythmias. It discusses the electrical activity and associated muscle movements in the atria and ventricles that produce the different waves of the EKG. Common arrhythmias like AV block, atrial flutter, and atrial fibrillation are described. The characteristics of normal sinus rhythm as well as abnormal rhythms including premature ventricular contractions, ventricular tachycardia, and ventricular fibrillation are summarized. The document provides a guide for interpreting EKG readings to identify arrhythmias and dysrhythmias.
This document provides guidelines on the management of stable coronary artery disease (SCAD). SCAD is characterized by reversible episodes of ischemia that are usually induced by stress and reproducible. The main features of SCAD include plaque-related obstruction, focal or diffuse arterial spasm, microvascular dysfunction, and left ventricular dysfunction from prior acute necrosis. Diagnosis involves assessing symptoms, obtaining a medical history, and performing tests like electrocardiograms, imaging, and invasive coronary angiography. Risk stratification uses test results to determine a patient's annual mortality risk as low (<1%), intermediate (1-3%), or high (>3%) to guide management, which includes lifestyle changes, pharmacological therapy, and possible revascularization.
植入性心臟電子儀器地基本原理與設定
This document discusses the basic principles and settings of implantable cardiac electronic devices. It covers topics such as voltage, current, impedance, pacing modes, detection zones, cardioversion, defibrillation, anti-tachycardia pacing, and challenges in reducing inappropriate therapies. Key points include an overview of Ohm's Law and its application to pacemakers, examples of different pacing modes like VVI and DDD, considerations for programming detection zones and therapy levels in ICDs, and the use of ATP to terminate VT episodes.
This document provides an overview of diagnosing myocardial infarction (MI) using electrocardiograms (ECGs). It discusses that an MI is best diagnosed using a 12-lead ECG rather than just a rhythm strip. The 12-lead ECG views the heart from 12 angles and can identify ST elevation in different regions to locate the MI. Anterior MIs involve leads V1-V4, lateral MIs involve leads I, aVL, V5-V6, and inferior MIs involve leads II, III, and aVF. The document walks through examples of anterior, lateral, inferior, and anterolateral MIs.
This document provides an overview of pacemaker ECG interpretations with the following aims:
1) To determine the pacing mode and whether it is functioning normally or abnormally.
2) To define any abnormalities present and differentiate between true malfunctions versus pseudo-malfunctions.
3) To recognize ECG patterns that may appear abnormal but are actually due to the normal operation of complex pacemaker algorithms.
It describes the types of pacemakers, electrodes, identification systems, sensing and pacing functions, modes of ventricular and atrial pacemakers, dual chamber pacemaker ECG patterns, pacemaker-mediated tachycardia, and takes away the importance of determining pacing mode and diagnosing normal versus abnormal function.
This document discusses ablation of atypical flutter. It begins with a case presentation and surface ECG of a patient with incessant tachycardia. It then provides an overview of typical and atypical flutter mechanisms, including CTI-dependent typical flutter and various non-CTI dependent circuits. It describes challenges ablating non-CTI dependent flutters and mapping algorithms. The document concludes with examples of ablation of different atypical flutter circuits, including incisional flutters.
Defibrilasyon ve defibrilatör 12 nisan 2015Hamit Işıkalp
Resusitasyonu günlük klinik çalışmalarında sık uygulamayan sağlık çalışanları için defibrilasyon ve defibrilatörler hakkında bir yansı. Tüm bilgileri yazılı olarak içermiyor. Eğitmenin anlatımı ile anlam kazanır.
A slide prepared for healthcare workers who do not use resuscitation skills in their everyday clinic life. About defibrillation, defibrillators. Does not include all the knowledge written. Must be used by the lecturer.
The document describes the electrocardiogram (ECG or EKG), which measures electrical activity of the heart. It notes that the ECG waveform consists of P waves from atrial depolarization, QRS complex from ventricular depolarization, and T waves from ventricular repolarization. It explains that the ECG represents both depolarization and repolarization waves generated by the heart during each heartbeat. It provides details on normal ECG intervals and how to analyze ECG rhythms.
This document provides an overview of stress echocardiography including objectives, indications, protocols, interpretation, and complications. Key points include: stress echo can evaluate CAD using exercise or pharmacologic stress with dobutamine; it has good sensitivity and specificity for CAD compared to nuclear imaging; and provides prognostic information on cardiac events. Interpretation focuses on changes in wall motion, ejection fraction, and detection of ischemia. Stress echo helps evaluate multiple conditions including viability, valvular disease, and cardiomyopathies.
Atrial tachycardias are an uncommon cause of supraventricular tachycardia, accounting for around 5-15% of cases depending on whether the patient has congenital heart defects. Atrial tachycardias can be focal, originating from a single site, or macroreentrant utilizing existing anatomical barriers; 3D mapping systems have improved localization of focal atrial tachycardia origins by providing better atrial anatomy visualization. Successful focal atrial tachycardia ablation is identified by termination of tachycardia within 10 seconds of beginning radiofrequency delivery and inability to reinduce tachycardia with drug provocation.
Cardiac arrhythmias and mapping techniquesSpringer
This document provides an overview of clinical cardiac electrophysiology. It discusses the history and development of the field, including the first recordings of intracardiac electrograms in the 1940s-1960s and the development of programmed electrical stimulation in the 1960s-1970s which allowed investigation of arrhythmia mechanisms. It describes the methodology used in electrophysiology studies, including equipment for recording cardiac activity and electrical stimulation, as well as study protocols for evaluating conduction intervals, refractory periods, and inducing/terminating arrhythmias. It outlines the diagnostic and therapeutic indications for electrophysiology studies in evaluating bradycardias, tachycardias, guiding catheter ablation and medical therapy, and risk stratification of conditions like WPW
IVUS may not be clinically warranted in all interventions, and should be seen as an adjunct to angiography. IVUS provides information about vessel morphology, plaque topography, and therapeutic outcomes that is often either equivocal or unavailable in angiographic images.
There are 3 situations in which IVUS has the most clinical utility:
Small vessel stenting: Studies have shown that post-stent restenosis rates are higher in small vessels. This is particularly true for vessels with diameters of 3.0mm or less, wherein small increases in stent diameter have been shown to significantly decrease the rate of restenosis. A study by Moussa et al showed that, as measured by IVUS, the incidence of restenosis has an inverse relationship to the post-procedure in-stent lumen CSA1.
In-Stent restenosis: In these cases, IVUS helps to determine whether the restenosis is due to inadequate stent deployment (underexpansion or incomplete apposition) due to intimal hyperplasia. IVUS will also help you select the proper device size for treatment of the stented area.
Difficult to assess lesions: At times, images of a lesion and the adjacent reference segment are often hazy. IVUS should be used to identify whether the angiographic appearance is due to dissection, thrombus, residual plaque, or is benign.
This document provides information about interpreting electrocardiograms (ECGs) for patients with dual chamber pacemakers. It lists the worldwide headquarters and contact information for Medtronic, the medical device company that produces pacemakers. The document aims to help physicians and medical professionals interpret ECG readings for patients with Medtronic dual chamber pacemakers implanted.
This document describes the electrocardiographic features of atrial flutter. It discusses:
- Typical atrial flutter involves a macroreentrant circuit around the tricuspid valve that rotates either clockwise or counterclockwise.
- Atypical flutter has a less well defined circuit and rate over 350 bpm.
- ECG shows sawtooth flutter waves at 250-350 bpm without isoelectric segments. The ventricular response is typically 2:1 but can be variable.
- Counterclockwise flutter has negative flutter waves in inferior leads and positive in V1. Clockwise is reversed.
- Right versus left atrial flutter can be distinguished by the polarity of flutter waves in V1
The document discusses newer advancements in heart failure device therapy. It summarizes that device therapies have greatly improved outcomes for heart failure patients. Some key devices discussed include implantable cardioverter defibrillators (ICDs) which reduce sudden cardiac death, cardiac resynchronization therapy which improves heart function, and left ventricular assist devices (LVADs) which are increasingly being used as long term support devices or as a destination therapy for end stage heart failure patients. The document provides details on the development, indications, benefits and risks of these various heart failure devices.
An ECG records the electrical activity of the heart over time using skin electrodes. It detects tiny electrical changes on the skin caused by heart muscle depolarization during each heartbeat. The standard ECG graph paper records the electrocardiogram and has calibrations for speed, amplitude, and time intervals. Proper patient positioning and electrode placement are important to obtain an accurate recording and avoid artifacts. Key aspects of ECG interpretation include heart rate, rhythm, electrical axis, and analyzing the P, QRS, and T waves. Common arrhythmias and abnormalities produce distinctive ECG patterns.
This document provides an overview of EKG waveforms and arrhythmias. It discusses the electrical activity and associated muscle movements in the atria and ventricles that produce the different waves of the EKG. Common arrhythmias like AV block, atrial flutter, and atrial fibrillation are described. The characteristics of normal sinus rhythm as well as abnormal rhythms including premature ventricular contractions, ventricular tachycardia, and ventricular fibrillation are summarized. The document provides a guide for interpreting EKG readings to identify arrhythmias and dysrhythmias.
This document provides guidelines on the management of stable coronary artery disease (SCAD). SCAD is characterized by reversible episodes of ischemia that are usually induced by stress and reproducible. The main features of SCAD include plaque-related obstruction, focal or diffuse arterial spasm, microvascular dysfunction, and left ventricular dysfunction from prior acute necrosis. Diagnosis involves assessing symptoms, obtaining a medical history, and performing tests like electrocardiograms, imaging, and invasive coronary angiography. Risk stratification uses test results to determine a patient's annual mortality risk as low (<1%), intermediate (1-3%), or high (>3%) to guide management, which includes lifestyle changes, pharmacological therapy, and possible revascularization.