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HistoryofICDsInternaldefibrillatorLate1940’sto1950’sUnitshownisfromtheearly1960’sHistoryofICDsInternaldefibr1PioneerofICDTechnologyMichelMirowski,MDDedicatedhislifetodevelopingtheICDafterhisresearchpartnerdiedinhisarmsfromaventriculararrhythmiaCreatedthefirstimplantableICD,whichstartedclinicaltrialsin1980PioneerofICDTechnologyMiche21985-FirstapprovedICDBulky,heavyShort-lived(18m)AbdominalimplantThoracotomyrequiredNon-programmableLimitedtherapyoptionsVentakisatrademarkofCardiacPacemakers,Inc.1985-FirstapprovedICDBulky3ThenextmilestoneforICDsPectoralimplantsapprovedbytheFDAin1995MorecomfortableforpatientsFasterimplantsSmallerbutjustaspowerfulasolderdevicesThenextmilestoneforICDsPec4“ActiveCan”TechnologyTraditional
SystemRV-Can“ActiveCan”TechnologyTraditi5EvolutionofICDTechnology19911995TheFirstICDsFeatured
EpicardialLeadsTransvenousLeads
andAdvancedTherapy
IncreaseEffectiveness
ofICDTherapyPectoralICDs
ReduceCostsand
IncreaseSurgicalEase1985EvolutionofICDTechnology1996“DualChamber”ICDsIntroducedin1997CombinedualchamberpacingwithventriculararrhythmiadetectionandtherapyAbilitytosenseatrialactivityduringarrhythmiasSVTDiscrimination:Theabilitytowithholdtherapyfornon-lethalarrhythmias“DualChamber”ICDsIntroduced7CardioversionIncessantVTorVF.CardioversionIncreasedVTDetectionSpecificityIncessantVTorVF.ICDIndications,whogetsoneornotConnectdefibleadswithdefibboxPectoralICDs
ReduceCostsand
IncreaseSurgicalEaseAtrialFlutterLOOKBACKWINDOW
(8INTERVALSBEFORENID)CreatedthefirstimplantableICD,whichstartedclinicaltrialsin1980ClassI:Evidence/generalagreementregardingbenefit,usefulness,andeffectivenessIncessantVTorVF.(Levelofevidence:B)GregoratosG.(Levelofevidence:B)Post-paceblankingFasterimplantsICDIndications,whogetsoneornotVFCounter:BasicFunctionsofICDAutomaticallydetectandtreatVentricularTachycardia(VT)Antitachycardiapacing(ATP)CardioversionAutomaticallydetectandtreatVentricularFibrillation(VF)DefibrillationBradypacingVVI,VVIR,DDDRCardioversionBasicFunctionso8HowitworksSensingDetectionTherapyHowitworksSensing9
Auto-AdjustingSensitivityDesignedtosensefineVFPost-sensed
sensitivityadjustmentPost-paced
sensitivityadjustmentProgrammedsensitivityPost-paceblankingMarkerChannel?TelemetryVPACEVPACEVSENSEVPACEVSENSERectified
EGMChangingThresholdPost-PacePost-Sense10x4.5x0.3mV
Auto-AdjustingSensitivityDe10ThreeZoneDetectionVTFVTVFThreeZoneDetectionVT11VTDetectionVentricularsensitivityTachydetectioninterval(TDI)VTinitialNIDVTredetectNID
VF FVT VTDetectionStatus: ON OFF ONInterval(ms): 320 400InitialNID: 12/16 12Sensitivity(mV): 0.3VTCounterValue: 1 2 3 4 5 6 7 8 9 10 11 12200msVSVSVSVSVSTSTSTSTSTSTSTSTSTSTSTSTDVTDetectionVentricularsensit12VFDetectionVentricularsensitivityFibrillationdetectioninterval(FDI)VFinitialNIDVFredetectionNIDVFDetectionVentricularsensit13FVTDetectionviaVFCounter
VF FVT VTDetectionStatus: ON ON OFFInterval(ms): 320 260InitialNID: 12/16T
FT
F?121110987654321T
F?T
F?T
F?T
F?T
F?T
F?T
F?T
F?T
F?T
F?V
SV
SV
SV
SV
SLOOKBACKWINDOW
(8INTERVALSBEFORENID)FVTDetectionviaVFCounter 14FVTDetectionviaVTCounter
VF FVT VTDetectionStatus: ON ON ONInterval(ms): 320 380 500InitialNID: 12/16 12121110987654321LOOKBACKWINDOW
(8INTERVALSBEFORENID)V
SV
SV
ST
ST
ST
ST
ST
ST
ST
ST
ST
ST
F?T
ST
F?VFCounter:FVTDetectionviaVTCounter 15IncreasedVTDetectionSpecificitySinusTachycardiaAtrialTachycardiaAtrialFlutterAtrialFibrillationMorphologyXXXXOnsetXStability
XIncreasedVTDetectionSpecifi16TherapiesATPBurstRampRamp+CardioversionDefibrillationTherapiesATP17BurstBurst18
RampRamp19
Ramp+Ramp+20ICDIndications,whogetsoneornotClassI:Evidence/generalagreementregardingbenefit,usefulness,andeffectiveness ClassII:Conflictingevidence/divergenceofopinionregardingusefulness/effectivenessIIa:Weightofevidence/opinioninfavorofusefulness/effectivenessIIb:Usefulness/effectivenesslesswellestablishedbyevidence/opinion.ClassIII:Evidence/generalagreementregardinglackofusefulness/effectiveness(harmfulinsomecases)GregoratosG.JAmCollCardiol.1998;31:1175-1209.ICDIndications,whogetsone21IncessantVTorVF.PectoralICDs
ReduceCostsand
IncreaseSurgicalEaseTurnofdetection,closethewound(Levelofevidence:B)JAmCollCardiol.LOOKBACKWINDOW
(8INTERVALSBEFORENID)MichelMirowski,MDVentricularsensitivityIIb:Usefulness/effectivenesslesswellestablishedbyevidence/opinion.TheFirstICDsFeatured
EpicardialLeadsJAmCollCardiol.(Levelofevidence:A)DetectionStatus: ON ON ONIncessantVTorVF.(Levelofevidence:C)1998;31:1175-1209.Sensitivity(mV): 0.AbdominalimplantDesignedtosensefineVFMorecomfortableforpatients(Levelofevidence:C)1998ClassIIndicationsforICDTherapy1. CardiacarrestduetoVForVTnotduetoatransientorreversiblecause.(Levelofevidence:A)2. SpontaneoussustainedVT.(Levelofevidence:B)3. Syncopeofundeterminedoriginwithclinicallyrelevant,hemodynamicallysignificantsustainedVTorVFinduced
atEPstudywhendrugtherapyisineffective,nottolerated,ornotpreferred.(Levelofevidence:B)4. NonsustainedVTwithcoronarydisease,priorMI,LVdysfunction,andinducibleVForsustainedVTatEPstudythatisnotsuppressiblebyaClassIantiarrhythmicdrug.(Levelofevidence:B)GregoratosG.JAmCollCardiol.1998;31:1175-1209.IncessantVTorVF.1998Class221998ClassIIIndications1. CardiacarrestpresumedtobeduetoVFwhenEPtestingisprecludedbyothermedicalconditions.
(Levelofevidence:C)2. Severesymptomsattributabletosustainedventriculartachyarrhythmiaswhileawaitingcardiactransplantation.(Levelofevidence:C)3. Familialorinheritedconditionswithahighriskforlife-threateningventriculartachyarrhythmiassuchaslongQTsyndromeorhypertrophiccardiomyopathy.(Levelofevidence:B)GregoratosG.JAmCollCardiol.1998;31:1175-1209.1998ClassIIIndications1. Ca231998ClassIIIndications(cont.)4. NonsustainedVTwithcoronaryarterydisease,priorMI,andLVdysfunction,andinduciblesustainedVTorVFatEPstudy.(Levelofevidence:B)5. RecurrentsyncopeofundeterminedetiologyinthepresenceofventriculardysfunctionandinducibleventriculararrhythmiasatEPstudy,whenothercausesofsyncopehavebeenexcluded.
(Levelofevidence:C)GregoratosG.JAmCollCardiol.1998;31:1175-1209.1998ClassIIIndications(con241998ClassIIIIndications1. Syncopeofundeterminedcauseinapatientwithoutinducibleventriculartachyarrhythmias.(Levelofevidence:C)2. IncessantVTorVF.(Levelofevidence:C)3. VForVTresultingfromarrhythmiasamenabletosurgicalorcatheterablation;forexample,atrialarrhythmiasassociatedwiththeWolff-Parkinson-Whitesyndrome,rightventricularoutflowtractVT,idiopathicleft
ventriculartachycardia,orfascicularVT
(Levelofevidence:C)4. Ventriculartachyarrhythmiasduetoatransientorreversibledisorder(e.g.,AMI,electrolyteimbalance,
drugs,trauma).(Levelofevidence:C)GregoratosG.JAmCollCardiol.1998;31:1175-1209.1998ClassIIIIndications1. S251998ClassIIIIndications(cont.)5. Significantpsychiatricillnessesthatmaybeaggravatedbydeviceimplantationormayprecludesystematicfollow-up.(Levelofevidence:C)6. Terminalillnesseswithprojectedlifeexpectancy
￡6months.(Levelofevidence:C)7. PatientswithcoronaryarterydiseasewithLVdysfunctionandprolongedQRSdurationintheabsenceofspontaneousorinduciblesustainedornonsustainedVTwhoareundergoingcoronarybypasssurgery.(Levelofevidence:B)8. NYHAClassIVdrug-refractorycongestiveheartfailureinpatientswhoarenotcandidatesforcardiactransplantation.(Levelofevidence:C)GregoratosG.JAmCollCardiol.1998;31:1175-1209.1998ClassIIIIndications(co26ImplantProcedureInsertionofdefibleadsTestpacingparametersthroughanalyzerofP/Rwave,leadimpedances,andpacingthresholdConnectdefibleadswithdefibboxTestpacingimpedance,thresholdthroughtheboxInduceVF,implantsuccesscriterion:twoconsecutivetimesor3outof4successfuldefibrillation,10Jsafetymargin.Turnofdetection,closethewoundFinalprogrammingImplantProcedureInsertionof27ThenextmilestoneforICDsPectoralimplantsapprovedbytheFDAin1995MorecomfortableforpatientsFasterimplantsSmallerbutjustaspowerfulasolderdevicesThenextmilestoneforICDsPec28MarkerChannel?TelemetryGregoratosG.GregoratosG.FVTDetectionviaVTCounterJAmCollCardiol.Post-sensed
sensitivityadjustmentDetectionStatus: ON ON ONFVTDetectionviaVTCounterIncessantVTorVF.FVTDetectionviaVTCounterConnectdefibleadswithdefibboxThreeZoneDetectionSVTDiscrimination:Theabilitytowithholdtherapyfornon-lethalarrhythmias1998ClassIIIndicationsIntroducedin1997InsertionofdefibleadsIncessantVTorVF.Non-programmablePatientswithcoronaryarterydiseasewithLVdysfunctionandprolongedQRSdurationintheabsenceofspontaneousorinduciblesustainedornonsustainedVTwhoareundergoingcoronarybypasssurgery.DetectionStatus: ON ON ONEvolutionofICDTechnology19911995TheFirstICDsFeatured
EpicardialLeadsTransvenousLeads
andAdvancedTherapy
IncreaseEffectiveness
ofICDTherapyPectoralICDs
ReduceCostsand
IncreaseSurgicalEase1985MarkerChannel?TelemetryEvolu29ThreeZoneDetectionVTFVTVFThreeZoneDetectionVT30FVTDetectionviaVTCounter
VF FVT VTDetectionStatus: ON ON ONInterval(ms): 320 380 500InitialNID: 12/16 12121110987654321LOOKBACKWINDOW
(8INTERVALSBEFORENID)V
SV
SV
ST
ST
ST
ST
ST
ST
ST
ST
ST
ST
F?T
ST
F?VFCounter:FVTDetectionviaVTCounter 31
Ramp+Ramp+32GregoratosG.TheFirstICDsFeatured
EpicardialLeadsCardioversion1998;31:1175-1209.Traditional
SystemRamp+1998;31:1175-1209.Cardioversion1998ClassIIIndications(cont.InduceVF,implantsuccesscriterion:twoconsecutivetimesor3outof4successfuldefibrillation,10Jsafetymargin.(Levelofevidence:C)Short-lived(18m)IncreasedVTDetectionSpecificityTransvenousLeads
andAdvancedTherapy
IncreaseEffectiveness
ofICDTherapyVentriculartachyarrhythmiasduetoatransientorreversibledisorder(e.(Levelofevidence:C)Terminalillnesseswithprojectedlifeexpectancy
￡6months.MichelMirowski,MDVentricularsensitivityTachydetectioninterval(TDI)TestpacingparametersthroughanalyzerofP/Rwave,leadimpedances,andpacingthresholdSpontaneoussustainedVT.Familialorinheritedconditionswithahighriskforlife-threateningventriculartachyarrhythmiassuchaslongQTsyndromeorhypertrophiccardiomyopathy.IncessantVTorVF.(Levelofevidence:C)Significantpsychiatricillnessesthatmaybeaggravatedbydeviceimplantationormayprecludesystematicfollow-up.GregoratosG.(Levelofevidence:C)Defibrillation(Levelofevidence:C)RampPioneerofICDTechnologyLOOKBACKWINDOW
(8INTERVALSBEFORENID)PatientswithcoronaryarterydiseasewithLVdysfunctionandprolongedQRSdurationintheabsenceofspontaneousorinduciblesustainedornonsustainedVTwhoareundergoingcoronarybypasssurgery.1998;31:1175-1209.CardiacarrestpresumedtobeduetoVFwhenEPtestingisprecludedbyothermedicalconditions.JAmCollCardiol.GregoratosG.JAmCollCardiol.1998ClassIIndicationsforICDTherapyTransvenousLeads
andAdvancedTherapy
IncreaseEffectiveness
ofICDTherapy,AMI,electrolyteimbalance,drugs,trauma).EvolutionofICDTechnologyTerminalillnesseswithprojectedlifeexpectancy
￡6months.TransvenousLeads
andAdvancedTherapy
IncreaseEffectiveness
ofICDTherapyAuto-AdjustingSensitivitySignificantpsychiatricillnessesthatmaybeaggravatedbydeviceimplantationormayprecludesystematicfollow-up.TheFirstICDsFeatured
EpicardialLeadsTerminalillnesseswithprojectedlifeexpectancy
￡6months.JAmCollCardiol.AbilitytosenseatrialactivityduringarrhythmiasLOOKBACKWINDOW
(8INTERVALSBEFORENID)Antitachycardiapacing(ATP)AbilitytosenseatrialactivityduringarrhythmiasTheFirstICDsFeatured
EpicardialLeadsSignificantpsychiatricillnessesthatmaybeaggravatedbydeviceimplantationormayprecludesystematicfollow-up.Non-programmableCardioversionMorecomfortableforpatientsIncessantVTorVF.Defibrillation1998ClassIIIIndications(cont.)5. Significantpsychiatricillnessesthatmaybeaggravatedbydeviceimplantationormayprecludesystematicfollow-up.(Levelofevidence:C)6. Terminalillnesseswithprojectedlifeexpectancy
￡6months.(Levelofevidence:C)7. PatientswithcoronaryarterydiseasewithLVdysfunctionandprolongedQRSdurationintheabsenceofspontaneousorinduciblesustainedornonsustainedVTwhoareundergoingcoronarybypasssurgery.(Levelofevidence:B)8. NYHAClassIVdrug-refractorycongestiveheartfailureinpatientswhoarenotcandidatesforcardiactransplantation.(Levelofevidence:C)GregoratosG.JAmCollCardiol.1998;31:1175-1209.GregoratosG.Spontaneoussusta33HistoryofICDsInternaldefibrillatorLate1940’sto1950’sUnitshownisfromtheearly1960’sHistoryofICDsInternaldefibr34PioneerofICDTechnologyMichelMirowski,MDDedicatedhislifetodevelopingtheICDafterhisresearchpartnerdiedinhisarmsfromaventriculararrhythmiaCreatedthefirstimplantableICD,whichstartedclinicaltrialsin1980PioneerofICDTechnologyMiche351985-FirstapprovedICDBulky,heavyShort-lived(18m)AbdominalimplantThoracotomyrequiredNon-programmableLimitedtherapyoptionsVentakisatrademarkofCardiacPacemakers,Inc.1985-FirstapprovedICDBulky36ThenextmilestoneforICDsPectoralimplantsapprovedbytheFDAin1995MorecomfortableforpatientsFasterimplantsSmallerbutjustaspowerfulasolderdevicesThenextmilestoneforICDsPec37“ActiveCan”TechnologyTraditional
SystemRV-Can“ActiveCan”TechnologyTraditi38EvolutionofICDTechnology19911995TheFirstICDsFeatured
EpicardialLeadsTransvenousLeads
andAdvancedTherapy
IncreaseEffectiveness
ofICDTherapyPectoralICDs
ReduceCostsand
IncreaseSurgicalEase1985EvolutionofICDTechnology19939“DualChamber”ICDsIntroducedin1997CombinedualchamberpacingwithventriculararrhythmiadetectionandtherapyAbilitytosenseatrialactivityduringarrhythmiasSVTDiscrimination:Theabilitytowithholdtherapyfornon-lethalarrhythmias“DualChamber”ICDsIntroduced40CardioversionIncessantVTorVF.CardioversionIncreasedVTDetectionSpecificityIncessantVTorVF.ICDIndications,whogetsoneornotConnectdefibleadswithdefibboxPectoralICDs
ReduceCostsand
IncreaseSurgicalEaseAtrialFlutterLOOKBACKWINDOW
(8INTERVALSBEFORENID)CreatedthefirstimplantableICD,whichstartedclinicaltrialsin1980ClassI:Evidence/generalagreementregardingbenefit,usefulness,andeffectivenessIncessantVTorVF.(Levelofevidence:B)GregoratosG.(Levelofevidence:B)Post-paceblankingFasterimplantsICDIndications,whogetsoneornotVFCounter:BasicFunctionsofICDAutomaticallydetectandtreatVentricularTachycardia(VT)Antitachycardiapacing(ATP)CardioversionAutomaticallydetectandtreatVentricularFibrillation(VF)DefibrillationBradypacingVVI,VVIR,DDDRCardioversionBasicFunctionso41HowitworksSensingDetectionTherapyHowitworksSensing42
Auto-AdjustingSensitivityDesignedtosensefineVFPost-sensed
sensitivityadjustmentPost-paced
sensitivityadjustmentProgrammedsensitivityPost-paceblankingMarkerChannel?TelemetryVPACEVPACEVSENSEVPACEVSENSERectified
EGMChangingThresholdPost-PacePost-Sense10x4.5x0.3mV
Auto-AdjustingSensitivityDe43ThreeZoneDetectionVTFVTVFThreeZoneDetectionVT44VTDetectionVentricularsensitivityTachydetectioninterval(TDI)VTinitialNIDVTredetectNID
VF FVT VTDetectionStatus: ON OFF ONInterval(ms): 320 400InitialNID: 12/16 12Sensitivity(mV): 0.3VTCounterValue: 1 2 3 4 5 6 7 8 9 10 11 12200msVSVSVSVSVSTSTSTSTSTSTSTSTSTSTSTSTDVTDetectionVentricularsensit45VFDetectionVentricularsensitivityFibrillationdetectioninterval(FDI)VFinitialNIDVFredetectionNIDVFDetectionVentricularsensit46FVTDetectionviaVFCounter
VF FVT VTDetectionStatus: ON ON OFFInterval(ms): 320 260InitialNID: 12/16T
FT
F?121110987654321T
F?T
F?T
F?T
F?T
F?T
F?T
F?T
F?T
F?T
F?V
SV
SV
SV
SV
SLOOKBACKWINDOW
(8INTERVALSBEFORENID)FVTDetectionviaVFCounter 47FVTDetectionviaVTCounter
VF FVT VTDetectionStatus: ON ON ONInterval(ms): 320 380 500InitialNID: 12/16 12121110987654321LOOKBACKWINDOW
(8INTERVALSBEFORENID)V
SV
SV
ST
ST
ST
ST
ST
ST
ST
ST
ST
ST
F?T
ST
F?VFCounter:FVTDetectionviaVTCounter 48IncreasedVTDetectionSpecificitySinusTachycardiaAtrialTachycardiaAtrialFlutterAtrialFibrillationMorphologyXXXXOnsetXStability
XIncreasedVTDetectionSpecifi49TherapiesATPBurstRampRamp+CardioversionDefibrillationTherapiesATP50BurstBurst51
RampRamp52
Ramp+Ramp+53ICDIndications,whogetsoneornotClassI:Evidence/generalagreementregardingbenefit,usefulness,andeffectiveness ClassII:Conflictingevidence/divergenceofopinionregardingusefulness/effectivenessIIa:Weightofevidence/opinioninfavorofusefulness/effectivenessIIb:Usefulness/effectivenesslesswellestablishedbyevidence/opinion.ClassIII:Evidence/generalagreementregardinglackofusefulness/effectiveness(harmfulinsomecases)GregoratosG.JAmCollCardiol.1998;31:1175-1209.ICDIndications,whogetsone54IncessantVTorVF.PectoralICDs
ReduceCostsand
IncreaseSurgicalEaseTurnofdetection,closethewound(Levelofevidence:B)JAmCollCardiol.LOOKBACKWINDOW
(8INTERVALSBEFORENID)MichelMirowski,MDVentricularsensitivityIIb:Usefulness/effectivenesslesswellestablishedbyevidence/opinion.TheFirstICDsFeatured
EpicardialLeadsJAmCollCardiol.(Levelofevidence:A)DetectionStatus: ON ON ONIncessantVTorVF.(Levelofevidence:C)1998;31:1175-1209.Sensitivity(mV): 0.AbdominalimplantDesignedtosensefineVFMorecomfortableforpatients(Levelofevidence:C)1998ClassIIndicationsforICDTherapy1. CardiacarrestduetoVForVTnotduetoatransientorreversiblecause.(Levelofevidence:A)2. SpontaneoussustainedVT.(Levelofevidence:B)3. Syncopeofundeterminedoriginwithclinicallyrelevant,hemodynamicallysignificantsustainedVTorVFinduced
atEPstudywhendrugtherapyisineffective,nottolerated,ornotpreferred.(Levelofevidence:B)4. NonsustainedVTwithcoronarydisease,priorMI,LVdysfunction,andinducibleVForsustainedVTatEPstudythatisnotsuppressiblebyaClassIantiarrhythmicdrug.(Levelofevidence:B)GregoratosG.JAmCollCardiol.1998;31:1175-1209.IncessantVTorVF.1998Class551998ClassIIIndications1. CardiacarrestpresumedtobeduetoVFwhenEPtestingisprecludedbyothermedicalconditions.
(Levelofevidence:C)2. Severesymptomsattributabletosustainedventriculartachyarrhythmiaswhileawaitingcardiactransplantation.(Levelofevidence:C)3. Familialorinheritedconditionswithahighriskforlife-threateningventriculartachyarrhythmiassuchaslongQTsyndromeorhypertrophiccardiomyopathy.(Levelofevidence:B)GregoratosG.JAmCollCardiol.1998;31:1175-1209.1998ClassIIIndications1. Ca561998ClassIIIndications(cont.)4. NonsustainedVTwithcoronaryarterydisease,priorMI,andLVdysfunction,andinduciblesustainedVTorVFatEPstudy.(Levelofevidence:B)5. RecurrentsyncopeofundeterminedetiologyinthepresenceofventriculardysfunctionandinducibleventriculararrhythmiasatEPstudy,whenothercausesofsyncopehavebeenexcluded.
(Levelofevidence:C)GregoratosG.JAmCollCardiol.1998;31:1175-1209.1998ClassIIIndications(con571998ClassIIIIndications1. Syncopeofundeterminedcauseinapatientwithoutinducibleventriculartachyarrhythmias.(Levelofevidence:C)2. IncessantVTorVF.(Levelofevidence:C)3. VForVTresultingfromarrhythmiasamenabletosurgicalorcatheterablation;forexample,atrialarrhythmiasassociatedwiththeWolff-Parkinson-Whitesyndrome,rightventricularoutflowtractVT,idiopathicleft
ventriculartachycardia,orfascicularVT
(Levelofevidence:C)4. Ventriculartachyarrhythmiasduetoatransientorreversibledisorder(e.g.,AMI,electrolyteimbalance,
drugs,trauma).(Levelofevidence:C)GregoratosG.JAmCollCardiol.1998;31:1175-1209.1998ClassIIIIndications1. S581998ClassIIIIndications(cont.)5. Significantpsychiatricillnessesthatmaybeaggravatedbydeviceimplantationormayprecludesystematicfollow-up.(Levelofevidence:C)6. Terminalillnesseswithprojectedlifeexpectancy
￡6months.(Levelofevidence:C)7. PatientswithcoronaryarterydiseasewithLVdysfunctionandprolongedQRSdurationintheabsenceofspontaneousorinduciblesustainedornonsustainedVTwhoareundergoingcoronarybypasssurgery.(Levelofevidence:B)8. NYHAClassIVdrug-refractorycongestiveheartfailureinpatientswhoarenotcandidatesforcardiactransplantation.(Levelofevidence:C)GregoratosG.JAmCollCardiol.1998;31:1175-1209.1998ClassIIIIndications(co59ImplantProcedureInsertionofdefibleadsTestpacingparametersthroughanalyzerofP/Rwave,leadimpedances,andpacingthresholdConnectdefibleadswithdefibboxTestpacingimpedance,thresholdthroughtheboxInduceVF,implantsuccesscriterion:twoconsecutivetimesor3outof4successfuldefibrillation,10Jsafetymargin.Turnofdetection,closethewoundFinalprogrammingImplantProcedureInsertionof60ThenextmilestoneforICDsPectoralimplantsapprovedbytheFDAin1995MorecomfortableforpatientsFasterimplantsSmallerbutjustaspowerfulasolderdevicesThenextmilestoneforICDsPec61MarkerChannel?TelemetryGregoratosG.GregoratosG.FVTDetectionviaVTCounterJAmCollCardiol.Post-sensed
sensitivityadjustmentDetectionStatus: ON ON ONFVTDetectionviaVTCounterIncessantVTorVF.FVTDetectionviaVTCounterConnectdefibleadswithdefibboxThreeZoneDetectionSVTDiscrimination:Theabilitytowithholdtherapyfornon-lethalarrhythmias1998ClassIIIndicationsIntroducedin1997InsertionofdefibleadsIncessantVTorVF.Non-programmablePatientswithcoronaryarterydiseasewithLVdysfunctionandprolongedQRSdurationintheabsenceofspontaneousorinduciblesustainedornonsustainedVTwhoareundergoingcoronarybypasssurgery.DetectionStatus: ON ON ONEvolutionofICDTechnology19911995TheFirstICDsFeatured
EpicardialLeadsTransvenousLeads
andAdvancedTherapy
IncreaseEffectiveness
ofICDTherapyPectoralICDs
ReduceCostsand
IncreaseSurgicalEase1985MarkerChannel?TelemetryEvolu62ThreeZoneDetectionVTFVTVFThreeZoneDetectionVT63FVTDetectionviaVTCounter
VF FVT VTDetectionStatus: ON ON ONInterval(ms): 320 380 500InitialNID: 12/16 12121110987654321LOOKBACKWINDOW
(8INTERVALSBEFORENID)V
SV
SV
ST
ST
ST
ST
ST
ST
ST
ST
ST
ST
F?T
ST
F?VFCounter:FVTDetectionviaVTCounter 64
Ramp+Ramp+65GregoratosG.TheFirstICDsFeatured
EpicardialLeadsCardioversion1998;31:1175-1209.Traditional
SystemRamp+1998;31:1175-1209.Cardioversion1998ClassIIIndications(cont.InduceVF,implantsuccesscriterion:twoconsecutivetimesor3outof4successfuldefibrillation,10Jsafetymargin.(Levelofevidence:C)Short-lived(18m)IncreasedVTDetectionSpecificityTransvenousLeads
andAdvancedTherapy
IncreaseEffectiveness
ofICDTherapyVentriculartachyarrhythmiasduetoatransientorreversibledisorder(e.(Levelofevidence:C)Terminalillnesseswithprojectedlifeexpectancy
￡6months.MichelMirowsk
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