Case-Based Device Therapy for Heart Failure

✍ Scribed by Ulrika Birgersdotter-Green; Eric Adler

• Publisher: Springer
• Year: 2021
• Tongue: English
• Leaves: 336
• Edition: 1
• Category: Library

✦ Synopsis

This book provides a comprehensive practical guide to the plethora of devices that have been developed to support the failing heart. It features easy to follow clinically relevant guidance on mechanical devices used for improving cardiac electrical conduction and cardiac output. Chapters cover indications and implant considerations for the implantable cardioverter defibrillator and cardiac resynchronization therapy devices and hemodynamic monitoring in the intensive care unit. Case-Based Device Therapy for Heart Failure describes how to properly use a range of available devices to treat heart failure. Thanks to its multidisciplinary authorship, it is a valuable resource for practising and trainee heart failure cardiologists, electrophysiologists and cardiac surgeons.

✦ Table of Contents

Contents
Section I Management of Cardiogenic Shock
Assessment of the Shock Patient and Hemodynamic Monitoring
Case Vignette
Definition
Causes
Pathophysiology
Early Recognition of Shock
Risk Assessment
Risk Scores
Biomarkers
Echocardiography
Hemodynamic Monitoring
Hemodynamic Risk Profiling
Hemodynamic Goal Directed Therapy
Establishing Weaning Versus Dependence
Timing of Percutaneous Mechanical Circulatory Support
Shock Team Approach
Key Points
Case Conclusion
Conclusion
Future Direction
References
Temporary Mechanical Circulatory Support
Clinical Vignette 1
Introduction: IABP
IABP and Acute Myocardial Infarction
Clinical Vignette 2
Introduction: Impella
Impella and Cardiogenic Shock
Clinical Vignette 3
Introduction: TandemHeart
TandemHeart and Cardiogenic Shock
Special Considerations
Choosing a Percutaneous Support Device: Clinical Decision-Making
Conclusion
References
Extra Corporeal Membrane Oxygenation
Case
Introduction
Mechanism of ECMO Support
Modes of Vascular Access [5]
Patient Selection
Management Strategies and Troubleshooting
Hypotension
Differential Hypoxia—VA ECMO
Recirculation—VV ECMO
LV Venting Strategies
Complications
Hematologic
Vascular
Neurologic
Infection
Conclusion
References
Section II Chronic Device Therapy in the Advanced Heart Failure Patient
Selection Criteria for Durable Mechanical Circulatory Support
Clinical Case
Introduction
Patient Selection
INTERMACS
Indications
General Considerations
Cardiovascular Considerations
RV Failure
End-Organ Considerations
Renal Function
Hepatic Function
Pulmonary Function
Hematologic Function
Psychosocial Considerations
Case Conclusion
References
LVAD Inpatient Management
Case Vignette
Pre-Operative Optimization
Intra-Operative Management
Post-Operative Management
Anticoagulation Management
Infectious Prophylaxis
Blood Pressure Management and Hemodynamic Optimization
Case Vignette Conclusion
References
Outpatient Management of LVAD
Clinical Vignette
Introduction
Preparing for Life Outside Hospital
Patient and Caregiver Education
Home Safety
Rehabilitation
Optimization Study
Outpatient Clinic Visits
Blood Pressure Management
Driveline Exit-Site Management
Responsibilities of Other Providers and Local Teams
Pharmacological Consideration
LVAD Effect on Coagulation System
Antithrombotic Therapy
Long-Term Anticoagulation Management
Antiplatelet Therapy
Caregivers’ Issues
Case Conclusion
Equipment Management
References
Evaluation and Management of LVAD Complications
Clinical Vignette
Introduction
Basic LVAD Physiology
Pump Parameters
Evaluation of Abnormal LVAD Parameters
Approach
Pump Thrombosis
Background
Presentation of Pump Thrombosis
Diagnostic Evaluation
Management
Right Heart Failure
Presentation of Right Heart Failure
Prediction and Diagnostic Criteria
Differential
Management
Bleeding
Presentation and Assessment
Management
Stroke
Background and Presentation
Assessment
Management of Ischemic Stroke
Management of Hemorrhagic Stroke
Long-Term Management
Arrhythmias
Presentation
Risk Factors and Outcomes
Management
Aortic Insufficiency
Presentation
Diagnosis
Clinical Presentation
Management
Tamponade
Presentation
Differential and Diagnosis
Management
Infection
Presentation
Infectious Etiologies
Evaluation
Treatment
Clinical Vignette: Conclusion
Key Points
Future Directions
References
Section III Devices for Stage C Heart Failure
Long Term Hemodynamic Monitoring
Clinical Vignette
Burden of Heart Failure Readmissions
Telemonitoring
Cardiac Implantable Electronic Devices (CIEDs)
The Shift to Intracardiac Pressure Monitoring
The Right Ventricular Pressure Monitoring System
The HeartPOD Left Atrial Pressure Monitoring System
The Fidelity of Pulmonary Artery Measurements
The CardioMEMS Pulmonary Artery Monitoring System
Other Pulmonary Artery Pressure Monitoring Systems
Remote Monitoring Reimbursement
Case Conclusion
Key Points
References
Remote Monitoring for Cardiac Implantable Electronic Devices Used in Heart Failure
Case Vignette
Introduction
Follow up of Patients After Device Implantation
Remote Monitoring Technology: How It Works
Clinical Benefits of Remote Monitoring
Improving Utilization of Remote Monitoring
How to Establish a Remote Monitoring Program
Reimbursement
Legal Aspects and Security Considerations
Pitfalls with Remote Monitoring
What Should the HF Physician Look for in a Remote Interrogation?
Future Directions
Case Conclusion
Key Points
References
Section IV Device Based Arrhythmia Management
Indications for the Implantable Cardioverter Defibrillator (ICD)
Clinical Case
Introduction
Indications
Ischemic Heart Disease
Secondary Prevention
Primary Prevention
Nonischemic Cardiomyopathy
Secondary Prevention
Primary Prevention
ICD System
Defibrillator (Pulse Generator)
Lead Connector
Device Selection
Transvenous ICD Versus Subcutaneous ICD
Dual Chamber Versus Single Chamber
Single Coil Versus Dual Coil
Shock Polarity
Integrated Bipolar Versus Dedicated (True) Bipolar
Case Conclusion
Future Directions
Key Points
References
Implant Considerations for the Implantable Cardioverter Defibrillator
Clinical Case
Introduction
Implantation of ICD
Preparation for ICD Implantation
Management of Anticoagulation
Assessment of Axillary Vein
Implantation Techniques
Position of the ICD Can (Pulse Generator)
Venous Puncture
Various Approaches for Venous Access
Placement of Atrial and Ventricular Leads
Lead Connection, ICD Generator Placement, and Wound Closure
Defibrillation Threshold (DFT) Testing
Defibrillation Threshold (DFT) Testing in Clinical Practice
Right Pectoral Implantation
Complications
Follow up After Implantation
Case Conclusion
Future Directions
Key Points
References
Implantable Cardioverter Defibrillator Programming and Troubleshooting
Clinical Case
Basic Programming of the Pacemaker Function for Defibrillator
ICD Shocks and Inappropriate Shocks
Defibrillator Anti-tachycardia Detection and Therapy Setting
ICD Criteria to Minimize Inappropriate Shocks
Management of ICD Shocks
Common Causes of Inappropriate ICD Shocks
Subcutaneous ICD
Case Conclusion
Key Points
References
Use of the Subcutaneous Implantable Cardioverter Defibrillator in Patients with Heart Failure
Case Vignette
Introduction to Subcutaneous Implantable Defibrillators
Historical Perspective
Basic Information
Indications and Current Evidence of Subcutaneous Implantable Cardioverter-Defibrillators
Screening
Defibrillator Threshold Testing
Follow Up Considerations
Special Situations
References
How to Identify and Manage Complications from Cardiac Implantable Electronic Devices
Case Vignette
Introduction
Incidence of Complications
Risk Factors
Leadless Pacing Complications
References
Management of Implantable Cardioverter Defibrillators in Patients with a Left Ventricular Assist Device
Case Vignette
ICD Indications In Patients With LVADs
Generator Replacement After LVAD Implantation.
Use of Subcutaneous ICDS in LVAD Patients
ICD Troubleshooting After LVAD Implantation
Programming ICD Therapy Zones.
Case Conclusion
Key-Points
References
Indications and Use of the Wearable Cardioverter-Defibrillator
Clinical Case
Introduction
The Wearable Cardioverter-Defibrillator
WCD Functioning
Gaps in ICD Eligibility and SCD Risk
Eligible Patients
WCD Therapy Rate and Effectiveness
The VEST Trial
Controversies in WCD Use
Limitations to WCD
Current Recommendations
Future Directions
Case Conclusion
References
Cardiac Device Management in Palliative Care
Case Vignette 1
Introduction
Navigating Discussions
How to Deactivate Pacemakers and Defibrillators
Logistics of CIED Deactivation
ICD Deactivation
Pacemaker Deactivation
Case Conclusion
Clinical Case #2
Navigating Discussions
LVAD Deactivation
Case Conclusion
References
Section V Cardiac Resynchronization Therapy (CRT)
Indications for Cardiac Resynchronization Therapy
Clinical Vignette
Introduction
Indications for CRT
Case Conclusion
Future Directions
References
Implant Considerations for the CRT Device
Clinical Vignette
Introduction
Conclusion
Case Conclusion
References
Cardiac Resynchronization Therapy Programming and Troubleshooting
Case Scenario
CRT Pacing
Pacing Modes
CRT Programming
Atrioventricular (AV) Timing
Ventriculoventricular (VV) Timing
Other Optimizations
Rate Response in CRT Patients
Phrenic Nerve Stimulation
Post Implant Optimization
CRT Nonresponders
Case Wrap Up
References
His Bundle and Physiologic Pacing for Cardiac Resynchronization Therapy
Clinical Vignette
Introduction
His Bundle Pacing: Rationale and Evidence
His Bundle Pacing for Cardiac Resynchronization
Definitions
Implantation Technique—His Bundle Pacing
Implantation Technique—Left Bundle Branch Pacing
Troubleshooting
Future Directions
Clinical Vignette: Conclusion
References
Cardiac Resynchronization Therapy in Patients with Left Ventricular Assist Devices
Clinical Vignette
Introduction
Benefits of CRT in Patients with LVADs
Reasons to Discontinue CRT After LVAD Placement
Optimal Programming in Pacemaker-Dependent Patients
Case Conclusion
References
Index