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E-raamat: Cardiac Bioelectric Therapy: Mechanisms and Practical Implications

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  • Ilmumisaeg: 07-Nov-2008
  • Kirjastus: Springer-Verlag New York Inc.
  • Keel: eng
  • ISBN-13: 9780387794037
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  • Formaat: PDF+DRM
  • Ilmumisaeg: 07-Nov-2008
  • Kirjastus: Springer-Verlag New York Inc.
  • Keel: eng
  • ISBN-13: 9780387794037
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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.

Arvustused

From the reviews:









"This book discusses the background of the theory and methodology that drive current pacing and defibrillation strategies. The most likely readers are electrophysiologists, research scientists in the field of cardiac bioelectric therapy, or physician-scientists with an interest in this field. This is an extremely thorough book on the mechanisms that drive the current clinical utility of pacemakers and defibrillators. It will be a useful reference for many electrophysiologists and researchers in the field." (Louis A Salvaggio, Doodys Review Service, February, 2009)

Preface xv
List of Contributors
xix
Foreword xxiii
Part I History
History of Cardiac Pacing
3(12)
Earl Bakken: One Version of the First Pacemaker Story
3(1)
The Long List of Inventions and Observations that Led to the Pacemaker
4(1)
Pulse Theory and Observations that Bradycardia Leads to Syncope
4(1)
Early Cardiac Pacing
5(1)
Internal Pacemakers
6(6)
Pacing for Nonsurgeons
7(1)
Power Innovations
8(1)
Programming
8(1)
Dual-Chamber Pacing
9(1)
Activity Rate Responders
10(1)
Implantable Cardiac Defibrillators
10(1)
Michel Mirowski
10(2)
Conclusion
12(1)
References
12(3)
History of Defibrillation
15(26)
Introduction: Defibrillation and Its Creators
15(2)
Mysteries of Early Research: Abdilgaard's Chickens and Kite's Successes
17(5)
Elucidating the Mechanism, Imagining the Cure
22(4)
Defibrillation: From Russia and the Soviet Block
26(4)
Defibrillation: AC to DC, in America and Beyond
30(5)
Conclusion
35(3)
References
38(3)
Ventricular Fibrillation: A Historical Perspective
41(22)
Introduction
41(1)
Concepts, Instruments, and Institutions: Nineteenth-Century Legacy
42(2)
The Clinic and the Laboratory
44(3)
Ventricular Fibrillation: Experimental Evidence and Basic Concepts, 1880s--1920s
47(5)
From Wiggers to Moe: The Multiple Wavelet Hypothesis
52(1)
Modern Concepts of Ventricular Fibrillation
53(1)
Concluding Remarks
54(1)
References and Notes
54(9)
Part II Theory of Electric Stimulation and Defibrillation
The Bidomain Theory of Pacing
63(22)
Introduction
63(1)
Unipolar Stimulation
63(1)
Make and Break Excitation
64(7)
Strength-Interval Curves
71(5)
No-Response Phenomenon
76(2)
Effect of Potassium on Pacing
78(1)
Time Dependence of the Anodal and Cathodal Refractory Periods
79(2)
Conclusion
81(1)
Acknowledgments
81(1)
References
81(4)
Bidomain Model of Defibrillation
85(26)
Introduction
85(1)
Advancements Leading to the Development of the Bidomain Model of Defibrillation
86(1)
Bidomain Equations and Numerical Approaches for Large-Scale Simulations in Shock-Induced Arrhythmogenesis and Defibrillation
87(7)
Governing Equations
88(1)
Computational Considerations
89(1)
Numerical Schemes
90(1)
Linear Solvers
91(3)
Models of the Heart in Vulnerability and Defibrillation Studies
94(2)
Description of Myocardial Geometry and Fiber Architecture
94(1)
Representation of Ionic Currents and Membrane Electroporation
95(1)
Shock Electrodes and Waveforms
95(1)
Arrhythmia Induction with an Electric Shock and Defibrillation
96(1)
Postshock Activity in the Ventricles
97(7)
VEP Induced by the Shock in the 3D Volume of the Ventricles
97(2)
Postshock Activations in the 3D Volume of the Ventricles
99(1)
ULV and LLV
100(2)
Shock-Induced Phase Singularities and Filaments
102(1)
Induction of Arrhythmia with Biphasic Shocks
102(2)
Conclusion
104(1)
Acknowledgments
105(1)
References
105(6)
The Generalized Activating Function
111(22)
Introduction
111(1)
The Activating Function
112(2)
The Generalized Activating Function
114(2)
Examples
116(8)
Discussion
124(2)
Limitations
125(1)
Validation
126(1)
Conclusion
126(1)
Appendix
126(4)
References
130(3)
Theory of Electroporation
133(32)
Concept of Electroporation
133(1)
Physical Background of Electroporation
134(6)
Pore Energy
134(2)
Pore Creation
136(1)
Pore Evolution
137(1)
Postshock Pore Shrinkage and Coarsening
138(1)
Pore Resealing
139(1)
Mathematical Modeling of Electroporation
140(4)
Advection-Diffusion Equation
140(1)
Asymptotic Model of Electroporation
141(1)
Current-Voltage Relationship of a Pore
142(2)
Example of the Electroporation Process
144(7)
Governing Equation for the Transmembrane Potential
144(1)
Membrane Charging Phase
145(1)
Pore Creation Phase
145(1)
Pore Evolution Phase
146(2)
Postshock Pore Shrinkage Phase
148(1)
Pore Resealing Phase
149(1)
Effects of Shock Strength
149(2)
Limitations
151(2)
Conclusion
153(1)
Acknowledgment
153(1)
Appendix 1: Parameters of the Electroporation Model
154(1)
Appendix 2: Numerical Implementation
155(1)
References
156(9)
Part III Electrode Mapping of Defibrillation
Critical Points and the Upper Limit of Vulnerability for Defibrillation
165(24)
Introduction
165(2)
Mechanisms by which Shocks Induce VF
167(2)
The Field-Recovery Critical Point
169(11)
Inconsistencies with the Field-Recovery Critical Hypothesis for Defibrillation
180(2)
The Virtual Electrode Critical Point
182(3)
Other Possible Mechanisms for Defibrillation
185(1)
Acknowledgment
185(1)
References
185(4)
The Role of Shock-Induced Nonregenerative Depolarizations
189(32)
Brief Historical Perspectives
189(5)
The Era of Computerized Cardiac Mapping: New Insights
194(2)
Initiation of VF by Electrical Stimuli
195(1)
Different Proposed Hypotheses of Defibrillation
196(15)
The Graded Response Hypothesis of Fibrillation and Defibrillation
199(1)
Graded Response Characteristics
199(12)
Conclusions and Future Directions
211(1)
Acknowledgment
212(1)
References
212(9)
Part IV Optical Mapping of Stimulation and Defibrillation
Mechanisms of Isolated Cell Stimulation
221(34)
Introduction
221(1)
Transmembrane Potential (Vm) Responses of an Isolated Cell
222(15)
Theoretical Framework of Field Stimulation
222(3)
Experimental Responses During Field Stimulation
225(11)
Single Cells Versus Tissue Responses: Similarities and Differences
236(1)
Field-Induced Responses of an Isolated Cell-Pair: Sawtooth Effect
237(6)
Theoretical Treatment of Sawtooth Effect
238(1)
Experimental Measurement of Sawtooth Effect
239(2)
Sawtooth Effect's Role in Tissue: ``Fact or Fantasy''
241(2)
Effect of Electric Fields on Intracellular Calcium
243(6)
Measurement of Intracellular Ca2+ Transients Using Fluorescent Probes
244(1)
Effect of Field Stimulation on Intracellular Ca2+ Transients at Rest
244(4)
Effect of Field Stimulation on Intracellular Ca2+ Transients During Plateau
248(1)
Implications of Field-Induced Ca2+ Gradients
248(1)
Conclusion
249(1)
References
249(6)
The Role of Microscopic Tissue Structure in Defibrillation
255(28)
Introduction
255(1)
Possible Mechanisms of Intramural Shock-Induced Vm Changes
256(2)
The Role of Microscopic Tissue Structure in the Shock Effects: Experiments in Cell Cultures
258(12)
The Role of Cell Boundaries in Shock Effects
259(2)
The Role of Intercellular Clefts in the Shock Effects
261(2)
Shock-Induced Δ Vm in Cell Strands
263(7)
Measurements of Intramural Shock-Induced Δ Vm in Wedge Preparations
270(5)
Comparison between Microscopic and Macroscopic Δ Vm Measurements
275(2)
Conclusion
277(1)
References
277(6)
Virtual Electrode Theory of Pacing
283(48)
Introduction
283(1)
Virtual Electrodes during Unipolar Stimulation of Cardiac Tissue
284(6)
Anode and Cathode Make and Break Excitation
290(3)
Strength--Interval Curves
293(3)
Quatrefoil Reentry
296(5)
Defibrillation
301(5)
The No-Response Phenomenon and the Upper Limit of Vulnerability
306(1)
Influence of Physical Electrodes During a Shock
306(1)
The Effect of Fiber Curvature on Stimulation of Cardiac Tissue
307(3)
Heterogeneities
310(1)
Averaging over Depth During Optical Mapping
311(1)
Boundary Conditions and the Bidomain Model
312(1)
The Magnetic Field Produced by Cardiac Tissue
313(2)
Conclusion
315(1)
Acknowledgments
316(1)
References
317(14)
The Virtual Electrode Hypothesis of Defibrillation
331(26)
Introduction
331(4)
Historical Overview of Defibrillation Therapy
331(1)
Bidomain Model
332(1)
Fluorescent Optical Mapping
333(1)
Virtual Electrodes and the Activating Function
334(1)
Mechanisms of Defibrillation
335(9)
Theories of Defibrillation
335(1)
Virtual Electrode Hypothesis of Defibrillation: The Role of Deexcitation and Reexcitation
336(1)
Virtual Electrode-Induced Phase Singularity Mechanism
337(3)
Chirality of Shock-Induced Reentry Predicted by VEP Not the Repolarization Gradient
340(3)
Shock-Induced VEP as a Mechanism for Defibrillation Failure
343(1)
The Role of Electroporation
344(1)
Clinical Implications of the Virtual Electrode Hypothesis of Defibrillation
344(3)
The Role of Virtual Electrodes and Shock Polarity
344(1)
Waveform Optimization
345(2)
Toward Low-Energy Defibrillation
347(4)
Conclusion
351(1)
References
351(6)
Simultaneous Optical and Electrical Recordings
357(24)
Introduction to Electrooptical Measurements
357(1)
ITO Properties
358(1)
Ratiometric Optical Mapping
359(1)
Role of the Second Spatial Derivative of the Extracellular Potential in Field Stimulation
360(4)
Stimulatory Effects of a Spatial Variation of Extracellular Conductance in an Electric Field
364(1)
Effect of Unipolar Stimulation in the Tissue under the Electrode
365(3)
Electrooptical Mapping of Cardiac Excitation
368(1)
Method of Electrooptical Mapping
369(1)
Electrooptical Mapping of Epicardially Paced Beats and Sinus Beats
370(5)
Electrooptical Mapping of Fibrillation
375(3)
Conclusion
378(1)
References
378(3)
Optical Mapping of Multisite Ventricular Fibrillation Synchronization
381(20)
Pacing to Terminate Ventricular Fibrillation
382(1)
New Opportunities in Improving Ventricular Defibrillation
382(1)
Optical Mapping of Multisite Synchronization of Ventricular Fibrillation
383(4)
Optical Recording-Guided Pacing to Create Functional Block during VF
387(2)
Improvement of Defibrillation Efficacy with Synchronized Multisite Pacing
389(4)
Conclusion
393(1)
References
393(8)
Part V Methodology
The Bidomain Model of Cardiac Tissue: From Microscale to Macroscale
401(22)
Introduction
401(2)
Microscopic Modeling Cardiac Tissue
403(1)
Macroscopic Modeling Cardiac Tissue
404(2)
Homogenization
406(4)
Bidomain Model of Cardiac Tissue
410(1)
Bidomain Properties at the Tissue Level
411(5)
Bidomain Properties at the Heart Level
416(1)
Conclusion
417(1)
References
418(5)
Multielectrode Mapping of the Heart
423(18)
Introduction
423(1)
Methods
424(1)
Determining Activation Time
425(7)
Generating Contours
432(5)
Conclusion
437(1)
References
438(3)
The Role of Electroporation
441(18)
Role of Electroporation in Defibrillation
441(5)
Contribution of Electroporation to Optically Recorded Cellular Responses
446(2)
Electroporation Assessment by Membrane Impermeable Dye Diffusion
448(3)
Role of Electroporation in Pacing
451(1)
Irreversible Electroporation in Cardiac Surgery
451(1)
Conclusion
451(1)
References
452(7)
Part VI Implications for Implantable Devices
Lessons for the Clinical Implant
459(34)
Electrical Parameters of Defibrillation Waveforms
459(2)
Parameters that Influence Defibrillation
459(1)
Parameters that Influence ICD Design
459(2)
Principles of Capacitive Discharge Waveforms
461(3)
Truncation
461(2)
Stored Versus Delivered Energy
463(1)
Optimizing Waveforms with the RC Network Model
464(1)
Minimizing Shock Energy Without Electronic Constraints
465(3)
The Predicted Optimal Monophasic Shock
465(3)
The Predicted Optimal Biphasic Shock
468(1)
Optimizing Capacitive Discharge Waveforms
468(10)
Optimizing Duration: Monophasic Shock and First Phase of Biphasic Shock with a Fixed Capacitance
468(3)
Optimizing Capacitance
471(1)
Optimizing Phase Two of the Biphasic Waveform
472(1)
Truncation by Duration Versus Truncation by Tilt
473(5)
Waveform Polarity
478(2)
Waveforms in Commercially Available ICDs
480(3)
Other Considerations in Optimizing Waveforms
483(1)
The Misunderstood Superior Vena Cava Coil
484(1)
Conclusion
485(1)
References
486(7)
Resonance and Feedback Strategies for Low-Voltage Defibrillation
493(18)
Introduction
493(1)
Localized Stimulation: Induced Drift of Spiral Waves
493(2)
Delocalized Stimulation: Resonant Drift of Spiral Waves
495(3)
Feedback-Controlled Resonant Drift
498(3)
Three-Dimensional Aspects
501(1)
Pinning and Unpinning
502(5)
``Black-Box'' Approaches
507(1)
Conclusion
507(1)
Acknowledgments
508(1)
References
508(3)
Pacing Control of Local Cardiac Dynamics
511(14)
Introduction
511(1)
Chaos Control
511(4)
Alternans Control
515(6)
APD Alternans
515(5)
Conduction Velocity Alternans
520(1)
References
521(4)
Advanced Methods for Assessing the Stability and Control of Alternans
525(26)
Introduction
525(3)
What Is an Eigenmode?
528(3)
Characterization and Control of Alterans in Isolated Cardiac Myocytes
531(9)
Application of the Eigenmode Method
531(3)
The Ion Channel Mechanism Underlying Alternans
534(3)
Development and Testing of a Control Algorithm
537(3)
Characterization and Control of Spiral Wave Instabilities
540(3)
Nature of Spiral Wave Instabilities
540(2)
Elimination of Alternans in a Rotating Spiral Wave
542(1)
Summary and Implications for Treatment of Cardiac Arrhythmias
543(1)
Appendix: Mathematical Details
544(3)
References
547(4)
The Future of the Implantable Defibrillator
551(20)
Sensing and Detection
551(2)
Reduction of Ventricular Oversensing
551(1)
Active SVT-VT Discrimination
552(1)
Hemodynamic Sensors for ICDs
552(1)
Implant Testing
553(6)
Vulnerability Testing
555(2)
State of the Art
557(2)
After the Implant
559(1)
Novel Waveform Strategies
559(3)
Defibrillation Threshold Reduction
559(2)
Cardioversion Pain Reduction
561(1)
Medium Voltage Therapy
562(1)
Novel Packaging Strategies
562(1)
Subcutaneous ICDs
562(1)
Percutaneous, Fully Transvenous ICD
563(1)
Conclusion
563(1)
References
563(8)
Lessons Learned from Implantable Cardioverter-Defibrillators Recordings
571(44)
Introduction
571(1)
ICD Electrograms
572(3)
Interpretation of ICD Recordings
573(2)
Lessons Learned from ICD Treatment of Ventricular Tachyarrhythmias
575(16)
Incidence of Ventricular Tachyarrhythmias
575(3)
Therapy Efficacy and Failure Modes
578(1)
Therapy Efficacy: Defibrillation
579(2)
Therapy Efficacy: Cardioversion
581(2)
Therapy Efficacy: Antitachycardia Pacing
583(3)
Investigating the Causes of Tachyarrhythmia
586(5)
Lessons Learned from Inappropriately Treated ICD Episodes
591(6)
Inappropriate Detection Due to Oversensing
591(2)
Inappropriate Detection and Therapy Due to Nonsustained VT/VF
593(1)
Inappropriate Detection Due to Supraventricular Tachycardia
593(4)
Inappropriate ICD Therapies and Changing Patient Population
597(1)
Lessons Learned from Appropriately Treated AT/AF Episodes
597(7)
Atrial Tachyarrhythmia Detection and Termination Accuracy
597(3)
Efficacy of Device-Based Therapies for AT/AF
600(1)
AT/AF Therapy Efficacy: Impact of Early Recurrence of Atrial Fibrillation
600(1)
Atrial ATP Therapy Efficacy
600(3)
Atrial Defibrillation Shock Efficacy
603(1)
Conclusion
604(1)
References
604(11)
Index 615