Implantable Pulse Generators (IPGs) are indicated for rate adaptive pacing in patients who may benefit from increased pacing rates concurrent with increases in activity. Pacemakers are also indicated for dual chamber and atrial tracking modes in patients who may benefit from maintenance of AV synchrony. Dual chamber modes are specifically indicated for the treatment of conduction disorders that require restoration of both rate and AV synchrony, which include various degrees of AV block to maintain the atrial contribution to cardiac output and VVI intolerance (e.g. pacemaker syndrome) in the presence of persistent sinus rhythm. See device manuals for the accepted patient conditions warranting chronic cardiac pacing.  Antitachycardia pacing (ATP) is indicated for termination of atrial tachyarrhythmias in patients with one or more of the above pacing indications.

Cardiac Resynchronization Therapy (CRT) IPGs are indicated for NYHA Functional Class III and IV patients who remain symptomatic despite stable, optimal heart failure medical therapy and have an LVEF ≤ 35% and a prolonged QRS duration and for NYHA Functional Class I, II, or III patients who have a LVEF ≤ 50%, are on stable, optimal heart failure medical therapy if indicated and have atrioventricular block (AV block) that are expected to require a high percentage of ventricular pacing that cannot be managed with algorithms to minimize right ventricular pacing.  Optimization of heart failure medical therapy that is limited due to AV block or the urgent need for pacing should be done post-implant.  Rate adaptive pacing is provided for those patients developing a bradycardia indication who might benefit from increased pacing rates concurrent with increases in activity.  Dual chamber and atrial tracking modes are indicated for patients who may benefit from maintenance of AV synchrony.  Antitachycardia pacing (ATP) is indicated for termination of atrial tachyarrhythmias in patients with one or more of the above pacing indications.

Implantable cardioverter defibrillators (ICDs) are indicated to provide ventricular antitachycardia pacing and ventricular defibrillation for automated treatment of life-threatening ventricular arrhythmias.  Notes for DR ICDs: The use of the device has not been demonstrated to decrease the morbidity related to atrial tachyarrhythmias. The effectiveness of high-frequency burst pacing (atrial 50 Hz Burst therapy) in terminating device classified atrial tachycardia (AT) was found to be 17%, and in terminating device classified atrial fibrillation (AF) was found to be 16.8%, in the VT/AT patient population studied. The effectiveness of high-frequency burst pacing (atrial 50 Hz Burst therapy) in terminating device classified atrial tachycardia (AT) was found to be 11.7%, and in terminating device classified atrial fibrillation (AF) was found to be 18.2% in the AF-only patient population studied. CRT ICDs are indicated for ventricular antitachycardia pacing and ventricular defibrillation for automated treatment of life-threatening ventricular arrhythmias and for providing cardiac resynchronization therapy in heart failure patients on stable, optimal heart failure medical therapy if indicated, and meet any of the following classifications: New York Heart Association (NYHA) Functional Class III or IV and who have a left ventricular ejection fraction < 35% and a prolonged QRS duration. Left bundle branch block (LBBB) with a QRS duration > 130 ms, left ventricular ejection fraction < 30%, and NYHA Functional Class II. NYHA Functional Class I, II, or III and who have left ventricular ejection fraction ≤ 50% and atrioventricular block (AV block) that are expected to require a high percentage of ventricular pacing that cannot be managed with algorithms to minimize right ventricular pacing. Optimization of heart failure medical therapy that is limited due to AV block or the urgent need for pacing should be done post-implant. Some ICDs and CRT ICDs are also indicated for use in patients with atrial tachyarrhythmias, or those patients who are at significant risk for developing atrial tachyarrhythmias.  The RV Lead Integrity Alert (LIA) feature is intended primarily for patients who have a Medtronic ICD or CRT-D device and a Sprint Fidelis lead (Models 6949, 6948, 6931, and 6930), based on performance data. The RV LIA feature may not perform as well with a St. Jude Riata/Durata lead or a Boston Scientific Endotak lead as it does when used with a Medtronic Sprint Fidelis lead. This is because different lead designs may have different failure signatures and conditions that may or may not be detected early by the RV LIA feature.

Contraindications:

IPGs and CRT IPGs are contraindicated for the concomitant implant with another bradycardia device and concomitant implant with an implantable cardioverter defibrillator.  There are no known contraindications for the use of pacing as a therapeutic modality to control heart rate. The patient’s age and medical condition, however, may dictate the particular pacing system, mode of operation, and implant procedure used by the physician.  Rate-responsive modes may be contraindicated in those patients who cannot tolerate pacing rates above the programmed Lower Rate.  Dual chamber sequential pacing is contraindicated in patients with chronic or persistent supraventricular tachycardias, including atrial fibrillation or flutter.  Asynchronous pacing is contraindicated in the presence (or likelihood) of competition between paced and intrinsic rhythms.  Single chamber atrial pacing is contraindicated in patients with an AV conduction disturbance.  Anti-tachycardia pacing (ATP) therapy is contraindicated in patients with an accessory antegrade pathway.

ICDs and CRT ICDs are contraindicated in patients experiencing tachyarrhythmias with transient or reversible causes including, but not limited to, the following: acute myocardial infarction, drug intoxication, drowning, electric shock, electrolyte imbalance, hypoxia, or sepsis; patients who have a unipolar pacemaker implanted, patients with incessant ventricular tachycardia (VT) or ventricular fibrillation (VF), and patients whose primary disorder is chronic atrial tachyarrhythmia with no concomitant VT or VF.

Warnings/Precautions:

Changes in a patient’s disease and/or medications may alter the efficacy of the device’s programmed parameters. Patients should avoid sources of magnetic and electromagnetic radiation to avoid possible underdetection, inappropriate sensing and/or therapy delivery, tissue damage, induction of an arrhythmia, device electrical reset or device damage. Do not place transthoracic defibrillation paddles directly over the device.

Additionally, for CRT ICDs and CRT IPGs, certain programming and device operations may not provide cardiac resynchronization.  Also for CRT IPGs, Elective Replacement Indicator (ERI) results in the device switching to VVI pacing at 65 ppm.  In this mode, patients may experience loss of cardiac resynchronization therapy and/or loss of AV synchrony.  For this reason, the device should be replaced prior to ERI being set. Use of the device should not change the application of established anticoagulation protocols.

Potential Complications:

Potential complications include, but are not limited to, rejection phenomena, erosion through the skin, muscle or nerve stimulation, oversensing, failure to detect and/or terminate arrhythmia episodes, and surgical complications such as hematoma, infection, inflammation, and thrombosis.

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An Atrial Septal Defect (ASD) is an opening or hole in the wall that separates the two upper chambers of the heart. This wall is called the atrial septum. The hole causes oxygen-rich blood to leak from the left side of the heart to the right side. This causes extra work for the right side of the heart, since more blood than necessary is flowing through the right ventricle to the lungs.

If the ASD is small enough, it can be closed with a special device. The procedure is done in the heart catheterization lab.

Types of Atrial Septal Defects :

Atrial Septal Defects are classified by where they occur and their size.

The electrocardiogram (ECG or EKG) is a diagnostic tool that is routinely used to assess the electrical and muscular functions of the heart.

The heart is a two stage electrical pump and the heart’s electrical activity can be measured by electrodes placed on the skin. The electrocardiogram can measure the rate and rhythm of the heartbeat, as well as provide indirect evidence of blood flow to the heart muscle.

ECG Basics :

It is the technique of mechanically widening narrowed or obstructed arteries. This is done by putting a guide wire with a collapsed balloon on it, into the narrowed location and then inflating the balloon. The balloon forces expansion of the plaque deposits and surrounding muscle wall, opening up the blood vessel and thereby improving bloodflow. A stent (a fine mesh stainless steel tube) may be inserted at the same time as ballooning, which helps to ensure the narrowing remains open.

The test is performed for a variety of reasons :

The Doctors in charge of your case, and the Radiologist doing the Angioplasty, will have discussed the situation, and feel that this is the most appropriate treatment. However, you will also have the opportunity for your opinion to be taken into account, and if, after discussion with your Doctors, you do not want the procedure carried out, then you can decide against it.

Balloon valvuloplasty (also called valvulotomy or valvotomy) is a procedure that widens a heart valve that is narrowed. The cause of this narrowing in the aortic valve is aortic valve stenosis.

During this procedure, a thin flexible tube called a catheter is inserted through an artery in the groin or arm and threaded into the heart. When the tube reaches the narrowed heart valve, a balloon at the end of the tube is inflated. The balloon widens the valve opening.

During the procedure, you will be awake. But you will receive local anesthesia where the catheter is inserted as well as intravenous (IV) pain medicine along with a sedative to help you relax.

The test is performed for a variety of reasons :

Two-Dimensional Echocardiogram (2D Echo) It is a test in which ultrasound is used to picture out the heart. It is capable of displaying a cross sectional “slice” of the beating heart, including the chambers, valves and the major blood vessels that exit from the left and right part of the heart.

The procedure typically takes about 5 to 10 minutes, but may be longer if additional pictures and calculations are needed. Echo imaging is sometimes challenging in people who are very thin, obese, or have lung disease such as COPD.

The test is performed for a variety of reasons :