New Arrhythmia Technologies, 1st Edition

Visit the link below to download the full version of this book:

https://medipdf.com/product/new-arrhythmia-technologies-1st-edition/

Click Download Now

New Arrhythmia Technologies
To our families and the memories of all those
who have inspired us to look toward the future.
New Arrhythmia
Technologies
EDITED BY

Paul J. Wang, MD
Director, Cardiac Arrhythmia Service and Cardiac Electrophysiology Laboratory
Professor of Medicine
Stanford University Medical Center

AND CO-EDITORS
Gerald V. Naccarelli, MD
Chief, Division of Cardiology
Professor of Medicine
Penn State University College of Medicine

Michael R. Rosen, MD
Gustavus A. Pfeiffer Professor of Pharmacology
Professor of Pediatrics
Director, Center for Molecular Therapeutics
Columbia University

N.A. Mark Estes III, MD

Director, Cardiac Arrhythmia Service
Professor of Medicine
Tufts New England Medical Center

David L. Hayes, MD
Chair, Division of Cardiovascular Diseases
Professor of Medicine
Mayo Clinic

David E. Haines, MD
Director, Heart Rhythm Center
William Beaumont Hospital
© 2005 by Blackwell Publishing
Blackwell Futura is an imprint of Blackwell Publishing

Blackwell Publishing, Inc., 350 Main Street, Malden, Massachusetts 02148-5020, USA
Blackwell Publishing Ltd, 9600 Garsington Road, Oxford OX4 2DQ, UK
Blackwell Science Asia Pty Ltd, 550 Swanston Street, Carlton, Victoria 3053, Australia

All rights reserved. No part of this publication may be reproduced in any form or by any
electronic or mechanical means, including information storage and retrieval systems, without
permission in writing from the publisher, except by a reviewer who may quote brief passages
in a review.

First published 2005

ISBN-13: 978-1-4051-3293-0
ISBN-10: 1-4051-3293-0

Library of Congress Cataloging-in-Publication Data

New arrhythmia technologies/edited by Paul J. Wang … [et al.].

p. ; cm.
Includes bibliographical references and index.
ISBN-13: 978-1-4051-3293-0 (alk. paper)
ISBN-10: 1-4051-3293-0 (alk. paper)
1. Arrhythmia–Treatment–Technological innovations.
[DNLM: 1. Arrhythmia–therapy. 2. Anti–Arrhythmia Agents–therapeutic use.
3. Defibrillators. 4. Electric Countershock–methods. WG 330 N532 2005] I. Wang, Paul J.

RC685.A65N49 2005
616.128–dc22 2005004581

A catalogue record for this title is available from the British Library
Commissioning Editor: Gina Almond
Development Editor: Vicki Donald
Set in 9.5/12 pt Minion by Newgen Imaging Systems (P) Ltd, Chennai, India
Printed and bound in Harayana, India by Replika Press PVT Ltd.

For further information on Blackwell Publishing, visit our website:

www.blackwellcardiology.com

The publisher’s policy is to use permanent paper from mills that operate a sustainable forestry
policy, and which has been manufactured from pulp processed using acid-free and elementary
chlorine-free practices. Furthermore, the publisher ensures that the text paper and cover
board used have met acceptable environmental accreditation standards.

Notice: The indications and dosages of all drugs in this book have been recommended in
the medical literature and conform to the practices of the general community. The
medications described do not necessarily have specific approval by the Food and Drug
Administration for use in the diseases and dosages for which they are recommended. The
package insert for each drug should be consulted for use and dosage as approved by the
FDA. Because standards for usage change, it is advisable to keep abreast of revised
recommendations, particularly those concerning new drugs.
 Contents

List of Contributors, vii 6 Gene and cell therapy for sinus and AV nodal
Preface, xiii dysfunction, 54
Peter Danilo, Jr., Steven Girouard, Peter
R Brink, Ira S. Cohen, Richard B. Robinson,
Part I Advances in antiarrhythmic Michael R. Rosen
pharmacologic therapy
7 Gene therapy for cardiac tachyarrhythmias, 65
Gerald V. Naccarelli (Section Editor)
J. Kevin Donahue, Amy D. McDonald,
1 New antiarrhythmic pharmacologic therapies Alexander Bauer, Kan Kikuchi, Tetsuo Sasano
and regulatory issues in antiarrhythmic drug
development, 3
Heather M. Ross, Peter R. Kowey, Gerald Part III Monitoring, noninvasive
V. Naccarelli mapping, risk assessment, and
external defibrillation
2 New frontiers in antithrombotic therapy for N.A. Mark Estes III (Section Editor)
atrial fibrillation, 14
James A. Reiffel 8 New developments in noninvasive rhythm
monitoring, implantable hemodynamic
monitoring, functional status monitoring,
and noninvasive mapping, 75
Part II Future of antiarrhythmic
Jonathan Weinstock, Munther K. Homoud,
therapy
Mark S. Link, N.A. Mark Estes III
Michael R. Rosen (Section Editor)
9 Techniques of prediction of arrhythmia
3 Principles of pharmacogenomics: Focus on
occurrence and stratification for sudden
arrhythmias, 31
cardiac death, 84
Dan M. Roden
Aseem D. Desai, Bradley P. Knight
4 The cardiac sodium-channel carboxy terminus:
10 Beta-blocker efficacy in long-QT syndrome
predicted and detected structure provide a
patients with mutations in the pore and
novel target for antiarrhythmic drugs
nonpore regions of the hERG potassium-
development, 36
channel gene, 91
Robert S. Kass, Joseph W. Cormier,
Arthur J. Moss, Derick R. Peterson, Wojciech
Ian W. Glaaser
Zareba, Rahul Seth, Scott A. McNitt, Mark
5 Embryonic stem-cell-derived cardiomyocytes L. Andrews, Ming Qi, Michael J. Ackerman,
as a model for arrhythmia, 48 Jesaia Benhorin, Elizabeth S. Kaufman, Jennifer
J. Hescheler, M. Halbach, Z.J. Lu, H. Bohlen, L. Robinson, Jeffrey A. Towbin, G. Michael
B.K. Fleischmann, M. Reppel Vincent, Li Zhang

v
vi Contents

11 New developments in out-of-hospital cardiac 19 Arrhythmia prevention and termination

defibrillation: evaluation of AED strategies, 95 algorithms, 178
Robert J. Myerburg, Shaurtelle Elliot, Donald Gregory Engel, Paul J. Wang, Amin Al-Ahmad
G. Rosemberg, Alberto Interian Jr., Agustin
20 New lead designs and lead-less systems, 187
Castellanos
Kenneth A. Ellenbogen, Bruce D. Gunderson,
Mark A. Wood
Part IV Advances in pacing 21 Optimization of defibrillation function, 197
David L. Hayes (Section Editor) Michael R. Gold, Paul J. DeGroot

12 Sensor and sensor integration, 111 22 Remote web-based device monitoring, 206
Robert F. Rea Edmund Keung, Yang Xue
23 New ICD indications, 219
13 New electrode and lead designs for
Erik Sirulnick, Amin Al-Ahmad, Paul J. Wang
pacemakers, 119
Charles J. Love
Part VI Advances in catheter
14 Current concepts in intravascular pacemaker
surgical ablation
and defibrillator lead extraction, 124
David E. Haines (Section Editor)
Dhanunjaya R. Lakkireddy, Atul Verma, Bruce
L. Wilkoff 24 Advances in surgical ablation devices for atrial
fibrillation, 233
15 Left ventricular epicardial lead implantation: Spencer J. Melby, Anson M. Lee, Ralph J.
Anatomy, techniques, and tools, 134 Damiano, Jr.
Jennifer Cummings, William Belden, Bruce L.
Wilkoff 25 Epicardial access: present and future
applications for interventional
16 New resynchronization lead systems and electrophysiologists, 242
devices, 145 Robert A. Schweikert, Andre Natale
Robert F. Rea
26 Advances in catheter control devices, 257
17 New indications for pacing, 154 Girish Narayan, Paul J. Wang,
David L. Hayes Amin Al-Ahmad
27 Advances in energy sources in catheter
ablation, 262
Part V Advances in implantable
David E. Haines
defibrillators
Paul J. Wang (Section Editor) 28 New ablation paradigms: Anatomic ablation of
complex arrhythmia substrates, 274
18 Implantable defibrillator sensing and David J. Callans
discrimination algorithms, 163
Kelly Richardson, Amin Al-Ahmad,
Paul J. Wang Index, 283
 Contributors

Michael J. Ackerman, MD, PhD David J. Callans, MD

Director, LQTS Clinic and Sudden Death Professor of Medicine, University of Pennsylvania
Genomics Laboratory, Hospital of the University of Philadelphia, PA,
Mayo Clinic, Rochester, MN, USA USA

Amin Al-Ahmad, MD Agustin Castellanos, MD

Associate Director of Cardiac Arrhythmia Service Professor of Medicine, Division of Cardiology
Cardiac Arrhythmia Service, Miller School of Medicine,
Standford University Medical Center University of Miami
Stanford, CA, USA Miami, FL, USA

Mark L. Andrews, BBS Ira S. Cohen, PhD

Analyst/Programmer Leading Professor of Physiology and Biophysics;
University of Rochester Medical Center Director of the Institute of Molecular Cardiology
Rochester, NY, USA Health Sciences Center, Stony Brook University
Stony Brook, NY, USA
Alexander Bauer, MD
Johns Hopkins Unviersity School of Medicine
Baltimore, MD, USA
Joseph W. Cormier, PhD
Graduate Research Assistant
Department of Pharmacology,
William Belden, MD Columbia University
Fellow in Electrophysiology,
New York, NY, USA
Cleveland Clinic Foundation, Cleveland Clinic
Cleveland, OH, USA
Jennifer Cummings, MD
Jesaia Benhorin, MD Associate Staff
Professor of Medicine Cleveland Clinic Foundation
The Heiden Department of Cardiology, Cleveland, OH, USA
Bikur Cholim Hospital
Jerusalem, Israel Ralph J. Damiano, Jr, MD
John M. Shoenberg Professor of Surgery,
Heribert Bohlen, PhD Chief of Cardiac Surgery,
Director of Axiogenesis AG Washington University School of
Axiogenesis AG Medicine at Barnes Jewish Hospital
Cologne, Germany St Louis, MO, USA

Peter R. Brink, PhD Peter Danilo, Jr, PhD

Professor and Chairman, Senior Research Scientist
Department of Physiology and Biophysics Department of Pharmacology,
Health Sciences Center, Center for Molecular Therapeutics,
Stony Brook University Columbia University
Stony Brook, NY, USA New York, NY, USA

vii
viii Contributors

Paul J. DeGroot, MS Michael R. Gold, MD

Senior Principal Scientist and Bakken Fellow, Chief of Cardiology and Director of
Cardiac Rhythm Management Research, Heart and Vascular Center
Medtronic Inc. Medical University of South
Minneapolis, MN, USA Carolina
Charleston, SC, USA
Aseem D. Desai, MD
Assistant Professor of Medicine, Cardiac Bruce D. Gunderson, MS
Electrophysiology, University of Chicago Hospitals; Principal Scientist, Medtronic Inc.
Director, Implantable Deice Therapy Minneapolis, MN,
Cardiac Electrophysiology, USA
University of Chicago Hospitals
Chicago, IL, USA
David E. Haines, MD
J. Kevin Donahue, MD Director, Heart Rhythm Center,
Associate Professor of Medicine Cardiology Division,
Johns Hopkins University School of Medicine William Beaumont Hospital
Baltimore, MD, USA Royal Oak, Ml,
USA
Kenneth A. Ellenbogen, MD
Director, Electrophysiology and Pacing M. Halbach, PhD
VCU School of Medicine Institute of Neurophysiology,
Richmond, VA, USA University of Cologne
Cologne, Germany
Shauntelle Elliott, RN
Clinical Research Coordinator
Jackson Memorial Medical Center
David L. Hayes, MD
Chair, Divison of Cardiovascular
Cardiac Arrhythmia Service,
Diseases
Miami, FL, USA
Mayo Clinic
Rochester, MN, USA
Gregory Engel, MD
Cardiac Electrophysiology Fellow
Cardiac Arrhythmia Service, Jurgen Hescheler, MD, PhD
Standford University Medical Center Director, Institute of Neurophysiology
Stanford, CA, USA University of Cologne
Cologne, Germany
N. A. Mark Estes III, MD
Director, Cardiac Arrthythmia Service, Munther K. Homoud, MD
Tufts New England Medical Center; Assistant Professor of Medicine,
Professor of Medicine, Tufts University School of Medicine
New England Medical Center Tufts New England Medical Center
Boston, MA, Boston, MA, USA
USA

Bernd Fleischmann Alberto Interian Jr, MD

Director, Institute of Physiology Professor of Medicine; Interim Chief,
University of Bonn Division of Cardiology;
Bonn, Germany Director, Electrophysiology
Miller School of Medicine,
Steven Girouard, PhD University of Miami
Director, Basic Research Miami, FL, USA
Guidant Corporation
St Paul, MN, USA Robert S. Kass, PhD
David Hossack Professor of Pharmacology
Ian W. Glaaser, PhD (in the Center of Neurobiology and Behavior)
Graduate Research Assistant and Chairman
Department of Pharmacology, Department of Pharmacology,
Columbia University Columbia University
New York, NY, USA New York, NY, USA
 Contributors ix

Elizabeth S. Kaufman, MD Amy D. McDonald, BS

Associate Professor of Medicine Johns Hopkins University School of Medicine
MHMC Arrhythmia Service Baltimore, MD, USA
Cleveland, OH, USA
Scott A. McNitt, MS
Associate Professor
Edmund Keung, MD
University of Rochester Medical Center
Director, VA National ICD Surveillance Center and
Rochester, NY, USA
Western Pacemaker Surveillance Center
Associate Chief, Cardiology Section
San Francisco VA Medical Center Spencer J. Melby, MD
San Francisco, CA, USA Washington University School of Medicine
St Louis, MO, USA

Kan Kikuchi, PhD Arthur J. Moss, MD

Johns Hopkins University School of Medicine
Professor of Medicine
Baltimore, MD,
University of Rochester Medical Center
USA
Rochester, NY, USA

Bradley P. Knight, MD Robert J. Myerburg, MD

Director of Cardiac Electrophysiology Professor of Medicine and Physiology; American Heart
Cardiac Electrophysiology, Association Chair in Cardiovascular Research
University of Chicago Hospitals Miller School of Medicine,
Chicago, IL, USA University of Miami
Miami, FL, USA

Peter R. Kowey, MD
Chief of Cardiology, Main Line Health System
Gerald V. Naccarelli, MD
Bernard Trabin Chair in Cardiology
Professor of Medicine, Jefferson Medical College
Professor of Medicine
Wynnewood, PA, USA
Chief, Division of Cardiology
Director, Cardiovascular Center
Penn State University College of Medicine
Dhanunjaya R. Lakkireddy, MD
Hershey, PA, USA
Fellow in Electrophysiology
Cleveland Clinic Foundation
Cleveland, OH, USA Girish Narayan, MD
Falk Cardiovascular Center,
Stanford University Hospital
Anson M. Lee, BS Stanford, CA, USA
Medical Student
Washington University School of
Medicine at Barnes Jewish Hospital Andrea Natale, MD
St Louis, MO, USA Co-Section Head, Electrophysiology and Pacing
Director, Center for Artial Fibrillation and
EP Laboratories
Mark S. Link, MD Cleveland Clinic Foundation
Assistant Professor of Medicine Cleveland, OH, USA
Tufts University School of Medicine
Tufts New England Medical Center Derick R. Peterson, PhD
Boston, MA, USA Associate Professor, Biostatistics and
Computational Biology
University of Rochester Medical Center
Charles J. Love, MD
Rochester, NY, USA
Professor of Clinical Medicine
Director, Arrythmia Device Services
Director, Electrophysiology Ming Qi, PhD
Section and Laboratory Research Assistant Professor, Pathology and Lab Medicine
OSU Division of Cardiovascular Medicine University of Rochester Medical Center
Columbus, OH, USA Rochester, NY, USA
x Contributors

Robert F. Rea, MD Heather M. Ross, MS, APRN

Associate Professor of Medicine, Nurse Practitioner
Mayo Clinic Center for Adult Congenital Heart Disease,
Rochester, MN, USA St Joseph’s Hospital and Medical Center
Phoenix, AZ, USA
James A. Reiffel, MD
Professor of Clinical Medicine Tetsuo Sasano, MD
Columbia University Johns Hopkins University School of Medicine
New York, NY, USA Baltimore, MD, USA

M. Reppel, PhD Robert A. Schweikert, MD

Group Leader Staff Physician
Institute of Neurophysiology, Department of Cardiovascular Medicine,
University of Cologne Cleveland Clinic
Cologne, Germany Cleveland, OH, USA

Kelly Richardson, MD & Rahul Seth, BS

University of Rochester Medical Center
Jennifer L. Robinson, MS Rochester, NY, USA
Electrophysiology Fellow
Stanford Hospital
Stanford, CA, USA Erik Sirulnick, MD
Electrophysiology Fellow
Falk Cardiovascular Center,
Richard B. Robinson, PhD Stanford University Hospital
Professor of Pharmacology Stanford, CA, USA
Department of Pharmacology,
Center for Molecular Therapeutics,
Columbia University
Jeffrey A. Towbin, MD
Professor of Pediatrics
New York, NY, USA
Texas Children’s Hospital
Houston, TX, USA
Jennifer Robinson
Research Associate
Atul Verma, MD
University of Rochester Medical Center
Fellow in Electrophysiology
Rochester, NY, USA
Cleveland Clinic Foundation
Cleveland, OH, USA
Dan M. Roden, MD
Professor of Medicine and Pharmacology; G. Michael Vincent, MD
Director, Oates Institute for Experimental Professor of Medicine
Therapeutics Department of Medicine, LDS Hospital
Vanderbilt University School of Medicine Salt Lake City, UT, USA
Nashville, TN, USA
Paul J. Wang, MD
Michael R. Rosen, MD, PhD Professor of Medicine,
Gustavus A Pfeiffer Professor of Pharmacology; Stanford University School of Medicine;
Professor of Pediatrics; Director, Center for Director, Cardiac Arrhythmia Service and
Molecular Therapeutics Cardiac Electrophysiology Laboratory,
Columbia University Stanford Hospital and Clinics
New York, NY, USA Stanford University Medical Center
Stanford, CA, USA
Donald G. Rosenberg, MD
Professor of Clinical Medicine, Jonathan Weinstock, MD
Division of Cardiology Assistant Professor of Medicine,
Miller School of Medicine, Tufts University School of Medicine
University of Miami Tufts New England Medical Center
Miami, FL, USA Boston, MA, USA
 Contributors xi

Bruce L. Wilkoff, MD Yang Xue, BS

Director of Cardiac Pacing and University of Michigan Medical School
Tachyarrhythmia Devices, Fremont, CA, USA
Department of Cardiovascular Medicine,
Cleveland Clinic Foundation Wojciech Zareba, MD, PhD
Cleveland Associate Professor of Medicine
OH, USA University of Rochester Medical Center
Rochester, NY, USA
Mark A. Wood, MD
Professor of Medicine Li Zhang, MD
Virginia Commonwealth Assistant Professor of Medicine
University Medical Center Department of Medicine, LDS Hospital
Richmond, VA, USA Salt Lake City, UT, USA
 Preface

New Arrhythmia Technologies is designed to serve In the exploding field of new arrhythmia devices,
as an up-to-date text on the rapidly advancing field the text covers sensors and sensor algorithms, new
of arrhythmia innovations. The breadth of the electrode and lead designs for both pacing and
topics covered mirrors the expansive nature of the defibrillation, advances in lead extraction, new
growing field of arrhythmia evaluation and resynchronization devices and left ventricular lead
therapy. The text begins with a comprehensive delivery systems for cardiac venous and epicardial
discussion of new pharmacologic agents for placement, and new pacing indications. In the field
arrhythmia management and new antithrombotic of defibrillation, chapters are devoted to important
agents, particularly for atrial fibrillation, and pro- advances in arrhythmia prevention and termination
ceeds to include chapters on future arrhythmia algorithms, sensing and discrimination algorithms,
therapies utilizing pharmacogenomics, structural new ICD lead design and lead-less systems,
approaches to novel antiarrhythmic drug therapy, optimization of defibrillator waveforms, new ICD
embryonic stem cell-derived cardiomyocytes, and indications, and web-based monitoring.
gene and cell therapy for sinus node and A-V nodal There have been remarkable advances in the
dysfunction and cardiac tachyarrhythmias. The development of techniques and devices for the sur-
numerous advances in noninvasive rhythm moni- gical and catheter ablation of arrhythmias. A series
toring, implantable hemodynamic monitoring, of chapters are devoted to the explosion in surgical
functional status monitoring, and non-invasive devices and techniques for atrial fibrillation, novel
mapping are discussed. There have been important epicardial access techniques, innovative catheter
advances in risk stratification for sudden death and control devices, new energy sources for catheter
the identification of relationships between the gene ablation, and new ablation paradigms.
defect and the response to therapy. Because of the We believe that New Arrhythmia Technologies
central role that out-of-hospital cardiac defibrillation provides a unique view into the latest in arrhyth-
has played in improving survival of sudden cardiac mia innovations through the eyes of the experts in
death, a chapter has been devoted to this topic. the field.
PW

xiii