Surgical Implantation of Cardiac Rhythm Devices E-Book

Jeanne Poole, Lyle W. Larson

• Publisher: Elsevier
• Year: 2017
• ISBN:
  9780323429252
• Topic: Médecine
• Subtopic: Cardiologie

Unique in the field, Surgical Implantation of Cardiac Rhythm Devices provides complete, easy-to-follow guidance for safe, effective surgical implantation of pacemakers, ICDs, and other devices. Beginning with surgical anatomy and surgical principles, expert authors provide thorough coverage of surgical technique and procedures – everything from sutures to special circumstances and complications. Detailed, high-quality illustrations show you exactly how to proceed, and each procedure includes an accompanying video clip online.

• Outlines relevant anatomic structures and landmarks, as well as various types of sutures and instruments.
• Provides authoritative, detailed guidance on transvenous lead placement, including novel or alternative placements, as well as implantation of subcutaneous ICDs.
• Covers tools and techniques, anesthesia, radiation safety, pitfalls and complications, tips and pearls, patient preparation, postoperative patient management, and follow-up care.
• Offers expert coverage of pediatric considerations and other special circumstances.
• Allows you to view surgical procedures and relevant anatomy in video clips online, as well as through extensive, high-quality illustrations in the text.
• Ideal for EP fellows, practicing electrophysiologists, and cardiologists who perform surgical procedures to implant pacemakers, ICDs, and other devices.

1

Development of Cardiac Implantable Electrical Devices

Rakesh Gopinathannair, and Brian Olshansky

Introduction

A remarkable collaborative and forward-thinking effort led to the development of cardiac implantable electrical devices (CIEDs), which can stimulate the heart to beat, protect against cardiac arrest, monitor physiologic parameters and arrhythmias, and improve and forestall heart failure. Some key events that led to modern CIEDs and their implantation are described here with a look toward the future.

Where Did It Start?

Myths and science converge in the initial attempts at cardiac stimulation. The rather dubious beginnings are hard to establish precisely, considering the naivety regarding mechanisms and lack of documentation and peer review. Initial observations occurred before electricity was understood fully and before wall power. Nevertheless, cardiac stimulation began hundreds of years ago, if not long before that, first mechanically, then electrically.

William Harvey made an arrested pigeon’s heart beat with the flick of a finger.^1–3 Physicist Nickolev Abildgaard realized that electrical shocks could cause a hen to collapse but additional shocks brought it “back to life.”⁴ By the 1900s, electrical currents were seen to start and stop ventricular fibrillation.⁵ Rudimentary electrical resuscitative device attempts for ambulances, however, initially met with little success.

Birth of the Pacemaker

Astounding observations lent credence to the concept that electricity affected the heart (Table 1.1). In one instance, a child who drowned was resuscitated by attaching one electrode to the leg while rhythmically tapping the heart with another (Duchenne de Boulogne, 1806–1875). Why this was attempted is not clear. In another instance, electrical cardiac stimulation was seen to affect heart rate directly in a woman who had a chest tumor removed, leaving her heart exposed (H. von Ziemssen, 1829–1902). Unfortunately, stimulation attempts may have resulted in her death.

In 1889, John Alexander McWilliam reported brilliant work that showed electrical impulses could cause ventricular contraction (Fig. 1.1). He stated:

The heart was inhibited by stimulation of the vagus nerve in the neck, and then a periodic series of induction shocks (regulated by a metronome) was applied to the apex of the ventricles.… A series of single induction shocks excites a corresponding series of cardiac beats; the ventricular contraction precedes the auricular contraction when the exciting shocks are applied to the ventricles. Each systole causes the ejection of a considerable amount of blood into the aorta and pulmonary artery, and a marked rise of the blood-pressure at each beat.⁶

Although early experiences were not uniformly successful, by 1927, Marmrostein had found a way to electrically stimulate a dog’s heart.⁷ Soon thereafter, human cardiac pacing emerged. Mark Lidwell, an Australian physician, is considered one of the fathers of modern pacing. In 1928, with alternating current and a needle inserted into a ventricle, he used intermittent electrical stimulation to resuscitate a child born with a cardiac arrest.⁸ To extend these initial observations, in 1932, Albert Hyman, a cardiologist working at the Beth David Hospital in New York, utilized a needle he called a “pace-maker” to create an injury current in the heart (“intracardiac” therapy) to allow it to beat again. In collaboration with his engineer brother, C. Henry Hyman, he developed a spring-wound, hand-cranked stimulating motor he called an “artificial pacemaker.”² The mechanism was simple, but it worked and was used 43 times with success in 14 patients (Fig. 1.2). Based on the need for increasing heart rates during hypothermic procedures, Wilfred Bigelow, working with John A. Hopps, an electrical engineer, developed a transvenous catheter electrode that was placed in the heart and activated using an external stimulator.¹

Further development halted for quite some time when, in 1951, Boston cardiologist Paul Zoll developed an external (transcutaneous) pacemaker that could stimulate the heart but required 50 to 150 V of alternating current delivered via external metal electrodes strapped to the chest (Fig. 1.3). It was painful and caused skin burns. The longest period of pacing with his system was approximately 11 days, but his initial work became a starting point for development of the implantable pacemaker. Aubrey Leatham and Geoffrey Davies improved Zoll’s transcutaneous stimulator by developing circuitry that could sense the electrocardiogram and pace only when needed. It had a fixed rate and two output ranges, thus creating the first “demand” pacemaker.⁹

TABLE 1.1

History of Electrotherapy and Cardiac Pacing

Year	Observation/Development	Scientist
1580	Syncope and association with slow pulse	Geronimo Mercuriale
1600	Restarted an arrested pigeon’s heart by a simple flick of the finger	William Harvey
1791	Electricity can stimulate living tissue	Luigi Galvani
1800	Devised the first electric battery	Alessandro Volta
1850	Induced ventricular fibrillation by electrical current in a dog heart	Carl Ludwig
1872	First successful resuscitation using external cardiac stimulation	Duchenne de Boulogne
1882	Heart rate change and arrhythmias through direct electrical current to the heart	Hugo von Ziemssen
1880–1890	Electrical currents could initiate ventricular fibrillation but strong electrical shocks can also potentially defibrillate the heart	Jon McWilliam, Jean-Louis Prevost, and Frederic Batelli
1892	The electrocardiogram	William Einthoven
1927	Used transvenous and transthoracic electrodes to pace various chambers of the dog heart	M. Marmrostein
1928	With alternative current and a needle inserted into a ventricle, intermittent electrical stimulation was able to resuscitate a child born with a cardiac arrest	Mark Lidwell
1932	The first “artificial pacemaker” (Hymanotor)	Albert Hyman, Henry C. Hyman
1949	First catheter electrode for pacing	Wilfred Bigelow, John A. Hopps
1951	External (transcutaneous) cardiac pacemaker	Paul Zoll
1957	First battery-operated wearable pacemaker	Earl Bakken, C. Walton Lillehei
1958	First implantable pacemaker	Rune Elmqvist and Ake Senning
1958	Endocardial pacing electrode	Seymour Furman, John Schwedel
1960	The lithium-iodide battery	Wilson Greatbatch
1972	Radioisotope pacemaker	Victor Parsonnet
1978	First dual-chamber pacemaker	H.D. Funke
Early 1980s	Steroid-eluting leads
Mid-1980s	Rate-responsive pacemaker
1990s	Microprocessor-driven pacemakers
2000s	Biventricular pacemakers

C. Walton Lillehei found that a pacemaker, attached with a wire electrode directly placed in a dog’s heart, could stimulate at lower voltages and with shorter pulse widths. In January 1957, a 3-year-old girl, who had developed complete heart block after open-heart surgery to correct a congenital defect, was paced using the Lillehei system and ultima...