Implantable defibrillators as originally conceived by Michel Mirowski were limited to the detection and automatic termination of ventricular fibrillation. In the original "AID" device, the detection algoritlun sought to distinguish sinus rhytlun from ventricular fibrillation by identifying the "more sinusoidal waveform of ventricular fibrillation. " The therapeutic intervention was elicited only once deadly polymorphic rhythms had developed. It was rapidly learned, however, that ventricular fibrillation is usually preceded by ventricular tachycardia. Mirowski recognized the pivotal importance of developing algoritllms based on heart rate. Ventricular tachycardia detection allowed the successful development of interventions for the termination of ventricular tachyarrhythmias before they degenerated into ventricular fibrillation. Current device therapy no longer confines itself to tlle termination of chaotic rhythms but seeks to prevent them. Diagnostic algorithms moved upward along the chain of events leading to catastrophic rhytlulls. Rate smoothing algorithms were developed to prevent postextrasystolic pauses from triggering ventricular and atrial tachyarrhytlmlias. Beyond the renaissance of ectopy-centered strategies, long-term prevention received increasing attention. Multisite pacing therapies provided by "Arrhythmia Management Devices" were designed to reduce the "arrhytlunia burden" and optimize the synergy of cardiac contraction and relaxation. Clinical evidence now suggests that atrial fibrillation prevention by pacing is feasible and tllat biventricular pacing may be of benefit in selected patients with heart failure. However, these applications of device therapy that generally require ventricular defibrillation backup remain investigational and were not considered in this book.
The exact mechanism of a cardiac arrhythmia becomes fundamentally important when treatment can be directed specifically toward that mechanism. Advances in body surface electrograms and mapping techniques have allowed the causes of ventricular tachyarrhythmias to be pinpointed, thus suggesting viable targets for ablation therapy. However, substantial anatomical and electrophysiological knowledge and catheter-handling skills on the part of the physician are prerequisites for successful ablative technique. Catheter Ablation of Ventricular Tachycardia in Patients with Structural Heart Disease is an in-depth review of this still-expanding subject, presenting both updated information from the current literature and the personal experiences of the authors. The purpose of this book is to provide a comprehensive description of radiofrequency catheter ablation of ventricular tachycardia from history, basic concepts and pathophysiology of radiofrequency lesion formation, to clinical applications and outcomes of these techniques in various subsets of patients with ventricular tachycardia and underlying structural heart disease. Its 128 pages offer a succinct yet comprehensive exchange of information relative to this still-experimental and important field. This book will benefit readers including clinical electrophysiologists, cardiologists, allied industry, and other health care providers who work with patients suffering from ventricular tachycardia.
Implantable defibrillators as originally conceived by Michel Mirowski were limited to the detection and automatic termination of ventricular fibrillation. In the original "AID" device, the detection algoritlun sought to distinguish sinus rhytlun from ventricular fibrillation by identifying the "more sinusoidal waveform of ventricular fibrillation. " The therapeutic intervention was elicited only once deadly polymorphic rhythms had developed. It was rapidly learned, however, that ventricular fibrillation is usually preceded by ventricular tachycardia. Mirowski recognized the pivotal importance of developing algoritllms based on heart rate. Ventricular tachycardia detection allowed the successful development of interventions for the termination of ventricular tachyarrhythmias before they degenerated into ventricular fibrillation. Current device therapy no longer confines itself to tlle termination of chaotic rhythms but seeks to prevent them. Diagnostic algorithms moved upward along the chain of events leading to catastrophic rhytlulls. Rate smoothing algorithms were developed to prevent postextrasystolic pauses from triggering ventricular and atrial tachyarrhytlmlias. Beyond the renaissance of ectopy-centered strategies, long-term prevention received increasing attention. Multisite pacing therapies provided by "Arrhythmia Management Devices" were designed to reduce the "arrhytlunia burden" and optimize the synergy of cardiac contraction and relaxation. Clinical evidence now suggests that atrial fibrillation prevention by pacing is feasible and tllat biventricular pacing may be of benefit in selected patients with heart failure. However, these applications of device therapy that generally require ventricular defibrillation backup remain investigational and were not considered in this book.
Central motor conduction time (CMCT) is the most frequently studied measure derived from transcranial magnetic stimulation (TMS) in multiple sclerosis (MS); it is abnormal in 57–93% of patients. Addition of the triple stimulation technique and combining motor with other evoked potentials (EPs) increases sensitivity. Cross-sectional correlations of TMS measures with clinical assessments of motor dysfunction or global disability are high. Longitudinally, CMCT is sensitive to both worsening and improvement of motor function, showing its potential to detect therapeutic responses. Moreover, combined multimodal EPs are valid quantitative predictors of the clinical course over periods ranging from 2 to 14 years. Measures of transcallosal connectivity (ipsilateral silent period and interhemispheric inhibition) are altered even in early MS, and yield complementary information on subclinical changes. Pathological brain plasticity in MS has been demonstrated by paired associative stimulation studies revealing a compensatory role of the ipsilateral motor and premotor areas. Central motor fatigue is associated with reduced motor EP amplitudes and increased cortical silent periods in normal controls, whereas patients with MS suffering from subjective fatigue show various abnormalities in cortical modulation of the motor system.
AAOS Comprehensive Orthopaedic Review, 2nd edition offers sweeping coverage of the core of orthopaedic knowledge that spans the spectrum of the orthopaedic specialties. Gathered in one convenient and comprehensive text, you'll find the specific information you need to prepare for your examination.
This book targets three fields of computational multi-scale cardiac modeling. First, advanced models of the cellular atrial electrophysiology and fiber orientation are introduced. Second, novel methods to create patient-specific models of the atria are described. Third, applications of personalized models in basic research and clinical practice are presented. The results mark an important step towards the patient-specific model-based atrial fibrillation diagnosis, understanding and treatment.
The most widely used clinical reference in cardiac anesthesia, A Practical Approach to Cardiac Anesthesia, provides complete information on drugs, monitoring, cardiopulmonary bypass, circulatory support, and anesthetic management of specific cardiac disorders. This large handbook incorporates clinically relevant basic science into a practical "what-to-do" approach and is written in an easy-to-read outline format. Designed for practicing anesthesiologists, as well as anesthesia residents, fellows in cardiothoracic anesthesia, perfusionists, and all other anesthesia practitioners, this handbook delivers comprehensive and expertly presented views of the discipline – with outstanding color graphics and the practical, how-to style of a manual.
Explore effective ways to enhance the wellness and independence of older adults across the wellness-illness continuum. From an overview of the theories of aging and assessment through the treatment of disorders, including complex illnesses, this evidence-based book provides the comprehensive gerontological coverage you need to prepare for your role as an Advanced Practice Nurse. Understand how to easily identify factors that may affect the wellness of your patients and their families. Plus, enhance your critical-thinking skills with real-world case studies that bring concepts to life.
All the essentials of internal medicine in an instant! This concise, yet all-inclusive review is the perfect tool to prepare for primary certification and recertification exams, or for use as a clinical refresher. Its streamlined format conveniently condenses and simplifies the most important content, for maximum yield and comprehension -- making it indispensable for internal medicine residents, clerkship students, and busy practitioners. FEATURES: Compact review of key board-type material that spans the entire spectrum of internal medicine Coverage that reflects the weighting of the ABIM exam and adheres to its blueprint--including interdisciplinary medicine, geriatrics, gender-specific health care problems, interpretation of the medical literature, and all major internal medicine subspecialities Insights from a team of leading academics and clinicians from the country's top medical schools Standardized, bulleted presentation that emphasizes key points of epidemiology, pathophysiology, clinical features, differential diagnosis, diagnosis, procedures and treatment, prognosis, plus references Numerous clinical algorithms Chapter organization arranged by specialty
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