Nonpharmacological Therapy of Arrhythmias for the 21st Century [antikvár]

PrefaceInterventional electrophysiology has emerged as a major subspecialty of clinical electrophysiology. It continues to evolve with breathtaking speed. Technological developments, scientific advances, and computerization have made possible today what pioneers of this dynamic specialty could only dream of only two decades ago. It was only 18 years since the implantable defibrillator (ICD) debuted at the Johns Hopkins Hospital in Baltimore imder the pioneering genius of Michel Mirowski, and barely 30 years since His bimdle recordings were first introduced into clinical practice. In the last decade the advances in catheter technologies, mapping systems, and micro-circuits have made possible therapies that were once considered unthinkable. The ICD, once considered by some as a bizarre and unethical invention, has now become commonplace. The ICD has not only been demonstrated to be superior to all other therapies for lethal ventricular arrhythmias, but is now being tested for primary prevention of sudden cardiac death. Parallel developments in pacing and defibrillation have led to the marriage of antitachycardia devices, dual chamber pacemakers, and defibrillators. Development of small caliber transvenous electrodes and small devices have made it possible for ICDs to be implanted in the electrophysiology laboratory by trained electrophysiologists. Similarly, evolution of steerable catheters and percutaneous multi-electrode mapping systems has provided electrophysiologists with tools to ablate most reentrant tachycardias, with few notable exceptions. Boundaries of interventional electrophysiology are continuously challenged by new discoveries, re-finements in technology, and imaginative procedures.It is with this backdrop in mind that this book was conceived. We are at the threshold of the new century. Consequently, we have chosen as the title for this book Non-pharmacological Therapy of Arrhythmias for the 2V' Century: The State of the Art to reflect our current knowledge. This is a carefully integrated book covering most relevant subjects of interest to interventional electrophysiologists. It was our intention at the outset that this should be up to date, as difficult and elusive as this goal might seem, be practically oriented, and especially geared to the interventionists and others interested in this rapidly growing field: general cardiologists, cardiothoracic surgeons, cardiology fellows, engineers, nurSes, and technicians.The book is divided into four sections:Section I deals with advances in catheter ablation techniques and covers specific procedures for accessory pathways, AV node reentrant tachycardia, atrial flutter, atrial fibrillation, and ventricular tachycardia. Scientific and anatomic basis for ablation therapies are extensively discussed. A chapter is also devoted to new catheter designs for interventional electrophysiology.Section II describes the current knowledge base of ICD therapy, indications, and implantation techniques, including new developments in dual chamber and atrial defibrillators. The recenfly completed and published randomized multicenter trials of ICD therapy and trials for prophylaxis of sudden cardiac death are presented. Implications for current and future use of ICDs are discussed, as well as the role of pharmacological therapy.XI