Maisel Device Therapy in Heart Failure

1. Auflage 2010
ISBN: 978-1-59745-424-7
Verlag: Humana Press
Format: PDF
Kopierschutz: 1 - PDF Watermark

E-Book, Englisch, 400 Seiten

Reihe: Contemporary Cardiology

Heart failure affects over 5 million patients in the United States alone, and is a chronic and debilitating disease. While a number of pharmacologic therapies have shown varying degrees of effectiveness, many recent advances in the treatment of heart failure has focused on device based therapies. In Device Therapy in Heart Failure, William H. Maisel and a panel of authorities on the use and implementation of device based therapies provide a comprehensive overview of the current and developing technologies that are used to treat heart failure. Individual chapters provide an in-depth analysis of devices such as CRT's and ICD's, while broader topics such as the pathophysiology of heart failure and its current medical therapies are also discussed. Additional topics include Pacing and Defibrillation for Atrial Arrhythmias, Atrial Fibrillation Ablation, and Percutaneous Treatment of Coronary Artery Disease.

Autoren/Hrsg.

Maisel, William H.

Inhaltsverzeichnis

1;Preface;6
2;Contents;7
3;Contributors;8
4;1 Pathophysiology of Heart Failure;10
4.1;1 The Pathophysiology of Compensatory Systems in Heart Failure;11
4.1.1;1.1 Normal Cardiac Function;11
4.1.2;1.2 The Frank--Starling Mechanism in HF;12
4.1.3;1.3 Chronic Ventricular Remodeling;13
4.1.3.1;1.3.1 Myocardial Hypertrophy and Remodeling;14
4.1.4;1.4 Neurohormones in Heart Failure;17
4.1.4.1;1.4.1 The Sympathetic Nervous System;18
4.1.4.2;1.4.2 The Renin--Angiotensin--Aldosterone System;19
4.1.4.3;1.4.3 Arginine Vasopressin;21
4.1.4.4;1.4.4 Endothelin;21
4.1.4.5;1.4.5 Nitric Oxide;22
4.1.4.6;1.4.6 Natriuretic Peptides;23
4.1.4.7;1.4.7 Inflammatory Cytokines;24
4.2;2 Molecular Mechanisms Affecting Cardiac Arrhythmogenesis;24
4.2.1;2.1 Calcium Cycling in Normal and Failing Cardiac Myocytes;25
4.2.2;2.2 Prolongation of the Cardiac Action Potential;27
4.2.3;2.3 Abnormalities in Conduction;28
4.3;3 Atrial Fibrillation in HF;29
4.4;4 Conclusions;29
4.5;References;30
5;2 Medical Therapy for Heart Failure;37
5.1;1 Introduction;37
5.2;2 Digitalis Glycosides;38
5.3;3 Diuretic Therapy for Heart Failure;41
5.4;4 Vasodilator Therapy;45
5.4.1;4.1 Angiotensin-Converting Enzyme (ACE) Inhibitors;45
5.4.2;4.2 Angiotensin Receptor Blockers (ARBs);50
5.4.3;4.3 Other Vasodilators;55
5.5;5 Aldosterone Receptor Antagonists;57
5.6;6 Beta-Adrenergic Receptor Blockers;59
5.7;7 Anticoagulation;64
5.8;8 Statins;65
5.9;9 Medications to Avoid;66
5.10;10 Consensus Statements;68
5.11;References;69
6;3 Device Trials in Chronic Heart Failure: Implications of Trial Design;77
6.1;1 Introduction;78
6.2;2 Tenets of Good Clinical Trial Design;78
6.2.1;2.1 The Question;78
6.3;3 Current Trial Designs in Heart Failure Populations;82
6.3.1;3.1 The Endpoint: Symptom Relief in Acute DecompensatedHeart Failure;82
6.3.2;3.2 The Endpoint: Functional Improvement and Quality of Life;83
6.4;4 Impact of Trial Design on Outcome;91
6.5;5 Newer Approaches to Clinical Trial Design for Devices in Patients with Heart Failure;93
6.6;6 Conclusions;93
6.7;References;94
7;4 The FDA Perspective on Heart Failure Devices;96
7.1;1 Introduction;97
7.2;2 Device Development, Evaluation, Approval, and Postmarket Surveillance;98
7.2.1;2.1 Regulatory Terminology and Submission Types;98
7.2.2;2.2 Device Labeling;102
7.2.3;2.3 Product Recalls;103
7.2.4;2.4 Premarket vs. Postmarket Review;104
7.3;3 Considerations in Clinical Trial Design;104
7.3.1;3.1 Choosing a Control Group;104
7.3.2;3.2 Selecting the Appropriate Endpoints;106
7.3.3;3.3 Utilizing Quality Control Measures;110
7.3.4;3.4 Methods for Handling Missing Data;111
7.3.5;3.5 Gender Bias;111
7.4;4 Review Paradigms for Heart Failure Devices;112
7.4.1;4.1 Cardiac Resynchronization Therapy;112
7.4.2;4.2 Ventricular Assist Devices and Total Artificial Hearts;113
7.4.3;4.3 Hemodynamic Monitoring Technologies;117
7.5;5 Role of the Circulatory System Devices Advisory Panel;118
7.6;6 Interactions with External Stakeholders and Government Partners;119
7.7;7 Conclusions;121
7.8;References;121
8;5 Hemodynamic Monitoring in Heart Failure;125
8.1;1 Introduction;126
8.2;2 Clinical Assessment of Hemodynamic Profiles;126
8.2.1;2.1 Symptoms;126
8.2.2;2.2 Physical Examination;127
8.3;3 Laboratory Evaluation of Elevated Filling Pressures;128
8.4;4 Modalities of Hemodynamic Monitoring;130
8.5;5 Invasive Modalities of Hemodynamic Monitoring;130
8.5.1;5.1 The Pulmonary Artery Catheter;130
8.5.1.1;5.1.1 Indications for the Use of the Pulmonary Artery Catheter;131
8.5.1.2;5.1.2 Use of the Pulmonary Artery Catheter to ''Tailor Therapy'' in Heart Failure;132
8.5.1.3;5.1.3 Controversy Surrounding the Use of Pulmonary Artery Catheters;133
8.5.1.4;5.1.4 Safety and Efficacy of the Pulmonary Artery Catheter in Advanced Decompensated Heart Failure: The Escape Trial;138
8.5.1.5;5.1.5 Recommendations for the Use of Pulmonary Artery Catheters in Heart Failure;139
8.5.2;5.2 Implantable Hemodynamic Monitors (IHM);140
8.5.2.1;5.2.1 The Medtronic Chronicle ® Implantable Hemodynamic Monitor Design;141
8.5.2.2;5.2.2 Validation of the Chronicle ® Implantable Hemodynamic Monitor;142
8.5.2.3;5.2.3 Clinical Trials with the Chronicle ® Implantable Hemodynamic Monitor in Heart Failure;144
8.5.3;5.3 Other Investigational Implantable Hemodynamic Monitoring Devices;146
8.6;6 Non-Invasive Methods of Hemodynamic Monitoring;147
8.6.1;6.1 Non-invasive Assessment of Hemodynamics by Echocardiography;148
8.6.2;6.2 Bioimpedance Cardiography;148
8.6.3;6.3 Non-invasive Measurement of Left Ventricular End-Diastolic Pressure Based on the Arterial Blood Pressure Response to the Valsalva Maneuver;153
8.7;7 Summary;155
8.8;References;156
9;6 Implantable Cardioverter-Defibrillators;161
9.1;1 Sudden Cardiac Death in Heart Failure;161
9.2;2 Indications for ICD Implantation in Patients with HF;162
9.2.1;2.1 Secondary Prevention Trials;162
9.2.2;2.2 Primary Prevention Trials;165
9.2.3;2.3 Benefit of the ICD in Patients with Advanced Heart Failure;171
9.3;3 ICD Function and Technology;177
9.3.1;3.1 Treatment;177
9.3.2;3.2 Detection;180
9.3.3;3.3 Management Issues in the Care of the CHF Patient with an ICD ;182
9.3.3.1;3.3.1 Programming of the ICD: Bradycardia Pacing ;182
9.3.4;3.4 Management of Frequent Shocks;183
9.3.5;3.5 Device Malfunction;183
9.3.6;3.6 Management of the ICD in End-of-Life Care;184
9.4;4 Conclusions;184
9.5;References;185
10;7 Cardiac Resynchronization Therapy;191
10.1;1 Pathophysiology of Dyssynchrony and Definitions;192
10.1.1;1.1 Context;192
10.1.2;1.2 Electrical Timing;193
10.1.3;1.3 CRT Compared with Other Methods of Increasing Cardiac Output (Inotropes);194
10.1.4;1.4 Mitral Regurgitation;195
10.1.5;1.5 LV vs. BiV Pacing;195
10.2;2 Imaging Modalities to Identify Patients;196
10.2.1;2.1 Echocardiography;196
10.2.2;2.2 Other Imaging Techniques;196
10.3;3 Clinical Evidence;197
10.3.1;3.1 Trials;197
10.3.2;3.2 Patient Characteristics/Subsets;201
10.3.3;3.3 QRS Morphology;202
10.3.4;3.4 Atrial Fibrillation;204
10.3.5;3.5 Cost-Effectiveness;204
10.4;4 Hardware;204
10.4.1;4.1 Leads and Delivery Systems;204
10.4.2;4.2 Technical Considerations;205
10.4.3;4.3 Devices;207
10.4.3.1;4.3.1 Pacing Configurations;207
10.4.3.2;4.3.2 Maximizing LV Pacing;207
10.4.3.3;4.3.3 Other Diagnostics;209
10.4.4;4.4 CRT Defibrillators vs. CRT Pacemakers;210
10.5;5 Troubleshooting/Optimization;210
10.5.1;5.1 ECG Patterns;210
10.5.2;5.2 AV Optimization;211
10.5.3;5.3 VV Optimization;213
10.5.4;5.4 Additional Evaluation;213
10.6;6 Guidelines;213
10.7;7 Conclusions;215
10.8;References;215
11;8 Pacing and Defibrillation for Atrial Arrhythmias;220
11.1;1 Mechanisms of Atrial Arrhythmias and Interaction with Electrical Pacing;221
11.2;2 Atrial Fibrillation in Patients with Pacemakers;222
11.3;3 Diagnosis of Atrial Arrhythmias in Patients with Pacemakers;224
11.4;4 Alternate Site Atrial Pacing;226
11.5;5 Pacing Algorithms to Prevent Atrial Fibrillation;229
11.6;6 Termination of Atrial Arrhythmias: Antitachycardia Pacing and Cardioversion;231
11.7;7 Conclusions;233
11.8;References;234
12;9 Atrial Fibrillation Ablation;240
12.1;1 Atrial Fibrillation Prevalence and Morbidity;240
12.2;2 Treatment Options;241
12.2.1;2.1 Pharmacologic Therapy;241
12.2.2;2.2 Nonpharmacologic Therapy;242
12.3;3 Catheter Ablation of Atrial Fibrillation;242
12.3.1;3.1 Clinical Guidelines for Atrial Fibrillation Ablation;244
12.3.2;3.2 Devices Used for Catheter Ablation of AF;244
12.3.2.1;3.2.1 Intracardiac Echocardiography ;245
12.3.2.2;3.2.2 Brockenbrough Transseptal Puncture Needle;247
12.3.2.3;3.2.3 Transseptal Sheaths;247
12.3.2.4;3.2.4 Nonfluoroscopic Three-Dimensional Mapping Techniques;249
12.3.2.5;3.2.5 Carto;249
12.3.2.6;3.2.6 EnSite NavX;252
12.3.2.7;3.2.7 LocaLisa;254
12.3.2.8;3.2.8 Remote Magnetic Catheter Navigation;254
12.3.2.9;3.2.9 Multielectrode Catheters for Electrical Mapping of the Pulmonary Veins;256
12.3.2.10;3.2.10 Ablation Catheters;258
12.4;4 Conclusion;262
12.5;References;262
13;10 Percutaneous Treatment of Coronary Artery Disease;267
13.1;1 A Historical Perspective;267
13.2;2 Balloon Angioplasty;268
13.3;3 Stenting;269
13.4;4 Drug-Eluting Stents;270
13.4.1;4.1 Cypher Stent;272
13.4.2;4.2 TAXUS Stent;273
13.5;5 The Controversy of Des;274
13.6;6 Coronary Artery Disease And Heart Failure;275
13.7;7 No-option Patients;277
13.7.1;7.1 Spinal Cord Stimulation (SCS);278
13.7.2;7.2 Enhanced External Counterpulsation (EECP);278
13.8;8 Conclusions;279
13.9;References;279
14;11 Percutaneous Management of Peripheral Arterial Disease;291
14.1;1 Introduction;291
14.2;2 Lower Extremity;292
14.2.1;2.1 Aortoiliac Disease;293
14.2.2;2.2 Femoropopliteal;295
14.2.3;2.3 Infrapopliteal;298
14.3;3 Renal Artery;299
14.4;4 Carotid Artery;301
14.5;5 Conclusion ;303
14.6;References;304
15;12 Percutaneous Management of Valvular Heart Disease;308
15.1;1 Introduction;309
15.1.1;1.1 Valvular Heart Disease and Heart Failure -- Scope of the Problem and Challenges for the Therapy;309
15.2;2 Percutaneous Treatment of Pulmonic Valvular Disease;309
15.2.1;2.1 Balloon Valvotomy;309
15.2.2;2.2 Percutaneous Pulmonic Valve Implantation (PPVI);310
15.2.2.1;2.2.1 Historical Perspective and Initial Valve Design;310
15.2.2.2;2.2.2 Indications;310
15.2.2.3;2.2.3 Clinical Outcome of Percutaneous Pulmonary Valve Implantation;310
15.2.2.4;2.2.4 Limitations of the Approach and Future Directions;313
15.3;3 Percutaneous Treatment of Aortic Valve Disease;314
15.3.1;3.1 Aortic Stenosis;314
15.3.2;3.2 Indications for Intervention;314
15.3.3;3.3 Balloon Aortic Valvuloplasty (BAV);315
15.3.4;3.4 Percutaneous Aortic Valve Replacement;316
15.3.4.1;3.4.1 Aortic Percutaneous Valve Designs and Preliminary Clinical Results;316
15.3.4.2;3.4.2 Limitations and Future Direction;319
15.4;4 Percutaneous Treatment of Mitral Valve Disease;321
15.4.1;4.1 Mitral Stenosis and Valvuloplasty;321
15.4.2;4.2 Percutaneous Mitral Valve Repair for Mitral Regurgitation;322
15.4.2.1;4.2.1 Primary Versus Secondary Mitral Regurgitation and Indications for Intervention;322
15.4.2.2;4.2.2 Anatomic Challenges Associated with Mitral Regurgitation and Left Ventricular Dilatation;323
15.4.2.3;4.2.3 Approaches to Repair of Primary Valvular Pathology;323
15.5;5 Percutaneous Atrioventricular Valve Replacement Preliminary Results;332
15.6;6 Guidelines for Percutaneous Valve Interventions;333
15.7;7 Future Directions and Challenges;333
15.8;References;337
16;13 Ventricular Assist Devices and Total Artificial Hearts;341
16.1;1 Background;342
16.2;2 Physiologic Considerations;343
16.3;3 The Devices;345
16.4;4 Short-Term Devices (1 Month of Support);345
16.4.1;4.1 Tandemheart Percutaneous Ventricular Assist ® ;345
16.4.2;4.2 Impella Recover ® ;346
16.4.3;4.3 Abiomed BVS 5000 ® and AB 5000 ® ;347
16.4.4;4.4 Levitronix CENTriMAG ® ;348
16.5;5 Long-Term Devices (1 Month of Support);349
16.5.1;5.1 Thoratec ® Paracorporeal and Intracorporeal Ventricular Assist Devices (PVAD/IVAD);349
16.5.2;5.2 Heartmate ® LVAD;350
16.5.3;5.3 Novacor ® ;351
16.6;6 Second-Generation Devices: Axial Flow Pumps;352
16.6.1;6.1 Debakey VAD ® ;352
16.6.2;6.2 Heartmate II ® ;353
16.6.3;6.3 Jarvik 2000 ® ;354
16.7;7 Third-Generation Devices: Maglev Technology;354
16.8;8 Total Artificial Hearts (TAH);355
16.9;9 Patient and Device Selection;356
16.10;10 Clinical Experiences;357
16.10.1;10.1 Acute Cardiogenic Shock;357
16.10.2;10.2 Postcardiotomy Cardiogenic Shock;358
16.10.3;10.3 Bridge to Decision and Bridge to Bridge;359
16.10.4;10.4 Bridge to Transplantation (BTT);359
16.10.5;10.5 Bridge to Recovery;362
16.10.6;10.6 Destination Therapy (DT);363
16.10.7;10.7 Complications;365
16.11;11 Conclusions;368
16.12;References;369
17;14 Device Therapy for Left Ventricular Dysfunction;374
17.1;1 Introduction;374
17.2;2 History of Left Ventricular Remodeling Surgery;377
17.3;3 Left Ventricular Device Therapies;378
17.3.1;3.1 Tethers;379
17.3.2;3.2 Socks;379
17.3.3;3.3 Cardiac Support Devices;380
17.3.4;3.4 Mitral Valve Interventions;382
17.4;4 A Regulatory Perspective;385
17.5;5 Conclusions;386
17.6;References;386
18;Subject Index;389