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Implantable cardioverter defibrillator principles 

Implantable cardioverter defibrillator principles
Chapter:
Implantable cardioverter defibrillator principles
Author(s):

Rajesh Chelliah

and Raj Khiani

DOI:
10.1093/med/9780199687831.003.0009
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date: 21 September 2019

This chapter covers the principles of implantable cardioverter defibrillators (ICDs). Indications and potential problems for insertion of an ICD are described, including the evidence base for insertion based on randomized trials. International clinical guidelines are summarized. The mechanism and components of an ICD are defined, including diagrams to show the pulse generator, electrodes, and a section on which lead to choose. Arrhythmia detection, sensitivity, oversensing, and rate determination are all discussed. Supraventricular tachycardia (SVT) discriminators, pacing for anti-tachycardia and bradycardia, anti-tachycardia pacing (ATP) delivery, defibrillation, and configuration of shock vector are covered. The importance of avoiding inappropriate shocks is briefly outlined, and strategies for home monitoring are featured.

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