Cardiac resynchronization therapy pacemaker

Carbon monofluoride (CFx) is one such fluoride compound that today is used as a positive electrode material in Li batteries for a number of different applications. For example, they are used in certain types of heart failure devices - implantable cardiac resynchronization therapy pacemakers (CRT-P). CRT-P devices can pace the right atrium and right ventricle, but they are also capable of pacing the left ventricle. Pacing three chambers requires more power than a cell can deliver, so a different battery type is needed. Li/CFx cells were developed in response to the increased power required by CRT-P devices. Vagal nerve stimulator devices also use a Li/CFx cells. 

However, the long-term effects of cardiac resynchronization therapy (CRT) on morbidity and mortality were not known. Two clinical trials have established the morbidity and mortality effects of CRT. The COMPANION trial was a three armed trial, testing optimal medical therapy (OPT) against OPT plus CRT by a pacemaker or a OPT plus CRT by an implantable cardioverter-defibrillator (CRT-D) [118]. In this study, patients were enrolled prior to... 

Recent studies demonstrate that cardiac resynchronization therapy (CRT) offers a promising approach to selected patients with chronic heart failure. Delayed electrical activation of the left ventricle, characterized on the ECG by a QRS duration that exceeds 120 ms, occurs in approximately one-third of patients with moderate to severe systolic heart failure. Since the left and right ventricles normally activate simultaneously, this delay results in asynchronous contraction of the left and right ventricles, which contributes to the hemodynamic abnormalities of this disorder. Implantation of a speciahzed biventricular pacemaker to restore synchronous activation of the ventricles can improve ventricular contraction and hemodynamics. Recent trials show improvements in exercise capacity, NYHA classification, quality of life, hemodynamic function, and hospitalizations. A device that combined CRT with an implantable cardioverter-defibrillator (ICD) improved survival in addition to functional status. CRT is currently indicated only in NYHA class ni-IV patients receiving optimal medical therapy (ACE inhibitors, diuretics, -blockers, and digoxin) and... 

There are three implantable devices used today to treat cardiac arrhythmias - the pacemaker, the implantable cardioverter defibrillator (ICD), and the cardiac resynchronization therapy (CRT) devices for heart failure patients. 

Management of a Biventricular Device. It has been estimated that up to 38% of patients with moderate to severe congestive heart failure due to left ventricular systolic dysfunction have intraventricular conduction delays with wide QRS complexes and ventricular dyssynchrony (79). Cardiac resynchronization therapy using a biventricular pacemaker is now a Class I indication therapy for systolic heart failure in patients with a QRS complex > 120 ms and left ventricular ejection fraction < 35% (80). Although cardiac resynchronization therapy decreases heart failure hospitalizations (81,82), as the overall number of patients with biventricular pacemakers and ICDs increase, more critical care patients will present with implanted biventricular devices, and familiarity with the management of these devices will become increasingly important. 

Physicians treat patients and for those individuals who have been implanted with a permanent pacemaker for a symptomatic bradycardia or pharmacologically refractory congestive heart failure with cardiac resynchronization therapy (CRT), it is necessary to periodically determine whether or not the present... 

An increasing number of patients present for vascular access surgery carrying a CIED (e.g. internal pacemaker, defibrillator ICD, or cardiac resynchronization therapy) [14]. In these patients, the surgeon needs to brief the team ahead of time about the use of electrocautery. If monopolar cautery is needed, the pathway of the cautery current should be directed far away from the CIED, and the device should be reprogrammed or deactivated temporarily. Depending on the device and indication, the pacemaker function maybe adjusted to a reasonable rate and mode of action [15]. 

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