Implantable Cardioverter Defibrillator

As a leading researcher in ICD therapy, Dr. Higgins has participated in over 1,000 such procedures. He was recently one of the principal investigators in the Multicenter Automated Defibrillator Implantation Trial (MADIT), a randomized trial in which ICD therapy was associated with a 56% reduction in two-year mortality versus those treatedwith conventional medical therapy.

"Dr. Higgins provides an important service to cardiology and to the patients who will benefit from the implantation of a transvenous defibrillator. [This is] an authoritative multimedia text that will be an invaluable guide for physicians involved in transplanting transvenous ICD systems." From the Preface by Dr. Arthur J. Moss

• Preface. Arthur J. Moss, MD.1. An Introduction to ICDs.• History.• Who Should Implant ICDs?.• An Introduction to the Video.2. Patient Selection; Site Selection.• Indications.• Risk Factors for ICD Surgery.• Risks of ICD Surgery.• ICD Site Selection.• Preparation of the Patient.3. The Logistics of ICD Insertion.• Setting Up an ICD Operating Room.• Surgical Instruments.• Staffing for ICD Surgery: Physicians and Support Personnel.• Surgical Support and Consultation.• Anesthesia: Agents and Who Should Administer Them.• Supplies.4. Venous Access and Lead Positioning.• General Considerations.• The Subclavian Venipuncture Technique.• The Cephalic Vein Cutdown Technique.5. ICD Lead Positioning and Testing.• ICD Lead Advancement.• DFT Testing.• Optimal Lead Placement: The Endotak-DSP Study.6. The Subcutaneous Pectoral Approach.• Advantages of the Subcutaneous Approach.• Disadvantages of Subcutaneous Pectoral Approach.• General Surgical Issues.• Antibiotic Usage.7. Submuscular Pectoral Approach.• Anatomy of the Subpectoral Region.• Anterior Approach.• Lateral (Anterior Axillary) Approach.• Multilayer Closure.8. Abdominal Generator Techniques.• Anatomy of the Abdominal Wall Region.• Subcutaneous Abdominal ICD Insertion.• Submuscular Abdominal ICD Insertion.• General Surgical Principles for Abdominal ICD Placement.• Techniques for ICD Lead Tunneling.9. Generator Change Procedures.• Pocket Revision.• Lead Evaluation and Repair.• Pocket Closure.10. Dressing Care and Postprocedure Management.• Dressing Options.• Immediate Postprocedure Care.• Predischarge Orders.• Postoperative Patient Education.• ICD Support Groups.11. Management of Complications.• Problems Encountered at Implant.• Problems Encountered in the Immediate Postimplant Period.• Chronic Lead and Device Complications