The Implantable Cardioverter Defibrillator: A Videotape and Manual

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