SKY IS THE LIMIT? ΝΕΩΤΕΡΙΣΜΟΙ ΣΤΟΥΣ ICD

Transcription

1 SKY IS THE LIMIT? ΝΕΩΤΕΡΙΣΜΟΙ ΣΤΟΥΣ ICD Λήδα Πιερέττα Παπαβασιλείου τμήμα Ηλεκτροφυσιολογίας, Βηματοδοτών και Απινιδωτών ΔΘΚΑ ΥΓΕΙΑ Διδάκτωρ Πανεπιστημίου Ρώμης Tor Vergata

2 1980. History was made... Shape and size Battery longevity Remote monitoring MRI Reducing inappropriate shocks and lead failure S-ICD CRT 4poles in LV lead Multi point pacing

3 ICD's come in all shapes and sizes... Medtronic VivaTM XT Boston Scientific Cognis St. Jude Medical Unify Medtronic Protecta Note: Pressure contour plots are scaled relative to each other: header to header, device body to device body. The relative pressures can therefore not be compared between the headers and device bodies.

4 One battery is better than two...

5 One battery is better than two...

6 Real life data confirmed by recent publication Indipendent single center registry Methods: 646 CRTD partients follow-up median 2.7± 1.5 years Reallife data Endpoint: device replacement for ERI Results: survivcal rate at 4 years is 94% for BSC, 67% for MDT, 92% for SJM (p< 0,001) and it s indipendent from programming and number of shocks

7 BATTERY CAPACITY: A major difference BSC = 2,0AH BIO = 1,7AH SJM 1,3AH MED = 1,1AH Significantly higher battery capacity of similar devices, while up to 50% thinner 9.9 mm thin 7

8 Impact of extending device longevity on the long-term costs of implantable cardioverterdefibrillator therapy: a modelling study with 15-year time horizon. Giuseppe Boriani et al Europace doi: /europace/eut133

9 Safety first... Big Brother...

10 64 year old patient with scattered paraesthesias. CT :frontal hypodense lesion Diagnosis: Tumor vs. Infarct MRI: sub-acute infarction of the middle cerebral artery CT/MRI courtesy of Dr. Torsten Sommer MD, University of Bonn Department of Radiology

11 Why 3 T is better than 1.5? 1.5T Cerebral familial cavernomatosis. 3.0T Many of the small cavernomas visible on 3 T are not detected on 1.5 T. Source :3 T MRI: Advances in brain imaging. Juan Alvarez-Linera. European Journal of Radiology 67 (2008)

12 To MRI or not to MRI... AUTOMATIC MRI SENSOR

13 S-ICD

14 S-ICD Clinical experience of entirely subcutaneousimplantable cardioverter defibrillators in children and adults: cause for caution Julian W. E. Jarman European Heart Journal (2012) 33,

15 Smart Detection TM Shock Guard TM Technology, Dynamic Tx TM SmartShock Technology 2.0 AcuShock TM Rhythm ID TM Rhythm Match TM, DNA, AGC, Quick Convert TM PARADYGM+ TM

16 4 electrodes are better than 2 Body Lead 4.7 Fr Ring 5.1 Fr Optim-Covered Tip 4 Fr In 2009

17 Improving dyssyncrony

18 Improving CRT EFFECTIVECRT TM EffectivCRT Diagnostic EffectivCRT During AF ADAPTIVECRT TM ATTAIN PERFORMA TM & VECTOREXPRESS2.0 T M MULTIPLE POINT PACING DX TECHNOLOGY AV and VV delay MPP

19 Dr. Giovanni Forleo, et al, Rome, Italy17,18 N = 313 patient, 57 center Italian registry During implant measured Capture Thresholds (CTs), presence of PNS Showed MultiPoint Pacing was programmable in 97% of patients At follow-up QRS was reduced and EF improved with MultiPoint Pacing relative to conventional BiV QRS Duration and Echo Changes P < % DeltaQRS Biv % DeltaQRS MPP EF baseline EF Biv EF MPP MultiPoint Pacing Programmability This presentation is for international use only. SJM-MLP

20 MultiPoint pacing shows improved CRT response rate MultiPoint Pacing improves responder rates at 12 months postimplant7 Methods: CRT patients were randomized to receive either conventional BiV or MultiPoint Pacing, and TTE was performed prior to implant, 3 months and 12 months postimplant (n = 44). Results: After 12 months, 12/21 (57%) of patients in the conventional BiV group and 16/21 (76%) of patients in the MultiPoint Pacing group were classified as positive responders (defined as ESV reduction 15%). ESV reduction and EF increase relative to baseline were significantly greater with MultiPoint Pacing than with conventional CRT (p = 0.01 and p < 0.001, respectively). NYHA class reduction was also greater within the MultiPoint Pacing group. This presentation is for international use only. SJM-MLP

21 Heart Failure and Ischemic heart disease

22 What about the future????

23 Combined LP and S-ICD implant in a sheep. 72-year-old patient. No interference in sensing and pacing during intrinsic and paced rhythm was noted in our animal model and human subject,

24 LAP monitors and CRT

25 LVAD and ICD/S-ICD

26 Integrated Remote Monitoring

27 THANK YOU FOR YOUR ATTENSION