How to treat Cardiac Resynchronization Therapy complications? C. Leclercq Departement of Cardiology Centre Cardio-Pneumologique Rennes, France
|
|
- Thomasina Miles
- 5 years ago
- Views:
Transcription
1 How to treat Cardiac Resynchronization Therapy complications? C. Leclercq Departement of Cardiology Centre Cardio-Pneumologique Rennes, France
2 Presenter Disclosure Information Christophe Leclercq, MD, PhD FINANCIAL DISCLOSURE: Research Grants: Boston Scientific, Medtronic, Sorin Group, St. Jude Medical, Consulting / Advisory board: Boston Scientific, Biotronik, Medtronic, St. Jude Medical, Sorin Group Lectures: Boston Scientific, Biotronik, Medtronic, St. Jude Medical, Sorin Group, GE, Boehringer Stock Options: None; Salary Support: None; Speaker Bureau: None
3 Introduction Dramatic increase in CRT devices implantations ~ CRTD in 2010 (over 420 mil. inhab.) ~ CRTP in 2010 (over 420 mil. inhab.) Rate of complications probably underestimated
4 Which complications with CRT? Common complications with implantation of PMs and ICDs Vein injury, pneumothorax (1%) 1, hematoma (VK antagonist) (2.4%) 1, infection (long procedure) Specific complications related to LV lead Failure of LV lead implantation (7%) 1 CS dissection ( 1.3%) 1 coronary vein perforation (1.3%) 1 High pacing threshold (acute and chronic) Phrenic nerve stimulation (short and long terms) LV lead dislodgement (short and long terms) (5.7%) 1 Non optimal pacing site non response to CRT X-rays exposure (patient, physician and staff) In hospital-death (0.3%) 1, 30-days mortality (0.7%) 1 1 Van Rees. J Am Coll Cardiol 2011; 58:
5 Italian registry Patients undergoing successful CRT-D implantation were included consecutively in the Italian ClinicalService project Patients undergoing de novo CRT-D placement with transvenous leads implantation, in accordance with current guidelines: advanced heart failure (NYHA class II, III or IV) depressed LV function (LV ejection fraction 35%) wide QRS complex ( 120 ms) Patients undergoing replacement of a CRT device (pacemaker or ICD) or upgrading from previous ICD to CRT-D were excluded Landolina. Circulation 2011; 123:
6 Methods End-points The project database was searched for all device-related adverse events: Untoward events resulting from the presence or performance of the implanted system: 1. Anticipated (i.e. device replacement for battery depletion) 1) Unanticipated device-related events resulting in surgical intervention for system revision The additional long-term risk related to CRT-D was assessed by comparing the events occurred in CRT-D group and in patients who underwent de novo implantation of single- or dual-chamber ICD systems at the study centers during the same period
7 Results Patient Population From 2004 to 2009, 3865 patients received a CRT-D and were enrolled in the 117 cardiovascular centers After excluding patients with a previous ICD or CRT device, we included in the analysis 3253 patients who underwent successful de novo CRT-D implantation During the same period, 1576 patients underwent de novo implantation of single- (n=741) or dual-chamber ICD (n=835) at the cardiovascular centers Parameter n=3253 Male gender, n (%) 2593 (80) Age, years 67±10 Ischemic etiology, n (%) 1364 (42) Permanent AF, n (%) 383 (12) NYHA class 2.7±0.6 QRS duration, ms 148±30 Primary prevention, n (%) 2841 (87) Myocardial infarction, n (%) 1341 (41) Previous CABG or angioplasty, n (%) 1088 (33) Valve disease, n (%) 604 (19) Previous single-chamber PM, n (%) 60 (2) Previous dual-chamber PM, n (%) 284 (9) LV ejection fraction, % 27±6 -Blocker use, n (%) 2294 (71) ACE-inhibitor use, n (%) 2405 (74) Diuretic use, n (%) 3168 (97) Class III antiarrhythmic use, n (%) 797 (24) Anticoagulant use, n (%) 814 (25) Antiplatelet use, n (%) 1338 (41)
8 Results During a median follow-up of 18 months (25th-75th percentiles: 9-30): 483 events resulting in surgical revision were reported in 390 patients 220 unanticipated events requiring surgical intervention occurred in 210 patients (on excluding device replacement for battery depletion) Unanticipated events requiring surgical revision (220) Device-related infections (30) Lead dislodgments or phrenic nerve stimulation (120) Left ventricular lead (96) Lead malfunctions (51) Prophylactic lead replacements # (7) Left ventricular lead (4) Right ventricular lead * (47) Leads added or replaced (12) : 22 additional events of LV lead dislodgment were noninvasively managed *: 44 leads of the Sprint Fidelis family #: Elective replacements of non-malfunctioning Sprint Fidelis leads Annual rate [events/100 Pt]
9 Results CRT-D demonstrated higher rates of events than singleand dual-chamber ICDs during a median follow-up of 18 months (25th-75th percentiles: 9-30) Time to first surgical revision Event-free Survival 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Log-rank test: - CRT-D Vs. DC-ICD, p< CRT-D Vs. SC-ICD, p< DC-ICD Vs. SC-ICD, p< days after im plant CRT-D dual chamber-icd single chamber-icd Landolina. Circulation 2011; 123:
10 Results Device Longevity The actuarial rate of battery depletion at 4 years was: 50% in CRT-D 13% in dual-chamber ICD 10% in single-chamber ICD Time to device replacement for battery exhaustion Time to device replacement for battery depletion 100% 90% 80% Event-free Survival 70% 60% 50% 40% 30% 20% 10% 0% Log-rank test: - CRT-D Vs. DC-ICD, p< CRT-D Vs. SC-ICD, p< DC-ICD Vs. SC-ICD, p<0.001 CRT-D dual chamber-icd single chamber-icd days after implant Landolina. Circulation 2011; 123:
11 Unanticipated Events Results At 4 years unanticipated events were reported in: 14% of CRT-D 9% of dual-chamber ICD 4% of single-chamber ICD Time to first unanticipated event requiring surgical revision 100% 90% Event-free Survival 80% 70% 60% Log-rank test: - CRT-D Vs. DC-ICD, p= CRT-D Vs. SC-ICD, p< DC-ICD Vs. SC-ICD, p= % days after implant CRT-D dual chamber-icd single chamber-icd
12 Results LV lead Dislodgments LV lead dislodgements were reported in 5% of patients at 4 years and were predicted by: longer fluoroscopy time (HR: 1.02, CI: ; p=0.015) higher pacing threshold on implantation (HR: 1.41, CI: ; p=0.006) Event-free Survival 100% 90% 80% 70% Time to first LV lead dislodgment Published data: LV lead dislodgments in 10% at 3 years (3) 5% repeated surgery, plus 2% of CRT discontinuation at 2 years with leads by multiple manufacturers (4) 60% 50% Johnson WB, et al. PACE Biffi M, et al. Circ AE days after im plant Landolina. Circulation 2011; 123:
13 Results Device-related Infections In CRT-D, infections occurred at a rate of 1.0%/y The risk of infections increased after device replacement procedures (HR: 2.04, CI: ; p=0.045) Time to first device-related infection 100% 90% Event-free Survival 80% 70% 60% 50% days after im plant This confirms with real-world data the findings acquired with previous trials and prospective studies (1,2) 1. McAlister FA, et al. JAMA Klug D, et al. Circulation 2007.
14 Freedom Trial : 1647 pts LV lead events in 164 pts Gras ESC 2011
15 Which solutions? Phrenic nerve stimulation Compromise between PNS threshold and LV pacing threshold: uncertain Risk of loss of LV capture Interest of autocapture algorithm (also for increase in PT) Repositioning of the LV lead Uncertain Risk of future dislodgement if LV lead in proximal location in the CS vein Risk of major CE: 19% in REPLACE trial Poole. Circulation. 2010;122: )
16 LV Lead Repositioning Due To Phrenic Nerve Stimulation
17 Which solutions? Phrenic nerve stimulation Electrical repositioning Non invasive solution Effective in many cases ERACE trial: PNS still present in 5% Biffi: 41pts with PNS» 10 pts surgical revision» 4 pts CRT-OFF
18 Which solutions? Phrenic nerve stimulation Implantation of a LV leads with multiple poles to provide more pacing configurations R3 R2 R1
19 Quadripolar LV lead
20 Primary Objective MORE-CRT Study To demonstrate that using the Quartet quadripolar left ventricular lead results in easier LV implantation procedures and less chronic lead related complications compared with existing left ventricular bipolar leads. Primary Endpoint (Assessed at 6 month post implant procedure) Survival from the composite endpoint of intra-operative and post-operative endpoints. Intra-operative LV lead related endpoint: Due to phrenic nerve stimulation, lead instability or high capture threshold: - Changing to a different tributary vein of the coronary sinus - Using more than one LV lead during the procedure for any reason - Using any device (eg. A stent) to actively fixate the lead Unsuccessful implant for any reason Post-operative: Any serious adverse effect related to the LV lead Abandoned CRT for any reason
21 Which solutions? LV lead dislodgement/ elevated PT Electrical repositioning Usually not applicable for LV lead dislodgement Uncertain Surgical revision Risk of complications Implantation of a LV leads with multiple poles to provide more pacing configurations
22 Methods of Resolving LV Lead Displacement Events (61 Events in 57 Patients) 29 Gras ESC 2011
23 Clinical advantage of a quadripoplar lead? n=22 n=23 Forleo. Heart rhythym 2011; 8: 31-7
24 Which solutions? Low battery longevity: auto-capture
25 X-Rays exposure Over the past 2 decades radiation exposure in the US has doubled Radiation Exposure Late 1990 s to Early 2000 s Fazel, et al. N Engl J Med, NCRP Report No. 160, 2009.
26 min Radiation Exposure During CRT Implantation 2.9% Great variability in dose area product across CRT procedures DAP (Gy*cm²)
27 MediGuide Technology*: EMN system Integrated with a fluoroscopic imaging system MediGuide System Sensors are tracked without continuous fluoro Tool location is rendered onto acquired X-ray images Mediguide Sensors in Heart Tools can be manipulated without additional fluoroscopy *MediGuide Technology is in development and is not approved. Its safety and effectiveness has not been determined by the FDA or any other regulatory body.
28 Conclusions CRT complications are underestimated Complications are more frequent in low volume centers The most frequent late complications are PNS and LV lead dislodgements Surgical revision of the LV lead is associated with major complications especially infections New technologies such as electrical repositioning are useful to solve the problem of PNS but not in all cases Implantation of a multipolar LV lead is promising to solve the problem of PNS, LV lead dislodgment and elevated pacing threshold New technologies to reduce X-rays exposures for patients, physicians and staff are definitively needed.
Qu attendre de la technologie pour un meilleur suivi? (traitement) D Gras, MD, Nantes, France
Qu attendre de la technologie pour un meilleur suivi? (traitement) D Gras, MD, Nantes, France New Technologies in CRT How do they impact daily clinical practice? Septal CRT Dual-Site LV CRT Quadripolar
More informationDevice based CRT optimization: is there a future? Lessons learned from published trials
Device based CRT optimization: is there a future? Lessons learned from published trials C. Leclercq Department of Cardiology Centre Cardio-Pneumologique Rennes, France Presenter Disclosure Information
More informationCRT implant using Mediguide: towards fluoroless implant?
CRT implant using Mediguide: towards fluoroless implant? Christopher Piorkowski University Dresden Heart Center - Department of Electrophysiology Presenter Disclosure Information C. Piorkowski has the
More informationThe SEPTAL CRT study (NCT: )
Comparison of right ventricular septal pacing and right ventricular apical pacing in patients receiving cardiac resynchronization therapy defibrillators The SEPTAL CRT study (NCT: 00833352) Christophe
More informationEBR Systems, Inc. 686 W. Maude Ave., Suite 102 Sunnyvale, CA USA
Over 200,000 patients worldwide are estimated to receive a CRT device each year. However, limitations prevent some patients from benefiting. CHALLENGING PROCEDURE 5% implanted patients fail to have coronary
More informationLeadless Pacing. Osama Diab Assistant Prof. of Cardiology Ain Shams University Egypt
Leadless Pacing Osama Diab Assistant Prof. of Cardiology Ain Shams University Egypt The weakest link in Pacemaker system the lead. The more the leads the more the complications Dislodgement Fracture Insulation
More informationInitial Clinical Experience With A Novel Left Ventricular Quadripolar Lead. Johannes Sperzel Kerckhoff Heart Center, Bad Nauheim, Germany
Initial Clinical Experience With A Novel Left Ventricular Quadripolar Lead Johannes Sperzel Kerckhoff Heart Center, Bad Nauheim, Germany Conflict of Interest - Disclosure Within the past 12 months, I have
More information58 Marc-Alexander Ohlow, MD 1 ; Bernward Lauer, PhD 1 ; Michele Brunelli, PhD 2, Yunis Daralammouri, MD 1 ; J Christoph Geller, PhD 2 ;
www.ipej.org 58 Original Article The Use of a Quadripolar Left Ventricular Lead Increases Successful Implantation Rates in Patients with Phrenic Nerve Stimulation and/or High Pacing Thresholds Undergoing
More informationINNOVATIONS IN DEVICE THERAPY:
INNOVATIONS IN DEVICE THERAPY: Subcutaneous ICDs, Leadless Pacemakers, CRT Indications David J Wilber MD Loyola University Medical Center Disclosures: ACC Foundation: Consultant; Biosense / Webster: Consultant,
More informationContinuous ECG telemonitoring with implantable devices: the expected clinical benefits
Continuous ECG telemonitoring with implantable devices: the expected clinical benefits C. W. Israel, M.D. Dept. of Cardiology Evangelical Hospital Bielefeld Germany Carsten.Israel@evkb.de Declaration of
More informationNew generations pacemakers and ICDs: an update
Advances in Cardiac Arrhythmias and Great Innovations in Cardiology XXVII Giornate Cardiologiche Torinesi New generations pacemakers and ICDs: an update Prof. Fiorenzo Gaita, MD Division of Cardiology
More informationCardiac resynchronization therapy for mild-to-moderate heart failure
For reprint orders, please contact reprints@expert-reviews.com Cardiac resynchronization therapy for mild-to-moderate heart failure Expert Rev. Med. Devices 8(3), 313 317 (2011) Haran Burri Electrophysiology
More informationImplantable Cardioverter Defibrillator Therapy in MADIT II Patients with Signs and Symptoms of Heart Failure
Implantable Cardioverter Defibrillator Therapy in MADIT II Patients with Signs and Symptoms of Heart Failure Wojciech Zareba Postinfarction patients with left ventricular dysfunction are at increased risk
More informationLONGITUDINAL SURVEILLANCE REGISTRY OF ACUITY SPIRAL LEAD
CLINICAL SUMMARY LONGITUDINAL SURVEILLANCE REGISTRY OF ACUITY SPIRAL LEAD CAUTION: Federal law restricts this device to sale by or on the order of a physician trained or experienced in device implant and
More informationTechnical Considerations Prior to CRT Implant: Quadripolar LV Lead, Adaptive CRT and Something Else? 2015 Update
Technical Considerations Prior to CRT Implant: Quadripolar LV Lead, Adaptive CRT and Something Else? 2015 Update ALAN CHENG, MD ASSOCIATE PROFESSOR OF MEDICINE JOHNS HOPKINS UNIVERSITY SCHOOL OF MEDICINE
More informationFollow-up of CRT patients ESC Munich Clinical and biological follow-up of CRT patients
Follow-up of CRT patients ESC Munich 12-08-26 Clinical and biological follow-up of CRT patients Frieder Braunschweig MD PhD FESC Associate Professor of Cardiology Karolinska University Hospital Stockholm,
More informationUpdate on Device Innovation (S-ICD, Wearable, Leadless)
Update on Device Innovation (S-ICD, Wearable, Leadless) C. W. Israel Dept. of Medicine - Cardiology Evangelical Hospital Bielefeld J. W. Goethe University Frankfurt Carsten.Israel@em.uni-frankfurt.de Conflicts
More informationThis is What I do to Improve CRT Response for CRT Non-Responders
This is What I do to Improve CRT Response for CRT Non-Responders Michael R Gold, MD, PhD Medical University of South Carolina Charleston, SC Disclosures: Steering Committees (unpaid) and Clinical Trials,
More informationESC Guidelines. ESC Guidelines Update For internal training purpose. European Heart Journal, doi: /eurheart/ehn309
ESC Guidelines Update 2008 ESC Guidelines Heart failure update 2008 For internal training purpose. 0 Agenda Introduction Classes of recommendations Level of evidence Treatment algorithm Changes to ESC
More informationDialysis-Dependent Cardiomyopathy Patients Demonstrate Poor Survival Despite Reverse Remodeling With Cardiac Resynchronization Therapy
Dialysis-Dependent Cardiomyopathy Patients Demonstrate Poor Survival Despite Reverse Remodeling With Cardiac Resynchronization Therapy Evan Adelstein, MD, FHRS John Gorcsan III, MD Samir Saba, MD, FHRS
More informationHis Bundle Pacing: Where is it going? Kenneth A. Ellenbogen, M.D. Kontos Professor, VCU School of Medicine November 17, 2017
His Bundle Pacing: Where is it going? Kenneth A. Ellenbogen, M.D. Kontos Professor, VCU School of Medicine November 17, 2017 Conflicts Medtronic: Research, Honoraria, Consulting Boston Scientific: Research,
More informationHF and CRT: CRT-P versus CRT-D
HF and CRT: CRT-P versus CRT-D Andrew E. Epstein, MD Professor of Medicine, Cardiovascular Division University of Pennsylvania Chief, Cardiology Section Philadelphia VA Medical Center Philadelphia, PA
More informationPrimary prevention ICD recipients: the need for defibrillator back-up after an event-free first battery service-life
Chapter 3 Primary prevention ICD recipients: the need for defibrillator back-up after an event-free first battery service-life Guido H. van Welsenes, MS, Johannes B. van Rees, MD, Joep Thijssen, MD, Serge
More informationHis Bundle Pacing in Bundle Branch Block May 11, 2017
His Bundle Pacing in Bundle Branch Block May 11, 2017 Gopi Dandamudi, MD FHRS System Medical Director, IUH Cardiac EP Program Director, IUH Atrial Fibrillation Center Assistant Professor of Clinical Medicine
More informationCAPTIVATE SUMMARY CLINICAL SUMMARY. CAPTure Information Via Automatic Threshold Evaluation
CLINICAL SUMMARY CAPTIVATE SUMMARY CAPTure Information Via Automatic Threshold Evaluation CAUTION: Federal law restricts this device to sale by or on the order of a physician trained or experienced in
More informationRemote monotoring of cardiac rhythm devices: present and future Pacemaker and ICD
Remote monotoring of cardiac rhythm devices: present and future Pacemaker and ICD Philippe Mabo University Hospital, Rennes, France ESC congress, Paris 30 August 2011 U642 Disclosures Biotronik: research
More informationDoes Changing the Pacing Configuration Affect Phrenic Stimulation? - A substudy of the DETECT PS Trial -
Does Changing the Pacing Configuration Affect Phrenic Stimulation? - A substudy of the DETECT PS Trial - Michael Glikson, MD 1, Vladmir Khalameizer, MD 2, Dominique Babuty, MD 3, Sunipa Saha 4, Holly Rockweiler
More informationESC Stockholm Arrhythmias & pacing
ESC Stockholm 2010 Take Home Messages for Practitioners Arrhythmias & pacing Prof. Panos E. Vardas Professor of Cardiology Heraklion University Hospital Crete, Greece Disclosures Small teaching fees from
More informationRiata lead extraction- a single centre experience
Riata lead extraction- a single centre experience Rebecca L Noad, Keith W Morrice, Vivek N Kodoth, Carol M Wilson, Michael JD Roberts. Royal Victoria Hospital, Belfast, United Kingdom Background of previous
More informationBSH Annual Autumn Meeting 2017
BSH Annual Autumn Meeting 2017 Presentation title: The Development of CRT Speaker: John GF Cleland Conflicts of interest: I have received research support and honoraria from Biotronik, Boston Scientific,
More informationMultisite Left Ventricular Pacing for Cardiac Resynchronization
Multisite Left Ventricular Pacing for Cardiac Resynchronization C. W. Israel, M.D. Ass. Prof. Dept. of Medicine Cardiology Evangelical Hospital Bielefeld Germany J. W. Goethe University Frankfurt C.W.Israel@em.uni-frankfurt.de
More informationTechnical option of surgical approach for trouble-shooting
JHRS Corner Device and lead trouble-shooting - standard strategy and technical option - Technical option of surgical approach for trouble-shooting Katsuhiko IMAI Department of Cardiovascular surgery, Hiroshima
More informationNOVEL DEVICE TECHNOLOGIES
NOVEL DEVICE TECHNOLOGIES Leadless Pacemakers and Subcutaneous ICDs Do the Benefits Outweigh MRI Incompatibility? Disclosures None Background PPMs and ICDs are very effective therapy for treating bradyarrhythmias
More informationBi-Ventricular pacing after the most recent studies
Seminars of the Hellenic Working Groups February 18th-20 20,, 2010, Thessaloniki, Greece Bi-Ventricular pacing after the most recent studies Maurizio Lunati MD Director EP Lab & Unit Cardiology Dpt. Niguarda
More informationDo All Patients With An ICD Indication Need A BiV Pacing Device?
Do All Patients With An ICD Indication Need A BiV Pacing Device? Muhammad A. Hammouda, MD Electrophysiology Laboratory Department of Critical Care Medicine Cairo University Etiology and Pathophysiology
More informationSupplemental Material
Supplemental Material 1 Table S1. Codes for Patient Selection Cohort Codes Primary PM CPT: 33206 or 33207 or 33208 (without 33225) ICD-9 proc: 37.81, 37.82, 37.83 Primary ICD Replacement PM Replacement
More informationCardiac Resynchronisation Therapy for all Patients Requiring Ventricular Pacing
Cardiac Resynchronisation Therapy for all Patients Requiring Ventricular Pacing Philippe Mabo University Hospital, Rennes, France ESC Congress 2010, Stockholm 29 Aug 2010 Which Patients? Candidate for
More informationNATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE Implantable cardioverter defibrillators for the treatment of arrhythmias and cardiac resynchronisation therapy for the treatment of heart failure (review
More informationENDURALIFE-powered CRT-D devices for the treatment of heart failure
NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE Medical technology guidance Assessment report overview ENDURALIFE-powered CRT-D devices for the This assessment report overview has been prepared by the
More informationComplications of Lead Extraction: Prevention and treatment. Maria Grazia Bongiorni, MD, FESC
Complications of Lead Extraction: Prevention and treatment Maria Grazia Bongiorni, MD, FESC Director of Cardiovascular Division University Hospital of Pisa (Italy) ourtesy of Dr Eivind Platou Potential
More informationBiventricular Pacemakers (Cardiac Resynchronization Therapy) for the Treatment of Heart Failure
Biventricular Pacemakers (Cardiac Resynchronization Therapy for the Treatment of Heart Failure 2.02.10 Biventricular Pacemakers (Cardiac Resynchronization Therapy for the Treatment of Heart Failure Policy
More informationArthur J. Moss, MD Professor of Medicine/Cardiology University of Rochester Medical Center Rochester, NY. DISCLOSURE INFORMATION Arthur J.
Saving Lives and Preventing Heart Failure: The MADIT Family of Trials Arthur J. Moss, MD Professor of Medicine/Cardiology University of Rochester Medical Center Rochester, NY Update in Electrocardiography
More informationTop 5 Things to Know about Pacemakers and ICD s. Jeffrey S. Osborn, M.D., C.C.D.S. March 4, 2017.
Top 5 Things to Know about Pacemakers and ICD s Jeffrey S. Osborn, M.D., C.C.D.S. March 4, 2017. Top 5 Things 1. Remote Monitoring leads to better care and outcomes. 2. MRI s CAN be done on device patients.
More informationSingle- versus Dual-Coil ICD Leads: Does it Matter?
Single- versus Dual-Coil ICD Leads: Does it Matter? C. W. Israel, M.D. Dept. of Cardiology Evangelical Hospital Bielefeld Germany Carsten.Israel@evkb.de Conflict of Interest Biotronik Boston-Scientific
More informationDevices and Other Non- Pharmacologic Therapy in CHF. Angel R. Leon, MD FACC Division of Cardiology Emory University School of Medicine
Devices and Other Non- Pharmacologic Therapy in CHF Angel R. Leon, MD FACC Division of Cardiology Emory University School of Medicine Disclosure None University of Miami vs. OSU Renegade Miami football
More informationSummary, conclusions and future perspectives
Summary, conclusions and future perspectives Summary The general introduction (Chapter 1) of this thesis describes aspects of sudden cardiac death (SCD), ventricular arrhythmias, substrates for ventricular
More informationGirish M Nair, Seeger Shen, Pablo B Nery, Calum J Redpath, David H Birnie
268 Case Report Cardiac Resynchronization Therapy in a Patient with Persistent Left Superior Vena Cava Draining into the Coronary Sinus and Absent Innominate Vein: A Case Report and Review of Literature
More informationPERFORMANCE MEASURE TECHNICAL SPECIFICATIONS. HRS-3: Implantable Cardioverter-Defibrillator (ICD) Complications Rate
PERFORMANCE MEASURE TECHNICAL SPECIFICATIONS HRS-3: Implantable Cardioverter-Defibrillator (ICD) Complications Rate Measure Title Description Measure Type Data Source Level of Analysis Numerator HRS-3:
More informationLeadless pacemakers and subcutaneous ICD s: will we use them for most of our patients? K.-H. Kuck Asklepios Klinik St. Georg Hamburg, Germany
Leadless pacemakers and subcutaneous ICD s: will we use them for most of our patients? K.-H. Kuck Asklepios Klinik St. Georg Hamburg, Germany Disclosure Statement Research Grants Consultant / Advisory
More informationBiventricular Pacemakers (Cardiac Resynchronization Therapy) for the Treatment of Heart Failure
Last Review Status/Date: June 2015 Page: 1 of 29 Resynchronization Therapy) for the Treatment Description Cardiac resynchronization therapy (CRT), which consists of synchronized pacing of the left and
More informationResponse of Right Ventricular Size to Treatment with Cardiac Resynchronization Therapy and the Risk of Ventricular Tachyarrhythmias in MADIT-CRT
Response of Right Ventricular Size to Treatment with Cardiac Resynchronization Therapy and the Risk of Ventricular Tachyarrhythmias in MADIT-CRT Heart Rhythm Society (May 11, 2012) Colin L. Doyle, BA,*
More informationCARDIAC DEVICE MR-CONDITIONAL PRODUCT SUMMARY CHART
CARDIAC DEVICE MR-CONDITIONAL PRODUCT SUMMARY CHART December 2015 This chart encompasses all Medtronic cardiac devices FDA-Approved as MR Conditional and included in the MRI SureScan portfolio. If a device
More informationImplantable cardioverter-defibrillators and cardiac resynchronization therapy
Implantable cardioverter-defibrillators and cardiac resynchronization therapy Johannes Holzmeister, MD University Hospital Zurich, Zurich, Switzerland Frontiers of heart failure controversies, ESC - Paris
More informationCardiac Devices CRT,ICD: Who is and is not a Candidate? Who Decides
Cardiac Devices CRT,ICD: Who is and is not a Candidate? Who Decides Colette Seifer MB(Hons) FRCP(UK) Associate Professor, University of Manitoba, Cardiologist, Cardiac Sciences Program, St Boniface Hospital
More informationMEDICAL POLICY Cardioverter Defibrillators
POLICY........ PG-0224 EFFECTIVE......06/01/09 LAST REVIEW... 01/27/17 MEDICAL POLICY Cardioverter Defibrillators GUIDELINES This policy does not certify benefits or authorization of benefits, which is
More informationName of Policy: Bi-Ventricular Pacemakers (Cardiac Resynchronization Therapy) for the Treatment of Heart Failure
Name of Policy: Bi-Ventricular Pacemakers (Cardiac Resynchronization Therapy) for the Treatment of Heart Failure Policy #: 055 Latest Review Date: April 2014 Category: Surgery Policy Grade: A Background/Definitions:
More informationJohn D. Fisher, MD. Montefiore Medical Center Professor of Medicine, Albert Einstein College of Medicine, NY
John D. Fisher, MD Montefiore Medical Center Professor of Medicine, Albert Einstein College of Medicine, NY Multisite pacing in CRT does it help? John D. Fisher, MD Professor of Medicine Montefiore Medical
More informationThe Role of ICD Therapy in Cardiac Resynchronization
The Role of ICD Therapy in Cardiac Resynchronization The Korean Society of Circulation 15 April 2005 Angel R. León, MD Carlyle Fraser Heart Center Division of Cardiology Emory University School of Medicine
More informationΜηνύματα από τις σπουδαιότερες μελέτες στην ηλεκτροφυσιολογία το διάστημα
Μηνύματα από τις σπουδαιότερες μελέτες στην ηλεκτροφυσιολογία το διάστημα 2015-2016 Δημήτριος M. Κωνσταντίνου Ειδικός Καρδιολόγος, MD, MSc, PhD, CCDS Πανεπιστημιακός Υπότροφος Dr. Konstantinou has received
More informationHow to Maximize CRT Response?
How to Maximize CRT Response? Chu-Pak Lau, MD Honorary Clinical Professor Department of Medicine University of Hong Kong Queen Mary Hospital Hong Kong 1 100% 1/3 of Patients Are Non-Responders of CRT 90%
More informationIs This Thing Working?
Is This *#@!* Thing Working? Pacemaker (and ICD) ECG and Telemetry Pitfalls Wayne O. Adkisson, MD adki0004@umn.edu Disclosures I currently receive research support from Medtronic, Inc. I have been compensated
More informationMADIT Studies: CRT in the Non-LBBB Patient and Other Findings. Arthur J. Moss, MD
MADIT Studies: CRT in the Non-LBBB Patient and Other Findings Arthur J. Moss, MD University of Rochester Medical Cntr. Rochester, NY 13 th Annual New Frontiers in Heart Failure Rx NYC, NY January 26, 2013
More informationBiomarkers and Arrhythmias/Devices Ulrika Birgersdotter-Green, M.D.
Biomarkers and Arrhythmias/Devices Ulrika Birgersdotter-Green, M.D. Professor of Medicine Division of Cardiology University of California, San Diego Disclosures Honoraria, Research Grants, Medtronic Honoraria,
More informationLa strategia diagnostica: il monitoraggio ecg prolungato. Michele Brignole
La strategia diagnostica: il monitoraggio ecg prolungato Michele Brignole ECG monitoring and syncope In-hospital monitoring Holter Monitoring External loop recorder Remote (at home) telemetry Implantable
More informationIBHRExam Prep Implanted CRM Device System Radiography
Implanted CRM Device System Radiography IBHRExam Prep www.pacericd.com 2 Where do they go? 3 Anatomy diagram 4 Anatomy 5 Pulse generator configurations www.pacericd.com 6 Guidant pacemaker pulse generator
More informationHow Long Patietns Will Be on Dual Antiplatelet Therapy?
How Long Patietns Will Be on Dual Antiplatelet Therapy? Ron Waksman,, MD, FACC Professor of Medicine (Cardiology) Georgetown University Associate Director, Division of Cardiology, Washington Hospital Center
More informationCRT Vs RV Pacing Benefits
CRT-P & CRT-D Indications According to Guidelines are Guidelines Fully Adopted? Salama H. Omar M.D. Prof. Critical Care Medicine, Cairo University CRT Vs RV Pacing Benefits 1 Benefit of Upgrade CTR-P &
More informationPreventing Sudden Death Current & Future Role of ICD Therapy
Preventing Sudden Death Current & Future Role of ICD Therapy Derek V Exner, MD, MPH, FRCPC, FACC, FAHA, FHRS Professor, Libin Cardiovascular Institute of Alberta Canada Research Chair, Cardiovascular Clinical
More informationUpgrade to Resynchronization Therapy. Saeed Oraii MD, Cardiologist Interventional Electrophysiologist Tehran Arrhythmia Clinic May 2016
Upgrade to Resynchronization Therapy Saeed Oraii MD, Cardiologist Interventional Electrophysiologist Tehran Arrhythmia Clinic May 2016 Event Free Survival (%) CRT Cardiac resynchronization therapy (CRT)
More informationImplantation of a biventricular implantable cardioverter-defibrillator guided by an electroanatomic mapping system
Europace (2012) 14, 107 111 doi:10.1093/europace/eur250 CLINICAL RESEARCH Pacing and Resynchronization Therapy Implantation of a biventricular implantable cardioverter-defibrillator guided by an electroanatomic
More informationManaging Atrial Fibrillation in the Heart Failure Patient
Managing Atrial Fibrillation in the Heart Failure Patient Jonathan S. Steinberg, MD Professor of Medicine (adj) University of Rochester School of Medicine & Dentistry Director, Arrhythmia Institute Valley
More informationParis, August 28 th Gian Paolo Ussia on behalf of the CoreValve Italian Registry Investigators
Paris, August 28 th 2011 Is TAVI the definitive treatment in high risk patients? Impact Of Coronary Artery Disease In Elderly Patients Undergoing TAVI: Insight The Italian CoreValve Registry Gian Paolo
More informationThe Management of Heart Failure after Biventricular Pacing
The Management of Heart Failure after Biventricular Pacing Juan M. Aranda, Jr., MD University of Florida College of Medicine, Division of Cardiovascular Medicine, Gainesville, Florida Approximately 271,000
More informationSubcutaneous Implantable Cardioverter Defibrillator (S-ICD)
Subcutaneous Implantable Cardioverter Defibrillator (S-ICD) D. D. MANOLATOS, MD, PhD, FESC Electrophysiology and Device Lab General Hospital Evangelismos, Athens The Problem: 300,000 people die each year
More informationBiventricular Pacemakers (Cardiac Resynchronization Therapy) for the Treatment of Heart Failure
Last Review Status/Date: September 2016 Page: 1 of 29 Resynchronization Therapy) for the Treatment Description Cardiac resynchronization therapy (CRT), which consists of synchronized pacing of the left
More informationMartin R Cowie Professor of Cardiology, National Heart & Lung Institute Imperial College London (Royal Brompton Hospital)
Treatment of Sleep-Disordered Breathing With Predominant Central Sleep Apnoea by Adaptive Servo Ventilation in Patients With Heart Failure and Reduced Ejection Fraction (SERVE-HF) Martin R Cowie Professor
More information(auto) à If Yes, Most Recent LVEF Date 4155 : à If Yes, Most Recent LVEF 4160 :
A. DEMOGRAPHICS Last Name 2000 : First Name 2010 : Middle Name 2020 : SSN 2030 : - - SSN N/A 2031 Patient ID 2040 : (auto) Other ID 2045 : Birth Date 2050 : Sex 2060 : O Male O Female Patient Zip Code
More informationBiventricular Pacing - Hemodynamic Benefit for Patients with Congestive Heart Failure
428 December 2000 Biventricular Pacing - Hemodynamic Benefit for Patients with Congestive Heart Failure K. MALINOWSKI Helios Clinics, Aue, Germany Summary Congestive heart failure afflicts a large and
More informationInappropriate electrical shocks: Tackling the beast
ESC Paris 2011 Inappropriate electrical shocks: Tackling the beast Gerhard Hindricks University of Leipzig Heart Center Dept. of Electrophysiology ESC Paris 2011 Inappropriate electrical shocks: Tackling
More informationSeek and Ye Shall Find: Surprising Findings When Using the ILR-LINQ
Seek and Ye Shall Find: Surprising Findings When Using the ILR-LINQ Suneet Mittal, MD, FACC, FHRS Director, Electrophysiology Laboratory Valley Health System www.arrhythmia.org; @drsuneet October 31, 2015
More informationMRI and CIEDs. Disclosures
Date Clinical Title MRI and CIEDs C. p. Lao Raul Weiss MD, FAHA, FACC, FHRS and CCDS Director, Electrophysiology Fellowship Program Professor of Medicine The Ohio State University Wexner Medical Center
More informationVentricular Arrhythmias
Presenting your most challenging cases Venice Arrhythmias Ventricular Arrhythmias Gioia Turitto, MD Presenter Disclosure Information A questionable indication for CRT-D in a patient with VT after successful
More informationResynchronization/Defibrillation
Resynchronization/Defibrillation for Ambulatory Heart Failure Trial Cardiac Resynchronization Therapy for Mild to Moderate Heart Failure George Wells University of Ottawa Heart Institute Department of
More information14ο Βορειοελλαδικό Καρδιολογικό Συνέδριο ΚΕΒΕ Βηματοδότηση: Νεότερες εξελίξεις Προοπτικές
14ο Βορειοελλαδικό Καρδιολογικό Συνέδριο ΚΕΒΕ Βηματοδότηση: Νεότερες εξελίξεις Προοπτικές Α.Γ. Κατσίβας Συντονιστής Διευθυντής, Α Καρδιολογική Κλινική, ΓΝΑ «Κοργιαλένειο-Μπενάκειο Ε.Ε.Σ» BRADY - ARRHYTHMIA
More informationSubclinical AF: Implications of device based episodes
Subclinical AF: Implications of device based episodes Michael R Gold, MD, PhD Medical University of South Carolina Charleston, SC Disclosures: Clinical Trials and Consulting: Medtronic, Boston Scientific
More informationResearch Article. Open Access. Hai-Bo ZHANG 1, Xu MENG 1, Jie HAN 1, Yan LI 1, Ye ZHANG 2, Teng-Yong JIANG 3, Ying-Xin ZHAO 3, Yu-Jie Zhou 3
Journal of Geriatric Cardiology (2017) 14: 261 265 2017 JGC All rights reserved; www.jgc301.com Research Article Open Access Transvenous versus open chest lead placement for resynchronization therapy in
More informationComparison of results with different left ventricular pacing leads
Europace (2008) 10, 35 39 doi:10.1093/europace/eum241 Comparison of results with different left ventricular pacing leads Eyal Nof*, Osnat Gurevitz, Shemy Carraso, David Bar-Lev, David Luria, Sharona Bachar,
More informationENDURALIFE-powered CRT-D devices for
NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE Medical technology consultation document ENDURALIFE-powered CRT-D devices for The National Institute for Health and Care Excellence (NICE) is producing
More informationOHTAC Recommendation: Internet- Based Device-Assisted Remote Monitoring of Cardiovascular Implantable Electronic Devices
OHTAC Recommendation: Internet- Based Device-Assisted Remote Monitoring of Cardiovascular Implantable Electronic Devices Ontario Health Technology Advisory Committee January 2012 Issue Background The Ontario
More informationCardiac resynchronisation therapy (biventricular pacing) for the treatment of heart failure
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE Health Technology Appraisal for the treatment of heart failure Final scope Appraisal objective To appraise the clinical and cost effectiveness of cardiac
More informationTeaching Rounds in Cardiac Electrophysiology
Teaching Rounds in Cardiac Electrophysiology Sustained Multiple Railroad Tracks on Implantable Cardiac Defibrillator Interval Plots Mechanisms and Management Alex Y. Tan, MD; Kenneth A. Ellenbogen, MD;
More informationGender and cardiac resynchronization therapy. Chairs: David Heaven & Belinda Green. Gender and Cardiac Resynchronisation Therapy
Electrophysiology Gender and cardiac resynchronization therapy Dean Boddington Chairs: David Heaven & Belinda Green Gender and Cardiac Resynchronisation Therapy Dean Boddington Tauranga Hospital 1 Disclosure/Warning
More informationImportance of CRT team for optimization of the results: a European point of view
Importance of CRT team for optimization of the results: a European point of view Matteo Bertini, MD, PhD Arcispedale S. Anna Azienda Ospedaliero-Universitaria Cona-Ferrara No conflict of interest to declare
More informationDanish Pacemaker and ICD Register Annual report 2015
Danish Pacemaker and ICD Register Annual report 2015 Preface The Danish Pacemaker Register was founded in 1982 by physicians from all Danish hospitals where pacemakers were implanted. When the first implantable
More informationCIEDs Infection: Lead Extraction, First or Last option?
CIEDs Infection: Lead Extraction, First or Last option? More CRM Systems & Leads 600,000 new devices annually 1.2 million new leads annually Sources: 1) Medtronic CRDM Product Performance Report, Jan 2009.
More informationCRT-D or CRT-P: HOW TO CHOOSE THE RIGHT PATIENT?
CRT-D or CRT-P: HOW TO CHOOSE THE RIGHT PATIENT? Alessandro Lipari, MD Chair and Department of Cardiology University of Study and Spedali Civili Brescia -Italy The birth of CRT in Europe, 20 years ago
More informationDECLARATION OF CONFLICT OF INTEREST. None to declare
DECLARATION OF CONFLICT OF INTEREST None to declare Influence of left and right ventricular leadtip position on clinical outcome after CRT: results from REVERSE C Thébault 1, C Meunier 1, R Gervais 1,
More informationBIVENTRICULAR PACEMAKER (CARDIAC RESYNCHRONIZATION THERAPY) FOR THE TREATMENT OF HEART FAILURE
FOR THE TREATMENT OF HEART FAILURE Non-Discrimination Statement and Multi-Language Interpreter Services information are located at the end of this document. Coverage for services, procedures, medical devices
More informationSudden death as co-morbidity in patients following vascular intervention
Sudden death as co-morbidity in patients following vascular intervention Impact of ICD therapy Seah Nisam Director, Medical Science, Guidant Corporation Advanced Angioplasty Meeting (BCIS) London, 16 Jan,
More informationMRI imaging for patients with cardiac implantable electronic devices (CIEDs)
MRI imaging for patients with cardiac implantable electronic devices (CIEDs) 13 th annual International Winter Arrhythmia School Collingwood, Ontario, Canada February 6, 2016 Andrew C.T. Ha, MD, MSc, FRCPC
More information