JACC, Volume 58, Issue 10, 2011, 1001 1006 Trends in the Infection Burden for Pacemakers and...
Transcript of JACC, Volume 58, Issue 10, 2011, 1001 1006 Trends in the Infection Burden for Pacemakers and...
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16-Year Trends in the In fection Burden fo r Pacemakers and Implan tab le Cardioverter-Defib rilla to rs in the United Sta tes :1993 to 2008
JACC, Volume 58, Issue 10, 2011, 1001–1006
Annual Number of ICD Implants : USA
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Me ta -An a lys is
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16-Year Trends in the In fection Burden for Pacemakers and Implan table Cardioverter-Defib rilla tors in the United States :1993 to 2008
JACC, Volume 58, Issue 10, 2011, 1001–1006
CIED Infec tion Rates Have Increas ed
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16-Year Trends in the In fection Burden for Pacemakers and Implan table Cardioverter-Defib rilla tors in the United States :1993 to 2008
JACC, Volume 58, Issue 10, 2011, 1001–1006
Comorbid itie s Keep Company with ICD Implants
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Clin ica l Outcomes of Diffe rent Lead Extrac tionMethods
Maurits S . Buiten e t a l. Europace 2015;17:689-700
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MADIT RITCumula tive Probab ility of Firs t Inappropria te
Therapy by Trea tment Group
Mos s , A. NEJ M, 2012
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Surface
In tra -card iac
S-ECG
The S u b c u ta n e ou s S ig n a l
The S -ICD S ys te m ca pture s high-re s olution,
morphologica lly rich s igna ls s im ila r to a s urfa ce ECG
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P re -Op e ra tive S c re e n in g To o l
Pre-implant screening ensures thepa tient is a good candida te for S-ICDSys tem implant and therapy.
• Collect the surface ECG at theintended loca tion of the implantedpulse genera tor and subcutaneouse lectrodes .
• Ensure the entire QRS complex and Twave fit within the recommendedprofile for proper rhythm discriminationby the S-ICD Sys tem.
• Verify a t leas t one lead sens ing vectoris acceptable for a t leas t two pos tures(supine , s tanding, optiona l exercise )
Bos ton Scientific
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SCD Cas e Study: ECG Screening
Secondary vec tor
Supine Standing
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SCD Cas e Study: Pres enting ECG
VT at ra te of 110 bpm
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SCD Cas e Study: Device EGM
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20%
11%
s hocks mos tly due to card iac overs ens ing
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8.3% of pa tien ts had inappropria tes hocks mos tly due to ca rd iac
overs ens ingL.R.A. Olde Nordkamp et al. / International J ournal of Cardiology 195 (2015) 126–133
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Lewis , GF. J ACC 2016
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d MR. Circ AE245
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L.R.A. Olde Nordkamp et al. / International Journal of Cardiology 195 (2015) 126–133
AF with T waveovers ens ing
Lowamplitude
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Courtes y of Bos ton Scientific
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Th re e fa r-fie ld s e n s in g ve c to rs
• P rima ry, S e conda ry, Alte rna te
• Automa tic or ma nua l ve ctor s e le ction
• Morphologica lly rich s igna l s imila r to a
s urfa ce ECG
• S e ns e e le ctrode s pos itione d a wa y
from la rge mus cle groups
• Ma ximum fle xibility to s olve s e ns ing
is s ue s non inva s ive ly
• Sense vector reprogramming
S ophis tica te d Rhythm De te ction Te chnology
AL
TE
RN
AT
E
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STATICMORPHOLOGY
Comparemorphology & width to NSRTemplate
DYNAMICMORPHOLOGY
Comparebeat-to-beat morphology
QRSWIDTH
CompareQRSWidth with NSRTemplate
SHOCKZONE
Heart rate within Shock Zone?
INSIGHT™DISCRIMINATION
Heart rate within Conditional Shock Zone?
NO
YES
POORMATCH
MONOMORPHIC
T (Tachy)
S (Sensed)
S (Sensed)
T (Tachy)
T (Tachy)
S (Sensed)
WIDEQRS
NARROW QRS
POLYMORPHIC
GOOD MATCH
NO
YES
INS IGHT™ Rh ythm Dis c rim in a tio n
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STARTResults
Sensit ivity Performance
– Single Zone: 100%for all tested devices
– Dual Zone: 99.3%(SC-TV), 100%(DC-TV), 100%(S-ICD)
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STARTResults
Specificity Performance
– Dual Zone: 68.0%(SC-TV), 67.4%(DC-TV), 98.0%(S-ICD)
* Sustained rate timers(i.e. SRD) programmed OFFif nominally active (BSX= 3 min, SJM = 30 secs)
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Cons is ten t evidence demons tra ting tha t ICDs hocks lead to anxie ty and depres s ion ,
decreas ing overa ll qua lity of life .
Shron EB, Exner DV, Yao , e t a l. Circula tion . 2002 5;105(5):589-94.J . Irvine , P. Dorian , B. Baker, e t a l. Am Heart J o urna l, 144(2), 282-289.Pas s man R, Subac ius H, Ruo B, e t a l. Arch Inte rn Med . 2007;167(20):2226-32.
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P a tie nts Who S urvive d a t Le a s t 24 Hours a fte r a Firs t ICD S hock