起搏器培訓(xùn)課件：新型左室四極電極

1、Attain Performa System 4298，4398，4598 Advanced Quadripolar Lead 新型左室四極電極新型左室四極電極 There Are Many Drivers for CRT Non-Response Mullens W, Grimm RA, Verga T, et al. Insights from a cardiac resynchronization optimization clinic as part of a heart failure disease management program. JACC. March 3, 2009;5

2、3(9):765-7723. Lead position, LV capture threshold and margin between LV Capture and Phrenic Nerve Stimulation are critical factors for successful CRT delivery. 缺血 Advanced Quadripolar Lead 新型四極電極 雙彎設(shè)計(jì)直線尖叉設(shè)計(jì)S型設(shè)計(jì) 459842984398 Advanced Quadripolar Lead 新型四極電極 1 Biffi M, et al, Utilizing Short Spacing

3、between Quadripolar LV lead Electrodes to Avoid PNS. Cardiostim 2014, Poster presentation, Session 56P 2 Biffi M, et al. Effect of Bipolar Electrode Spacing on Phrenic Nerve Stimulation and Left Ventricular Pacing Thresholds, Circ Arrhythm Electrophysiol. 2012;5:815-820 3 Biffi M1, Zanon F, Bertagli

4、a E, et al., Short-spaced dipole for managing phrenic nerve stimulation in patients with CRT: the phrenic nerve mapping and stimulation EP catheter study Heart Rhythm. 2013 Jan;10(1):39-45 Short Bipolar Electrode Spacing option to avoid PNS1-3 （ Phrenic Nerve Stimulation） 短極性間距選擇避免膈神經(jīng)刺激 Steroid on a

5、ll electrodes 所有電極都是類固醇 Compatible with Medtronic sub- selection catheters 與美敦力與美敦力亞亞鞘管兼容鞘管兼容 More shape options for varying patient anatomies 更多選擇適合不同血管 的解剖結(jié)構(gòu) 459842984398 Advanced Quadripolar Lead: Short Bipolar Electrode Spacing Reduces PNS Occurrence 四極四極電電極：短極：短間間距起搏減少距起搏減少PNS發(fā)發(fā)生率生率 Attain Perf

6、ormas short bipolar electrode spacing of 1.3 mm results in significantly higher phrenic nerve thresholds and lower phrenic nerve stimulation occurrence1 Attain Performas 1.3mm短間距起搏閾值明顯高于膈肌閾值，所以PNS 發(fā)生率比較低 1 Biffi M, et al.Circ Arrhythm Electrophysiol. 2012;5:815-820. PCTs：Pacing Capture Threshold 0.0

7、% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% LV1-RV coil LV1-LV2 LV1-LV3 LV1-LV4 LV2-RV coil LV2-LV1 LV2-LV3 LV2-LV4 LV3-RV coil LV3-LV1 LV3-LV2 LV3-LV4 LV4-RV coil LV4-LV1 LV4-LV2 LV4-LV3 PNS present at 8V Advanced Quadripolar Lead: Short Bipolar Electrode Spacing Reduces PNS Occurrence1 四極四極電電極：極：短起搏極性減少

8、短起搏極性減少PNS發(fā)發(fā)生率生率 1 Biffi M, et al, Utilizing Short Spacing between Quadripolar LV lead Electrodes to Avoid PNS. Cardiostim 2014, Poster presentation, Session 56P Attain Performa at 6 months (Models 4298, 4398, 4598 combined) PNS 8V 0 0.5 1 1.5 2 2.5 3 3.5 4 LV1-RVcoil LV1-LV2 LV1-LV3 LV1-LV4 LV2-RVc

9、oil LV2-LV1 LV2-LV3 LV2-LV4 LV3-RVcoil LV3-LV1 LV3-LV2 LV3-LV4 LV4-RVcoil LV4-LV1 LV4-LV2 LV4-LV3 PNS threshold - PCT threshold (V) 1 Biffi M, et al, Utilizing Short Spacing between Quadripolar LV lead Electrodes to Avoid PNS. Cardiostim 2014, Poster presentation, Session 56P Advanced Quadripolar Le

10、ad: Short Bipolar Spacing Provides Greater Margin Between PNS Thresholds and PCTs：新四極新四極電電極：短極：短間間距起搏增大距起搏增大PNS閾值閾值和和PCTs之之間間幅幅 度度 Attain Performa at 6 months (Models 4298, 4398, 4598 combined) Advanced Quadripolar Lead: Steroid on All Electrodes to Minimize Pacing Capture Thresholds (PCT) Steroid e

11、lution on all four electrodes maximizes viable programmable pacing options 4個(gè)起搏點(diǎn)的類固醇洗脫電極， 最大可行的編程選項(xiàng) Steroid stabilizes PCTs chronically for all pacing vectors1 所有的類固醇穩(wěn)定長期起搏向 量PCTS 1 Lunati MG, Gasparini M, Landolina M, et al. Long-Term Effect of Steroid Elution on the Electrical Performance of Coron

12、ary Sinus Leads for Cardiac Resynchronization Therapy. Presented at HRS 2012 (AB10-05). Advanced Quadripolar Lead: Steroid On Pacing Leads Is the Standard of Care 類固醇給予起搏電極標(biāo)準(zhǔn)的呵護(hù) 1 Mond HG, et al. Pacing Clin Electrophysiol. 1988; Vol 11 Steroid eluting pacing leads placed in the right ventricle are

13、the standard of care and have been for many years with proven benefits over non-steroid leads1 In addition to RV, we see its also helpful in the LV: Steroid helps to maintain significantly lower LV pacing capture thresholds chronically 類固醇激素有助于保持顯著低于LV起搏閾值長期穩(wěn)定 30% saving of chronic energy consumptio

14、n = improved battery longevity and lower chance of PNS1 節(jié)約慢性期30%的電量消耗，改善電池壽命，低的PNS發(fā)生率 1 Lunati MG, et al. Long-Term Effect of Steroid Elution on the Electrical Performance of Coronary Sinus Leads for Cardiac Resynchronization Therapy. Presented at HRS 2012 (AB10-05). Advanced Quadripolar Lead: Stero

15、id Minimizes Pacing Capture Thresholds (PCT) 類固醇極性帶來更小的起搏閾值 Advanced Quadripolar Lead: Steroid on All Four Electrodes Results in Low Chronic PCTs1 類類固醇洗脫極性固醇洗脫極性間間起搏：慢性期更低的起搏起搏：慢性期更低的起搏奪獲閾值奪獲閾值 1 Crossley GH, Biffi M, Johnson WB, et al. A Novel Quadripolar Lead with Narrow-Spaced Bipole Allows for E

16、ffective LV Pacing While Avoiding Phrenic Nerve Stimulation Attain Performa LV Lead Study Primary Results. AHA November 2014 Poster Session APS.506.01 Heart Failure Issues in Clinical Outcomes. PCTs：Pacing Capture Threshold Advanced Quadripolar Lead: Steroid on All Four Electrodes Results in Low Chr

17、onic PCTs1,2 1 Crossley GH, Biffi M, Johnson WB, et al. A Novel Quadripolar Lead with Narrow-Spaced Bipole Allows for Effective LV Pacing While Avoiding Phrenic Nerve Stimulation Attain Performa LV Lead Study Primary Results. AHA November 2014 Poster Session APS.506.01 Heart Failure Issues in Clinic

18、al Outcomes. 2 Tomassoni Gery, Baker , James, et. al., Postoperative Performance of the Quartet Left Ventricular Heart Lead, J Cardiovasc Electrophysiol, Vol. 24, pp. 449-456, April 2013 類固醇洗脫極性：慢性期更低的起搏閾值類固醇洗脫極性：慢性期更低的起搏閾值 Advanced Quadripolar Lead: More shape options for varying patient anatomies

19、對不同病人的解剖形狀的選擇更多 Three lead shapes to address implant and stability challenges 三種電極的形狀來應(yīng)對植入和穩(wěn)定性的挑戰(zhàn) Acute TakeoffLarger Diameter Vessel 急性期挑戰(zhàn)大血管 Advanced Quadripolar Lead: Low dislodgement rates1 低的脫位率 Medtronic1St. Jude Medical S Shape1.7% (6 months) 3.5%2 (3 months) Straight0.3% (6 months) Shape Not

20、 Available Canted2.0% (6 months) Shape Not Available 1 Crossley GH, Biffi M, Johnson WB, et al. A Novel Quadripolar Lead with Narrow-Spaced Bipole Allows for Effective LV Pacing While Avoiding Phrenic Nerve Stimulation Attain Performa LV Lead Study Primary Results. AHA November 2014 Poster Session A

21、PS.506.01 Heart Failure Issues in Clinical Outcomes. 2 Tomassoni Gery, Baker , James, et. al., Postoperative Performance of the Quartet Left Ventricular Heart Lead, J Cardiovasc Electrophysiol, Vol. 24, pp. 449-456, April 2013 Advanced Quadripolar Lead: Offset Performa S provides greater stability1-

22、3 ： The Offset Performa S 提高穩(wěn)定性 The Offset Performa S design increases the force required to dislodge the lead while enhancing trackability1 The Offset Performa S設(shè)計(jì)增強(qiáng)推送性的同時(shí)增加穩(wěn)定性 “S” centered around lead body axis“S” offset from lead body axis 1 Dahlberg L. Stability & Trackability Test for MDT Attai

23、n Performa 4598 & SJM Quartet 1458Q . Medtronic Data on file. November 2014. 1 Crossley GH, Biffi M, Johnson WB, et al. A Novel Quadripolar Lead with Narrow-Spaced Bipole Allows for Effective LV Pacing While Avoiding Phrenic Nerve Stimulation Attain Performa LV Lead Study Primary Results. AHA Novemb

24、er 2014 Poster Session APS.506.01 Heart Failure Issues in Clinical Outcomes. 2 Tomassoni Gery, Baker , James, et. al., Postoperative Performance of the Quartet Left Ventricular Heart Lead, J Cardiovasc Electrophysiol, Vol. 24, pp. 449-456, April 2013 新型四極電極新型四極電極 Advanced Quadripolar Lead: Offset Pe

25、rforma S Implant Considerations (4598) 新四極電極：植入（4598） Gradual/moderate vessel curvature 大彎/中迂曲血管 Medium/large vessel diameter 中等/粗的血管 Advanced Quadripolar Lead: Performa Straight Implant Considerations (4398) 新四極電極：植入（4398） Acute vessel curvature 迂曲血管 Small vessel diameter 細(xì)分支血管 Advanced Quadripolar

26、 Lead: Performa Canted Implant considerations (4298) 新四極電極：植入（4298） Moderate vessel curvature 中等彎曲血管 Medium vessel diameter 中等粗細(xì)血管 Advanced Quadripolar Lead: Compatible with Medtronic sub-selection catheters for varying anatomies 新四極新四極電電極：在不同解剖血管中兼容美敦力極：在不同解剖血管中兼容美敦力亞亞鞘管鞘管 電極全貌電極全貌 起搏向量起搏向量 The 4 a

27、vailable pacing polarities include RV defibrillation lead. The polarity of each of the 6 electrode pairs can be reversed to yield a total of 12 bipolar pacing polarities: 6組，12個(gè) 延伸雙極起搏極性 雙極（反轉(zhuǎn)）起搏極性 AccuRead 2.0 極性裸出來 兼容性 兼容亞鞘管 電極長度 極性間距 極性 頭端面積 近端面積 電極頭端直徑 近端直徑 單向閥 頭端形狀 固定方式 鋼絲遞送 鞘管遞送 被動(dòng)被動(dòng) 美敦美敦力力Att

28、ain家族家族 ：左室電極系列：左室電極系列 左室電極全家福 給患者左室更多選者 感感謝謝您的聆聽您的聆聽 1.Short Bipolar Electrode Spacing option to avoid PNS1-3 短雙極電間距選擇避免PNS 2.Steroid on all electrodes, and 類固醇電極 3.Compatible with all Medtronic left heart lead delivery tools 兼容所有的美敦力左心電極遞送工具 4.更多起搏雙極極性 優(yōu)勢要優(yōu)勢要 點(diǎn)點(diǎn) Brief Statements Viva Quad XT CRT-D

29、 Brief Statement Brief Statement: Viva Quad XT CRT-D Model DTBA1QQ, Viva Quad XT CRT-D Model DTBA1Q1 Indications: The Viva Quad XT CRT-D system is indicated for ventricular antitachycardia pacing and ventricular defibrillation for automated treatment of life- threatening ventricular arrhythmias, for

30、 use in patients with atrial tachyarrhythmias, or those patients who are at significant risk for developing atrial tachyarrhythmias and for providing cardiac resynchronization therapy in heart failure patients on stable, optimal heart failure medical therapy if indicated, and meet any of the followi

31、ng classifications: New York Heart Association (NYHA) Functional Class III or IV and who have a left ventricular ejection fraction 130 ms, left ventricular ejection fraction 30%, and NYHA Functional Class II. NYHA Functional Class I, II, or III and who have left ventricular ejection fraction 50% and

32、 atrioventricular block (AV block) that are expected to require a high percentage of ventricular pacing that cannot be managed with algorithms to minimize right ventricular pacing. Optimization of heart failure medical therapy that is limited due to AV block or the urgent need for pacing should be d

33、one post implant. Lead Integrity Alert The RV Lead Integrity Alert feature is intended primarily for patients who have a Medtronic ICD or CRT-D device and a Sprint Fidelis lead (Models 6949, 6948, 6931, and 6930, based on performance data. The RV LIA feature may not perform as well with a St. Jude R

34、iata/Durata lead or a Boston Scientific Endotak lead as it does when used with a Medtronic Sprint Fidelis lead. This is because different lead designs may have different failure signatures and conditions that may or may not be detected early by the RV LIA feature. Contraindications: The Viva XT CRT-

35、D system is contraindicated for patients experiencing tachyarrhythmias with transient or reversible causes including, but not limited to, the following: acute myocardial infarction, drug intoxication, drowning, electric shock, electrolyte imbalance, hypoxia, or sepsis. The device is contraindicated

36、for patients who have a unipolar pacemaker implanted. The device is contraindicated for patients with incessant VT or VF. The device is contraindicated for patients whose primary disorder is chronic atrial tachyarrhythmia with no concomitant VT or VF. Warnings and Precautions: Changes in a patients disease and/or medi