TECHNICAL FIELD ENGINEER ICD/CRTD BASICS OBJECTIVES Discuss - - PowerPoint PPT Presentation

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TECHNICAL FIELD ENGINEER ICD/CRTD BASICS OBJECTIVES Discuss - - PowerPoint PPT Presentation

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NEIL CISPER TECHNICAL FIELD ENGINEER ICD/CRTD BASICS OBJECTIVES Discuss history of ICDs Review the indications for ICD and CRT therapy Describe basic lead and device technology Discuss different therapies for ICDs Display

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NEIL CISPER TECHNICAL FIELD ENGINEER

ICD/CRTD BASICS

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OBJECTIVES

  • Discuss history of ICDs
  • Review the indications for ICD and CRT therapy
  • Describe basic lead and device technology
  • Discuss different therapies for ICDs
  • Display different fluoroscopy views of devices
  • Go through patient’s FAQ

2 ICD/CRTD Basics | September 30, 2016

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  • Dr. Paul Zoll (1911-1999)

Zoll, NEJM 1956

First human transthoracic defibrillation

ICD HISTORY

3 ICD/CRTD Basics | September 30, 2016

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HISTORY OF ICD THERAPY

  • 1966 Device conception
  • 1969 First experimental model
  • 1976 First animal implant
  • 1980 First human implant
  • 1982 Addition of cardioverting capability
  • 1985 FDA approval

4 ICD/CRTD Basics | September 30, 2016

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SLIDE 5
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HISTORY OF ICD THERAPY

  • 1988 First programmable device approved
  • 1991 Model with tiered therapy and single-chamber back-up

pacing approved

  • 1993 First endocardial defibrillation lead approved
  • 1995 First pectoral implants
  • 1997 Addition of atrial rhythm discrimination and backup dual-

chamber pacing approved

  • 2002 Model with cardiac resynchronization for CHF approved

6 ICD/CRTD Basics | September 30, 2016

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ICD INDICATIONS

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DISEASE STATES DEFIBRILLATORS

  • Defibrillators treat _____ heart rates or ___________
  • Prevent _____________________
  • Patients who are more prone to have a cardiac arrest -

________ Prevention

  • Patients who have had prior cardiac arrest – ___________

Prevention

8 ICD/CRTD Basics | September 30, 2016

Primary Secondary Fast Tachycardia Sudden Cardiac Death

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INDICATIONS FOR ICD – CLASS 1

  • 1. Cardiac Arrest
  • Due to VT or VF
  • Not due to transient or reversible cause
  • 2. Spontaneous sustained VT
  • Structural heart disease must be present
  • 3. Syncope of undetermined origin with:
  • Sustained VT that has clinical relevance and/or hemodynamic significance
  • VF induced during EP study when drug therapy to

sustained VT is not preferred

9 ICD/CRTD Basics | September 30, 2016

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INDICATIONS FOR ICD – CLASS 1

  • 4. Non-sustained VT with:
  • Coronary disease
  • Prior MI
  • LV Dysfunction
  • Inducible VF or sustained VT
  • (Non-suppressible by antiarrhythmic drugs)
  • 5. Spontaneous sustained VT
  • Not amenable to other treatments

10 ICD/CRTD Basics | September 30, 2016

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SPONTANEOUS VENTRICULAR FIBRILLATION

11 ICD/CRTD Basics | September 30, 2016

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SPONTANEOUS VENTRICULAR TACHYCARDIA

12 ICD/CRTD Basics | September 30, 2016

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SPONTANEOUS FAST VENTRICULAR TACHYCARDIA

13 ICD/CRTD Basics | September 30, 2016

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CRT INDICATIONS

ICD/CRTD | September 30, 2016

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CRT = BIVENTRICULAR (BIVS)

  • A CRT device sends small,

undetectable electrical impulses to both lower chambers of the heart to help them beat together in a more synchronized pattern. This improves the heart's ability to pump blood and oxygen to the body.

  • Indication is for patients who

have ____________ and Ventricular ____________

Right Atrial Lead Right Ventricular Lead Left Ventricular Lead

15 ICD/CRTD Basics | September 30, 2016

Heart Failure Dysfunction

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CRT DEFINITIONS

  • What Causes Ventricular Dysynchrony?1
  • Disruption of myocardial collagen matrix impairing electrical conduction

and mechanical efficiency

  • Intraventricular conduction delays usually manifested as left bundle

branch block

  • Regional wall motion abnormalities with increased workload and stress—

compromising ventricular mechanics

  • What is Cardiac Resynchronization Therapy?
  • Cardiac resynchronization therapy works by sending electrical signals to

the right and left ventricles of the heart so they contract together (resynchronize). By improving the pumping action of the heart, there may be an improvement in heart failure symptoms.

16 ICD/CRTD Basics | September 30, 2016

  • 1. Tavazzi L. Eur Heart J 2000;21:1211-1214
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DEVICE COMPONENTS

ICD/CRTD Basics | September 30, 2016
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18 Evolution of PPMs and ICDs | April 16, 2016 |

PACEMAKERS AND ICDS

All ______________ are ___________, not all___________ are ___________ Defibrillators Defibrillators Pacemakers Pacemakers

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FUNCTIONS OF AN ICD

  • 1. _______ appropriate cardiac signals
  • 2. ________dangerous rhythms
  • 3. Provide _________ for Ventricular Tachycardia and

Ventricular Fibrillation

  • 4. ______ if necessary

19 ICD/CRTD Basics | September 30, 2016

Senses Detects Therapy Paces

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IMPLANTABLE CARDIAC DEVICES

Pacemakers Defibrillators CRT-Pacemaker CRT-Defibrillator Heart Failure Devices

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IMPLANTABLE LEADS

Pacemaker Leads Defibrillator Leads LV Leads (CRT)

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DEFIBRILLATOR LEAD SELECTION

Multiple options for each patient Active or Passive fixation Single or Dual Coil DF1/IS1 or DF4 connector

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DETECTION

Pacemaker Basics |
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DETECTION

  • What does “Detection” mean?
  • A device defined arrhythmia is present based on what is

sensed as determined by ______ and ____________ criteria.

  • Based on multiple criteria
  • ____________
  • ____________

24 ICD/CRTD Basics | September 30, 2016

Rate Duration Rate Duration

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DETECTION

RATE

25 ICD/CRTD Basics | September 30, 2016

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ICD THERAPY

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ICD THERAPIES TYPES

ICD Therapy

  • High Power (Shock Therapies)
  • _____________
  • _____________
  • Low Power (Pacing Therapies)
  • __________________________
  • ______________________

27 ICD/CRTD Basics | September 30, 2016

Cardioversion Defibrillation Anti-tachycardia Pacing (ATP) Bradyarrhythmia Pacing

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ICD THERAPIES

ANTI-TACHYCARDIA PACING (ATP)

  • Pacing pulses delivered at a rate faster than the rhythm

detected

  • Can successfully terminate re-entrant tachycardias
  • “Speed up the heart to slow it down”

28 ICD/CRTD Basics | September 30, 2016

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ICD THERAPIES ATP

Re-entry initiated

ATP delivered at a rate faster than tachyarrhythmia. Wavefronts collide. Subsequent Pulse: Wavefronts collide closer to re-entry circuit

Subsequent Pulses: Wavefronts collide even closer to re-entry circuit Arrhythmia terminated

29 ICD/CRTD Basics | September 30, 2016

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FLUOROSCOPY

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FLUOROSCOPY IMAGES

  • Pacemakers
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FLUOROSCOPY IMAGES

Pacemakers

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FLUOROSCOPY IMAGES

Defibrillators

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FLUOROSCOPY IMAGES

CRT – HF – BiV Devices

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FLUOROSCOPY IMAGES

CRT – HF – BiV Devices

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REMOTE FOLLOW-UP

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REMOTE FOLLOW-UP

CareLink Monitor Old Monitor

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REMOTE FOLLOW-UP

MyCareLink Smart MyCareLink

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REMOTE FOLLOW-UP

Patient Instructions

  • Take monitor home
  • ICD/CRTD Patients
  • Plug into the wall next to wear you sleep at night
  • Each night it will monitor your device and transmit if necessary
  • Pacemaker Patients
  • Store monitor
  • Clinic will schedule transmissions
  • On the day of the scheduled transmissions, plug in device and follow the screen

prompts

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FAQS

  • Do you have any common patient questions?
  • Longevity??