起搏器培训课件：美敦力四极系统简介

Advanced Quadripolar Lead:
短双极间距使PNS阈值和 PCTs之间的差距更大1
4
Attain Performa at 6 months (Models 4298, 4398, 4598 combined)
3.5 3
2.5 2
1.5 1
0.5 0
1 Biffi M, et al, Utilizing Short Spacing between Quadripolar LV lead Electrodes to Avoid PNS. Cardiostim 2014, Poster presentation, Session 56P
Advanced Quadripolar Lead: 激素电极是行业标准
• 右室激素洗脱电极的使用是行业标准，而且多年来已证实比非激素电极 更优1
1 Mond HG, et al. Pacing Clin Electrophysiol. 1988; Vol 11
Advanced Quadripolar Lead: 激素最小化起搏阈值（PCT)
Advanced Quadripolar Lead植入优势：
高效率的 VectorExpress™与AdaptivCRT®已证实的临床获益
• 新型四极导线为实现CRT治疗提供更多 可行的选择
• VectorExpress™ 替代耗时的手动测试1 • AdaptivCRT 提高患者反应率
1 Demmer W. VectorExpress Performance Results. Medtronic Data on File. January 2013. 2 Birnie D, Lemke B, Aonuma K, et al. Clinical outcomes with synchronized left ventricular pacing: Analysis of the adaptive CRT trial. Heart Rhythm. September 2013; 9 (10): 1368-1374.
Available
ห้องสมุดไป่ตู้4598 4398 4298
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
除RV之外, 我们看到激素运用在LV也同样有益:
• 激素帮助维持显著降低的长期LV起搏阈值1 • 节省30%的能量损耗，从而延长使用寿命 • 减低 PNS发生1
Pacing Capture Thresholds (PCT)
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).
VectorExpress™
AdaptivCRT®
Advanced Quadripolar Lead
• 短双极电极间距选项可有效避免 PNS1-3
• 所有电极均为类固醇激素电极 • 与美敦力鞘中鞘兼容
1 Biffi M, et al, Utilizing Short Spacing 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, Bertaglia 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
PNS present at 8V
Advanced Quadripolar Lead: 短双极电极间距减少PNS的发生1
60.0% 50.0%
Attain Performa at 6 months (Models 4298, 4398, 4598 combined)
40.0%
30.0%
20.0%
10.0%
Advanced Quadripolar Lead:
4个激素电极导致低的长期 PCTs1
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 Clinical Outcomes.
Advanced Quadripolar Lead:
4个激素电极导致低的长期 PCTs1
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 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:
所有电极均包含激素以最小化起搏阈值(PCT)
• 4个激素洗脱电极最大化可程控 的起搏向量设置
• 激素使所有起搏向量的长期 PCTs 更稳定1
注：Pacing Capture Thresholds (PCT)
1 Lunati MG, Gasparini M, Landolina M, 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).
均影响疗效1,3
1/3的患者无法从CRT治疗中完全获益.2,4-7
1 Abraham WT, et al. N Engl J Med. 2002;346:1845-
1853.
5 Abraham WT, et al. Heart Rhythm. 2005;2:S65.
2 Bristow MR, et al. N Engl J Med. 2004;350:2140-2150. 6 Chung ES, et al. Circulation. 2008;117:2608-2616.
Viva™ Quad CRT-D and Attain® Performa System
Advanced Quadripolar Lead
VectorExpress™
AdaptivCRT®
Viva™ Quad CRT-D and Attain® Performa System
Advanced Quadripolar Lead
CRT 无反应的诸多因素
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;53(9):765-7723.
左室电极位置，左室阈值以及左室阈值在保障左室夺获和膈神经刺激之间是影响 CRT疗效的很重要因素
Viva™ Quad CRT-D & Attain® Performa ―CRT无反应解决方案
LV
LV2
LV
3
4
LV1
With AdaptivCRT® & VectorExpress™
5.3 Fr, double cant shape
Advanced Quadripolar Lead: 脱位率低1
Medtronic1 St. Jude Medical
S形
1.7%
3.5%2
(6 months) (3 months)
直 成角
0.3% (6 months)
2.0% (6 months)
Shape Not
Available
Shape Not
0.0%
1 Biffi M, et al, Utilizing Short Spacing between Quadripolar LV lead Electrodes to Avoid PNS. Cardiostim 2014, Poster presentation, Session 56P
PNS threshold - PCT threshold (V)
3 Young JB, et al. JAMA. 2003;289:2685-2694.
7 van Gelder BM, et al. J Cardiovasc Electrophysiol.
4 Abraham WT, et al. Circulation. 2004;110:2864-2868. 2008;19:939-944.
• Click to edit Master text styles
– Second level
• Third level
– F美our敦th l力eve四l 极系统简介
»Fifth level
CRT 治疗过程中, 从植入到患者管理挑战无处不在
• 患者选择很复杂 • 静脉解剖的多变使得植入不可预知 • 左室阈值的变化会导致CRT治疗丧失或发生膈神经刺激 (PNS) • 其他心衰管理问题 (依从性不好，并发症的影响，患者失随访)
为不同的患者解剖提供 更多的形状选择
Advanced Quadripolar Lead:
短双极电极间距减少PNS 的发生
Attain Performa 1.3 mm的短双极电极间距导致明显更高的膈神经阈 值，从而减少膈神经刺激的发生
1 Biffi M, et al.Circ Arrhythm Electrophysiol. 2012;5:815-820.