jacc, volume 58, issue 10, 2011, 1001 1006 trends in the infection burden for pacemakers and...

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

Me ta -An a lys is

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

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

Clin ica l Outcomes of Diffe rent Lead Extrac tionMethods

Maurits S . Buiten e t a l. Europace 2015;17:689-700

MADIT RITCumula tive Probab ility of Firs t Inappropria te

Therapy by Trea tment Group

Mos s , A. NEJ M, 2012

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

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

SCD Cas e Study: ECG Screening

Secondary vec tor

Supine Standing

SCD Cas e Study: Pres enting ECG

VT at ra te of 110 bpm

SCD Cas e Study: Device EGM

20%

11%

s hocks mos tly due to card iac overs ens ing

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

Lewis , GF. J ACC 2016

d MR. Circ AE245

L.R.A. Olde Nordkamp et al. / International Journal of Cardiology 195 (2015) 126–133

AF with T waveovers ens ing

Lowamplitude

Courtes y of Bos ton Scientific

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

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

STARTResults

Sensit ivity Performance

– Single Zone: 100%for all tested devices

– Dual Zone: 99.3%(SC-TV), 100%(DC-TV), 100%(S-ICD)

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)

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.

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