July/August 2009. Included in this newsletter is a presentation from Faith Mclean who attended the Heart Rhythm Society 2009 Boston MA USA Pacing conference held recently. Also in this issue is a profile and introduction from Krissy McFarlane who is a technologist from Rotorua Clinical physiology Department. AGM Meetings CPRB AGM meeting - Wednesday 23rd of September Time - 2:30 Cardiology Department Held : Tim Lowe conference room Level 3 Auckland Hospital Anyone who is registered may attend SCT AGM meeting Date- Friday 6th November Held - Greenlane lane room Level 5 Auckalnd Hopital Time – 9am – 1030am Please book into the above timeframe via corresponding by video conferencing

SCT Monthly Newsletter

Why become an SCT council member? From Kerry Conway SCT council chairperson

Shortly the SCT will be requesting nominations for persons who work within the technical field of cardiology to be put forward to become a member of the SCT Council. This small group of people are then the nationally elected representatives for the technical profession, and each person holds a specific and important role on the council. The council meets monthly to discuss many topics from:

New memberships Steering the future direction of the profession Methods and processes of how to increase the profile

of the profession and its overall perception. We facilitate these meetings utilising teleconferencing, so national whereabouts are not relevant for attendance to the meetings, just the commitment of your time and energies. So if you are the type of person who wants to be a key participant in the future developments, forward planning, personnel development, future direction, professional education and in developing a professional society and profession that we can all be proud of, put yourself forward. We value all opinions, and encourage differing viewpoints that facilitate well rounded decisions that work for the profession nationally. Being a council member will also allow you to give feedback to the council regarding the opinions of the members you work closely with, and for you to feedback to your colleagues on the developments that have been made on their behalf with their input.

Being a council member of SCT also enables you to claim 20CPD points towards your APC.

ENCLOSED ARE NOMINATION FORMS Nomination forms returned to SCT by Friday 18th September Voting forms sent out Monday 28th September Voting forms returned no later than: Friday 23rd October Results will be announced at AGM on the 6th November, where new council members start their duties for 2009-2010

c/o Cardiac Physiology, Level3, Auckland City Hospital, Private Bag 92024, Auckland, New

Zealand. www.sct.org.nz Telephone (09) 630-9924. Email: info@sct.org.nz

NOMINATIONS OF COUNCIL MEMBERS FOR 2010

I / We _______________________ of ______________________ (Hospital)

and _______________________ of ______________________ (Hospital)

nominate _____________________ of ______________________ (Hospital)

for election to the Council of The Society of Cardiopulmonary Technology (NZ) Inc. The above must be completed by the nominees only.

__________________________________________________________________

ACCEPTANCE OF NOMINATION

(Please complete this form if you, the nominated person, accept)

I consent to serve on the Council if I am nominated and elected.

Signed: _________________________

Date: _________________________

Detach the above and return it to the following address by September 18th:

The Society of Cardiopulmonary Technology Dept of Clinical Physiology

Level 3, Auckland City Hospital

Park Rd, Grafton, Auckland Contributions to the newsletter. We need contributions to this monthly newsletter. Contributions could be in the form of a case study (Pacing, EP, Holters Echo etc) or a profile of your hospital, news or anything that might be of interest to readers of the newsletter. Contributions to the newsletter should be emailed to Karen.harvey@cdhb.govt.nz or miriama.gideona@cmdhb.org.nz Profile hospital still needed. If your dept has not yet been profiled please don’t be shy…..

Profile of Rotorua Hospital’s Clinical Physiology Department

Who are we: Cardiologist - Dr Leigh Nairn Team Leader - Mark Reyes. Trained at the Cambridge Military

Hospital, England. (From Wigan).

Techs - Krissy McFarlane, Trained at Middlemore Hospital as a Cardiac Technologist - Tina Molony, trained at Rotorua Hospital, as a cardiac technician, currently completing DMU part II

- Jacqui Whalley, trained at Rotorua Hospital as a cardiac technician

Admin Staff - Heather Horton What Services we offer:

- ECG - Event monitors - Holter monitors - ETT - Spirometry - ABP monitoring - Echo (paed and adult service) - EEG

Also Waikato techs come for pacing clinics. About us: We are a small department made up of mostly part-time workers. Our services have been fairly limited mainly due to a lack of a cardiologist. However Leigh has been working here for over a year so we are expanding our service to include TOEs . Also currently we have one treadmill room and one ie33 echo machine with work station, but our hospital is FINALLY being upgraded with building starting this year, so in time we expect to increase this and also hope to extend our current services to include more in depth lung function testing, Holter monitor analysis, and ideally in the future pacemaker checks.

l sc

Up coming meeting.

29 – 31

Useful websites. http://www.dableducational.org/ This website brings together independent validation studies for BP measurement devices and gives recommendations –very useful for depts. Looking at purchasing equipment. Heart Web

www.heartweb.org Images in Paediatric Cardiology

www.health.gov.mt/impaedcard International Society and Federation of Cardiology

www.isfc.org Mayfield Education Centre

www.mayfield.edu.au Mayo Cardiology Continuing medical Education

www.mayo.edu/cme/cardiolgy Mayo Cardiovascular Diseases

www.mayo.edu/cv/wwwpg_cv/ cv_hmpg

Medscape www.medscape.com

National Heart, Lung and Blood Institute

www.nhlbi.nih.gov Resource for Echocardiology

www.echo-web.com Society for Cardiological Science and Technology (UK)

www.scst.org.uk American Society of Echocardiography

www.asecho.org Carries educational point earning articles and lots of sonographer information

American College of Cardiology www.acc.org

American Heart Association National Centre www.amhrt.org

Australian Sonographers Association www.a-s-a.com.au

Australian Sonographers Accreditation Registry www.asar.com.au

British Society of Echocardiography www.bsecho.org

Cardiologica www.1-3com.com/cs-east/ programs/medical/cvdbase

Digisonics www.digisonicsinc.com

Echo Links www.cardio-info.com/.com/lnkecho

E-chocardiology Journal (an Electronic Journal of Cardiac Ultrasound) www2.umdnj.edu/~shindler/echo

European Society of Cardiology www.escardio.org

Council members for 2009. Lisa Wilson/ Karen Harvey –combined secretary role. Karen Harvey/Mia Gideona –newsletter Christine Shanahan –Education coordinator (CCP) Kerry Conway –Chairperson Sonya Darlington –Correspondence coordinator and Education coordinator (CPM) Rachel Palmer - Treasurer Fiona Riddell –CPRB rep

Contacts Postal address and email contacts for SCT:

Society of Cardiopulmonary Technology NZ Ltd c/o Cardiac Physiology Level 3 Auckland City Hospital Private Bag 92024 Auckland New Zealand

To contact members of the SCT Council use the email links below.

General Enquiries: info@sct.org.nz Education Enquiries: edsec@sct.org.nz Newsletter Inclusion: miriama.gideona@middlemore.co Treasurer Enquiries: treasurer@sct.org.nz

If you wish to speak to an SCT Council member phone: +64 9 6309924

Postal address and email contact for the Registration Board:

Clinical Physiologists Registration Board c/o Cardiac Physiology Level 3 Auckland City Hospital Private Bag 92024 Auckland New Zealand

To contact a member of the Registration Board use the email link below.

Registration Enquiries: registration@sct.org.nz

If you wish to speak to a member of the registration board phone: +64 9 6309929 extension 23

Heart Rhythm Society Conference Centre 2009

Boston MA USA

As the SCT council we would like to encourage more Technologist and Technicians to attend conferences in the future, this would help you gain points towards APC. A good example is Faith Mclean, Rachel Lovatt, from Middlemore Hospital, Sheryl Tait, from Tauranga Hospital and Robin Bremner from North Shore Hospital were sponsored by NZPEG travelling fellowship to attend the Heart Rhythm Society Conference, in Boston America. The knowledge gained was presented at NZPEG conference. “WELL DONE GIRLS” you have earned at least ~ 27 points each for attending the Heart Rhythm Society conference, also gaining further point for presenting at NZPEG 2009 Christchurch.

Presenting today is Faith Mclean

AN OVER VIEWAN OVER VIEW

TOOLS AND TECHNIQUES FOR MAXIMIZING CARDIAC FUNCTION

SUDDEN CARDIAC DEATH IN ATHELETES

NEW TECHNOLOGY (Simplifying device lead and generator systems)

MRI Pacemakers

TOOLS AND TECHNIQUES FOR MAXIMIZING CARDIAC FUNCTION

SUDDEN CARDIAC DEATH IN ATHELETES

NEW TECHNOLOGY (Simplifying device lead and generator systems)

MRI Pacemakers

Tools and Techniques for Maximizing Cardiac Function

Tools and Techniques for Maximizing Cardiac Function

Ensite NavX - measures interventricular mechanical dysynchrony, during CRT implant to characterize the Interventricular Mechanical Dyssynchrony(VVMD) by using Mechanical Synchrony Index, computed from 3D electrode motion.

Ensite NavX - measures interventricular mechanical dysynchrony, during CRT implant to characterize the Interventricular Mechanical Dyssynchrony(VVMD) by using Mechanical Synchrony Index, computed from 3D electrode motion.

TRACKS 3D MOTION OF STANDARD LEAD ELECTRODES

TRACKS 3D MOTION OF STANDARD LEAD ELECTRODES

EnSite Mechanical Synchrony IndexRepresents the similarity (cross-covariance)

of RARV and RALV waveforms

EMSI Increases

Better synchrony

EnSite Mechanical Synchrony IndexRepresents the similarity (cross-covariance)

of RARV and RALV waveforms

EMSI Increases

Better synchrony

RA

LV

RV

RA

LV

RV

Synchrony index: + 0.978

Synchrony index: - 0.857

FIX HF-5 Trial: Multicenter Experience with

Implantation of a Heart Failure Device

FIX HF-5 Trial: Multicenter Experience with

Implantation of a Heart Failure Device

Device that is an equivalent to a biventricular assist device.

It is rechargeable

Device that is an equivalent to a biventricular assist device.

It is rechargeable

OPTIMIZER III IPGOPTIMIZER III IPG

Applies an electric signal during absolute

refractory.7v signal over 21msec 30msec after onset

of QRS.

Applies an electric signal during absolute refractory.

7v signal over 21msec 30msec after onset

of QRS.OP3 CCM Signal PulseOP3 CCM Signal Pulse

Sudden Cardiac Death Prevention and Device Treatment

in Athletes

Sudden Cardiac Death Prevention and Device Treatment

in Athletes

Should there be ICD’s available at sports venues.

What triggers arrhythmias?

Does exercise help stop SCD or cause it?

Where you live in the world matters.

Should we screen athletes.

What sports should be allowed.

Should there be ICD’s available at sports venues.

What triggers arrhythmias?

Does exercise help stop SCD or cause it?

Where you live in the world matters.

Should we screen athletes.

What sports should be allowed.

Current recommendationsCurrent recommendationsSports allowed with implanted device

pacemakers: all sports with low to moderate cardiovascular demand

defibrillators: competitive sports with low dynamic or static cardiovascular demand - golf, billiards, bowling, ... ･

leisure-time sports with low to moderate cardiovascular demand

Sports allowed with implanted devicepacemakers: all sports with low to moderate cardiovascular demand

defibrillators: competitive sports with low dynamic or static cardiovascular demand - golf, billiards, bowling, ... ･

leisure-time sports with low to moderate cardiovascular demand

･No sports with bodily impact lead fracture,

device malfunction, skin perforation

･No sports with bodily impact lead fracture,

device malfunction, skin perforationAvoid extreme arm movements first 6

weeks after implant:

Preventing danger to loss of consciousness. For patients and others

swimming, diving, motorsports, climbing.

Avoid extreme arm movements first 6 weeks after implant:

Preventing danger to loss of consciousness. For patients and others

swimming, diving, motorsports, climbing.

What the experts say Class IA sports: billiards, bowling, cricket, curling, golf and

riflery

What the experts say Class IA sports: billiards, bowling, cricket, curling, golf and

riflery

What does the clinical community think - Only 10% counselled ICD patients to avoid all activities more strenuous than golf.Most

(71%) base recommendations on patients underlying heart disease. Most (76%) recommended against contact sports

What does the clinical community think - Only 10% counselled ICD patients to avoid all activities more strenuous than golf.Most

(71%) base recommendations on patients underlying heart disease. Most (76%) recommended against contact sports

Registry on ICD in Sports in Europe and USA

Registry on ICD in Sports in Europe and USA

Determine the incidence of minor adverse events during sports multiple shocks, minor injuries, damage to lead/system

Determine whether risk is greater during sports than at other times

Determine whether risk is greater in specific populations ･competitive vs. recreational ･underlying cardiovascular disorder

Determine the incidence of minor adverse events during sports multiple shocks, minor injuries, damage to lead/system

Determine whether risk is greater during sports than at other times

Determine whether risk is greater in specific populations ･competitive vs. recreational ･underlying cardiovascular disorder

New technologyNew technology

SubucutaneousDefibrillation.

SubucutaneousDefibrillation.

S-ICDS-ICD

Totally subcutaneous system no electrodes in the heart.

System is placed by anatomical landmarks.

80 joules delivered

Active can

Totally subcutaneous system no electrodes in the heart.

System is placed by anatomical landmarks.

80 joules delivered

Active can

LEADLESS PACINGLEADLESS PACING

Selective site pacing.

Pediatric pacing.

Reduce long term risk : infection, lead failure and mechanical interference.

Selective site pacing.

Pediatric pacing.

Reduce long term risk : infection, lead failure and mechanical interference.

Energy SourcesEnergy Sources

Direct electrical current

Transmitted EM energy

Ultrasound energy

Direct electrical current

Transmitted EM energy

Ultrasound energy

Ultrasound pacingElectrical pacing

Ultrasound Array

Subcutaneous Sensing Electrodes

Transmitter

Cathode

3.5mm

10mm

2.6mm

Anode

Implanted electrode Acute

Electrode after 3 months

Future ChallengesFuture Challenges

Efficiency of energy conversion

Optimization of US beams

Sensing

Delivery and anchoring system

Long term stability

Anticoagulation

Efficiency of energy conversion

Optimization of US beams

Sensing

Delivery and anchoring system

Long term stability

Anticoagulation

MRI PacemakersMRI Pacemakers

SureScan MRI is the first MR-labelledpacemaker that expands therapeutic and diagnostic options for pacemaker patients because it combines proven MRI capabilities with the best in pacing therapy, automaticity and diagnostics

SureScan MRI is the first MR-labelledpacemaker that expands therapeutic and diagnostic options for pacemaker patients because it combines proven MRI capabilities with the best in pacing therapy, automaticity and diagnostics

MRI: Clinical NeedMRI: Clinical Need

The likelihood of MRI indication doubles >65 years

In a 12 months follow-up period 17 % of pacemaker patients required diagnostic MRI

It is estimated that up to 75% of pacemaker patients will need an MRI during the life of the device

The likelihood of MRI indication doubles >65 years

In a 12 months follow-up period 17 % of pacemaker patients required diagnostic MRI

It is estimated that up to 75% of pacemaker patients will need an MRI during the life of the device

Risks associated with scanning pacemakers that are not designed for use within the MRI

environment

Risks associated with scanning pacemakers that are not designed for use within the MRI

environment

During an MRI strong static, gradient and radiofrequency field are generated which can result in; Torque and device dislodgement High pacing rates beyond the pacemaker rate limit leading to

Cardiac arrhythmias Elevated thresholds and/or loss of capture Oversensing / Undersensing leading to inappropriate or failure to

pace Pacemaker component malfunction and or damage Interference with pacemaker function Electrical reset Lead tip heating, resulting in tissue damage

During an MRI strong static, gradient and radiofrequency field are generated which can result in; Torque and device dislodgement High pacing rates beyond the pacemaker rate limit leading to

Cardiac arrhythmias Elevated thresholds and/or loss of capture Oversensing / Undersensing leading to inappropriate or failure to

pace Pacemaker component malfunction and or damage Interference with pacemaker function Electrical reset Lead tip heating, resulting in tissue damage

MR-Conditional Cardiology Perspective

MR-Conditional Cardiology Perspective

EnRhythm MRI™ pacemaker and Model 5086 CapSureFix MRI™ leads are implanted

Implant > six weeks R/L pectoral implant Pacing Thresholds < 2.0 V @ 0.4 ms Lead Impedance 200-1,500 ohms No other leads, devices, adaptors, etc. in

place

EnRhythm MRI™ pacemaker and Model 5086 CapSureFix MRI™ leads are implanted

Implant > six weeks R/L pectoral implant Pacing Thresholds < 2.0 V @ 0.4 ms Lead Impedance 200-1,500 ohms No other leads, devices, adaptors, etc. in

place

Programming SureScanProgramming SureScan

Programming SureScan “on” will disable the diagnostics.

Use check list on programmer.

Do not leave the programmer in the room.

Programming SureScan “on” will disable the diagnostics.

Use check list on programmer.

Do not leave the programmer in the room.

Any QuestionsAny Questions

Santa and our SCT seretary, Pauline, at the Auckland Physiology Xmas Party.