Transcript It may be possible to improve prognosis of HF by CRT and ICD

Role of ICD and CRT devices in
Heart failure monitoring
A l i r e z a H e i d a r i B a k avo l i , M D.
Cardiology depar tment
Qaem medical center
M a s h h a d U n i ve r s i t y o f M e d i c a l
Science
Introduction
 Heart failure is a major public health concern
 A goal of HF management is reduction of hospital
admissions rates.
 While optimal medical therapy favorably impacts the
natural history of the disease, devices such as CRT
and ICDs have added incremental value in improving
HF outcomes.
CRT/ICD as a guide for heart failure management
 It may be possible to improve prognosis of
HF by CRT and ICD , beyond their directly
therapeutic effect, by following existing or
novel diagnostic parameters (shared by many
ICD devices) to guide therapy.
 For example monitoring the Af burden, percent
of biventricular pacing may be predictors of
worsening HF.
Many parameters can be monitored by ICD/CRT
devices
 Remote patient monitoring.
 Device based monitoring of physiological
parameters:
patient activity level
 Intrathoracic impedance
 HR variabillity
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 Using these data for direct day-to-day management
of HF patients can significantly reduce
hospitalization rates.
Optivol
Transthoracic Ω
Patient activity
Average
Ventricular rate
HR variabillity
Percent of pacing
Intrathoracic impedance monitoring
 Intrathoracic Impedance
and fluid accumulation
are inversely related(less
transthoracic impedace
means more wet lungs)
 Trans thoracic
Impedance inversely
correlated with
pulmonary capillary
wedge pressure and net
fluid loss
Transtoracic impedance monitoring
Optivol basics
Thranstoracic Impedance monitoring
Clinical evidence for usfullness of
thransthoracic impedance monitoring
Clinical evidence for usfullness of
thransthoracic impedance monitoring
Predictive values of parameters obtained at device in
HF patients
Heart rate variability
 Continuous HRV can be derived from implanted devices
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and remote patient monitoring systems.
HR variability is a marker of cardiac autonomic control,
describing the balance between sympathetic and
parasympathetic activity.
Increased sympathetic and decreased parasympathetic
activity in HF is associated with worse outcomes.
HR variability can be defined as the standard deviation
of 5 min median atrial-to-atrial intervals (SDAAM).
In one study, SDAAM ,50 ms when averaged over 4
weeks was associated with a > 3-fold mortality risk
Lower HRV higher mortality
ICD memory is a mirror of heart failure condition
Possible worsening of HF
due to increased RV pacing
AVN ablation
Remote monitoring
Remote Device Monitoring Systems
 Systems commonly available in the US:
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Medtronic Carelink®
St. Jude Merlin™@Home and HouseCall Plus™
Biotronik CardioMessenger®
Boston Scientific LATITUDE® system
Remote Device Monitoring
Remote Monitoring Systems
Medtronic CareLink Network
 The patient monitor enables you to “connect” your
implanted device to your clinic via a standard phone
line.
 Available for Medtronic ICDs, CRT, pacemakers and
implantable cardiac monitors in the United States.
www.carelinknetwork.com/
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Remote Device Monitoring
Remote Monitoring Systems
St. Jude Merlin@Home
 The patient monitor enables you to “connect”
your
implanted device to your clinic via a standard
phone line.
 For use with CurrentTM RF ICD and PromoteTM
RF CRT-D devices.
St. Jude Housecall Plus
 The patient monitor enables you to “connect”
your
implanted device to your clinic via a standard
phone line.
 For use with AtlasTM and EpicTM ICDs and
Atlas HF and Epic HF CRT devices.
www.sjm.com/
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Remote Device Monitoring
Remote Monitoring Systems
Biotronik CardioMessenger
 A portable unit that receives data from the
implanted device. It is the link that connects you
to the Biotronik service center.
 Available for Biotronik ICDs, CRT and pacemakers
in the continental United States and in over 50
countries.
www.biotronik.com/en/us/
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Remote Device Monitoring
Remote Monitoring Systems
Boston Scientific LATITUDE System
 The patient monitor enables you to “connect” your
implanted device to your clinic via a standard phone
line.
 Available for Boston Scientific ICDs and CRT devices in
the United States, Puerto Rico and the Virgin Islands.
www.aboutlatitude.com
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Remote Device Monitoring
Remote monitoring
Key messages
 Diagnostic data derived from ICD/CRT
memories are useful in HF management
 Clinical evaluation and the use of multiple
diagnostics saved in Device memory are
most efficacious
 EP and HF clinicians will need to work
together to improve overall patient care
Thank you
for your attention