il sistema home monitoring nella gestione dei pazienti con resincronizzazione cardiaca. dr andrea...
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Il sistema Home Il sistema Home Monitoring nella Monitoring nella gestione dei pazienti gestione dei pazienti con resincronizzazione con resincronizzazione cardiaca.cardiaca.
DR Andrea ColellaDR Andrea [email protected]@virgilio.it
EP. Laboratory EP. Laboratory Prof. L. Padeletti.Prof. L. Padeletti.
Dept. Heart and Vessels Dept. Heart and Vessels University of FlorenceUniversity of Florence
Prof. G.F. Gensini.Prof. G.F. Gensini.
DR Andrea ColellaDR Andrea [email protected]@virgilio.it
EP. Laboratory EP. Laboratory Prof. L. Padeletti.Prof. L. Padeletti.
Dept. Heart and Vessels Dept. Heart and Vessels University of FlorenceUniversity of Florence
Prof. G.F. Gensini.Prof. G.F. Gensini.
[email protected]@virgilio.itEP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.EP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.
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TELEMEDICNATELEMEDICNAMonitoraggio ECGMonitoraggio ECG
[email protected]@virgilio.itEP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.EP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.
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Randomized Controlled Trials on CRTRandomized Controlled Trials on CRTRandomized Controlled Trials on CRTRandomized Controlled Trials on CRT
Study (n randomized) NYHA QRS Sinus ICD? Status Results
MIRACLE (453) III, IV 130 Normal No Published +
MUSTIC SR (58) III 150 Normal No Published +
MUSTIC AF (43) III 200* AF No Published +
PATH CHF (41) III, IV 120 Normal No Published +
MIRACLE ICD (369) III, IV 130 Normal Yes Published +
CONTAK CD (490) II-IV 120 Normal Yes Published + ¶
COMPANION (1520) III, IV 120 Normal Yes Published +
PATH CHF II (89) III, IV 120 Normal Both Published +
MIRACLE ICD II (186) II 130 Normal Yes Published + ¶
CARE HF (814) III, IV 120 Normal No Published +
* RV paced QRS * RV paced QRS ¶¶ Primary endpoint not met; key secondary endpoints reachedPrimary endpoint not met; key secondary endpoints reached
LVEF LVEF 35% for all trials 35% for all trials
CRT improves:CRT improves:
NYHA ClassQuality of life score
Exercise Capacity: 6 MW, Peak VO2
LV function: EF, MRReverse remodeling: LVEDV
Hospitalization
EP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.EP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.
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Indication for Cardiac Resynchronization Indication for Cardiac Resynchronization TherapyTherapyIndication for Cardiac Resynchronization Indication for Cardiac Resynchronization TherapyTherapy
Resynchronization therapy using bi-ventricular pacing can be Resynchronization therapy using bi-ventricular pacing can be considered in pts with:considered in pts with:
Reduced ejection fraction and ventricular dyssynchrony (QRS Reduced ejection fraction and ventricular dyssynchrony (QRS width > 120 ms), who remain symptomatic (NYHA III–IV) despite width > 120 ms), who remain symptomatic (NYHA III–IV) despite optimal medical therapy to improve:optimal medical therapy to improve:
• SymptomsSymptoms (Class of recommendation I, level of evidence A);(Class of recommendation I, level of evidence A);
• HospitalizationsHospitalizations (Class of recommendation I, level of evidence A);(Class of recommendation I, level of evidence A);
• MortalityMortality (Class of recommendation I, level of evidence B).(Class of recommendation I, level of evidence B).
Resynchronization therapy using bi-ventricular pacing can be Resynchronization therapy using bi-ventricular pacing can be considered in pts with:considered in pts with:
Reduced ejection fraction and ventricular dyssynchrony (QRS Reduced ejection fraction and ventricular dyssynchrony (QRS width > 120 ms), who remain symptomatic (NYHA III–IV) despite width > 120 ms), who remain symptomatic (NYHA III–IV) despite optimal medical therapy to improve:optimal medical therapy to improve:
• SymptomsSymptoms (Class of recommendation I, level of evidence A);(Class of recommendation I, level of evidence A);
• HospitalizationsHospitalizations (Class of recommendation I, level of evidence A);(Class of recommendation I, level of evidence A);
• MortalityMortality (Class of recommendation I, level of evidence B).(Class of recommendation I, level of evidence B).
Devices for HF therapy: 2005 ESC Guidelines. Swedberg K et al, Eur Heart J 2005Devices for HF therapy: 2005 ESC Guidelines. Swedberg K et al, Eur Heart J 2005Devices for HF therapy: 2005 ESC Guidelines. Swedberg K et al, Eur Heart J 2005Devices for HF therapy: 2005 ESC Guidelines. Swedberg K et al, Eur Heart J 2005
[email protected]@virgilio.itEP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.EP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.
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CRT: open issuesCRT: open issuesCRT: open issuesCRT: open issues
Technical issues (access to LV, complications, …)Technical issues (access to LV, complications, …)
CRT efficacy in pts with permanent AFCRT efficacy in pts with permanent AF
CRT beneficial in pts with QRS CRT beneficial in pts with QRS << 120 ms ? 120 ms ?
How to select pts ? (LV dyssynchrony indexes, …)How to select pts ? (LV dyssynchrony indexes, …)
CRT in preventing disease progression (pts with mild CRT in preventing disease progression (pts with mild HF)HF)
Optimization technique: manual / automatic Optimization technique: manual / automatic
Non-responders …Non-responders …
Technical issues (access to LV, complications, …)Technical issues (access to LV, complications, …)
CRT efficacy in pts with permanent AFCRT efficacy in pts with permanent AF
CRT beneficial in pts with QRS CRT beneficial in pts with QRS << 120 ms ? 120 ms ?
How to select pts ? (LV dyssynchrony indexes, …)How to select pts ? (LV dyssynchrony indexes, …)
CRT in preventing disease progression (pts with mild CRT in preventing disease progression (pts with mild HF)HF)
Optimization technique: manual / automatic Optimization technique: manual / automatic
Non-responders …Non-responders …[email protected]@virgilio.it
EP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.EP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.
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Predirre nuovi eventi acuti Predirre nuovi eventi acuti di scompenso cardiacodi scompenso cardiaco
Predirre nuovi eventi acuti Predirre nuovi eventi acuti di scompenso cardiacodi scompenso cardiaco
Il sistema Home Monitoring nella Il sistema Home Monitoring nella gestione dei pazienti con gestione dei pazienti con
resincronizzazione cardiaca.resincronizzazione cardiaca.
Il sistema Home Monitoring nella Il sistema Home Monitoring nella gestione dei pazienti con gestione dei pazienti con
resincronizzazione cardiaca.resincronizzazione cardiaca.
[email protected]@virgilio.itEP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.EP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.
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Acute Acute eventevent
TimeTime
Fu
nct
ion
al
Fu
nct
ion
al
Ab
ilit
yA
bil
ity
With each event, myocardial injury (as shown by Tn release) might With each event, myocardial injury (as shown by Tn release) might occur, contributing to progressive ventricular dysfunction and occur, contributing to progressive ventricular dysfunction and
dilatationdilatation
With each event, myocardial injury (as shown by Tn release) might With each event, myocardial injury (as shown by Tn release) might occur, contributing to progressive ventricular dysfunction and occur, contributing to progressive ventricular dysfunction and
dilatationdilatation
Acute Exacerbations May Contribute Acute Exacerbations May Contribute to the Progression of Heart Failureto the Progression of Heart Failure
Acute Exacerbations May Contribute Acute Exacerbations May Contribute to the Progression of Heart Failureto the Progression of Heart Failure
[email protected]@virgilio.itEP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.EP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.
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Modelli organizzativi per la Prevenzione Secondaria CHFE’ possibile ridurre il tasso di ospedalizzazioni?
• Approccio multisciplinare:
nurses , dietologi, farmacisti, assistenti sociali
Ambulatorio dedicato
Monitoraggio domiciliare con personale infermieristico/medico
Gestione telefonica
•Identificazione Identificazione Precoce del Precoce del peggioramentopeggioramentodello stato di dello stato di compenso del compenso del pazientepaziente
• Approccio multisciplinare:
nurses , dietologi, farmacisti, assistenti sociali
Ambulatorio dedicato
Monitoraggio domiciliare con personale infermieristico/medico
Gestione telefonica
•Identificazione Identificazione Precoce del Precoce del peggioramentopeggioramentodello stato di dello stato di compenso del compenso del pazientepaziente
Tasso di ospedalizzazione
1) Coletta A.P. et al, Eur J Heart Fail. 2003 Jan; 5 (1): 95–99. Review.
2) Bondmass M. et al, J Am Coll Cardiol 2001; 37: 1A–648A.3) Whitten, Mair et al, BMJ. 2002 Jun 15; 324 (7351):1434–7.
[email protected]@virgilio.itEP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.EP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.
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Elementi predittivi di peggioramento del compenso (1)
• Incremento la frequenza cardiaca, per mantenere una sufficiente perfusione
Lechat (1) ha verificato che Lechat (1) ha verificato che un incremento di 1 bpm un incremento di 1 bpm della frequenza cardiaca della frequenza cardiaca media corrisponde ad un media corrisponde ad un incremento del 1,8 % del incremento del 1,8 % del rischio di ospedalizzazionerischio di ospedalizzazione
Opasich (2) ha rilevato una Opasich (2) ha rilevato una frequenza media > 100 frequenza media > 100 bpm aumenta del 61 % il bpm aumenta del 61 % il rischio di scompenso a rischio di scompenso a breve.breve.1) Lechat P. et al, Circulation. 2001 Mar 13; 103 (10): 1428–33.
2) Opasich C. et al, Am J Cardiol. 2001 Aug 15; 88 (4): 382–7.
[email protected]@virgilio.itEP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.EP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.
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Elementi predittivi di peggioramento del compenso (2)
• Riduzione dell’attività: La riduzione della distanza percorsa camminando è
significativamente correlata alla probabilità di morte e scompenso.
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Elementi predittivi di peggioramento del compenso (3)
• Fibrillazione Atriale
l’innesco di FA incrementa del 48% il rischio di perdita di compenso a breve (Opasich, 2001)
• Extrasistolia ventricolare
elevata ectopia ventricolare aumenta del 19% il rischio scompenso (Madsen, 1997)
• Perdita della risincronizzazione del VSx da parte dello stimolatore
[email protected]@virgilio.itEP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.EP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.
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Monitoraggio dei marker CRT di scompenso
• Oggi, il monitoraggio quotidiano ed automatico dei marker di scompenso è disponibile nei dispositivi per la terapia di resincronizzazione biventricolare.
• Tramite il Servizio Home Monitoring attivato nei dispositivi impiantabili per CRT, si può avere l’aggiornamento completo dei trend relativi a:
frequenza cardiaca media giornaliera e a riposo;
ore di attività;
tempo cumulativo di FA;
attività extrasistolica ventricolare;
% di stimolazione biventricolare.
[email protected]@virgilio.itEP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.EP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.
[email protected]@virgilio.it
EP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.EP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.
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84.0+26.285.1+26.5
68.4+21.6
94.2+29.991.3+28.6
71.3+21.2
60
70
80
90
100
Week 1 Week 26 Week 52
SD
AN
N, m
s
NYHA Class III-IV NYHA Class II
SDANN changes during 1 year follow-upSDANN changes during 1 year follow-up
* *
* °
*: p=0.0001 vs Week 1 °: p=0.008 vs NYHA III-IV*: p=0.0001 vs Week 1 °: p=0.008 vs NYHA III-IV
*
Investigators of the InSync / Investigators of the InSync / InSync ICD Italian RegistryInSync ICD Italian Registry
World Congress of Cardiology World Congress of Cardiology 20062006
September 2006 (Barcelona, September 2006 (Barcelona, Spain)Spain)
HRV monitored by implanted CRT devices predicts HRV monitored by implanted CRT devices predicts cardiovascular events in HF ptscardiovascular events in HF ptswith NYHA Class II & III / IVwith NYHA Class II & III / IV
[email protected]@virgilio.itEP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.EP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.
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27 Jun 2002
06 Dec 2002
Loss of LV capture,RV pacing only !
HRV & biV pacing efficacy: clinical case
[email protected]@virgilio.itEP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.EP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.
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““Dry” lungs Dry” lungs higher impedancehigher impedance
““Dry” lungs Dry” lungs higher impedancehigher impedance
BetterBetterBetterBetter
Optivol systemOptivol systemOptivol systemOptivol system
““Wet” lungs Wet” lungs lower impedancelower impedance““Wet” lungs Wet” lungs
lower impedancelower impedance
[email protected]@virgilio.it
EP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.EP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.
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Optivol sensor functioning Optivol sensor functioning Optivol sensor functioning Optivol sensor functioning
Accumulation of the difference between the
daily and reference
impedance
Observation and Alert Threshold
Reference impedance slowly
adapts to daily impedance
Daily impedance is the average of
each day’s measurements
[email protected]@virgilio.itEP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.EP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.
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CRT & transvalvular impedance sensorCRT & transvalvular impedance sensorCRT & transvalvular impedance sensorCRT & transvalvular impedance sensor
Chirife R & al. Europace 2006 jun; Suppl. 1: abst. 216/2
Conclusion:
“Implanted PMs (3 sheeps) accurately detected changes in RV volumes and allowed calculation of contractility-derived rate during inotropic challenge”
Chirife R & al. Europace 2006 jun; Suppl. 1: abst. 216/2
Conclusion:
“Implanted PMs (3 sheeps) accurately detected changes in RV volumes and allowed calculation of contractility-derived rate during inotropic challenge”
[email protected]@virgilio.itEP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.EP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.
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Time after Stimulus (s)0 0.1 0.2 0.3 0.4 0.5 0.6 0.7
Intracardiac impedance
CLS – Impedance PrincipleCLS – Impedance PrincipleCLS – Impedance PrincipleCLS – Impedance Principle
• CLS monitors cardiac CLS monitors cardiac contraction dynamicscontraction dynamics by by monitoring a monitoring a localized localized intracardiac impedance intracardiac impedance signalsignal..
• This impedance signal This impedance signal provides a direct provides a direct assessment of myocardial assessment of myocardial wall motion changeswall motion changes around the vicinity of the tip around the vicinity of the tip electrode.electrode.
• CLS monitors cardiac CLS monitors cardiac contraction dynamicscontraction dynamics by by monitoring a monitoring a localized localized intracardiac impedance intracardiac impedance signalsignal..
• This impedance signal This impedance signal provides a direct provides a direct assessment of myocardial assessment of myocardial wall motion changeswall motion changes around the vicinity of the tip around the vicinity of the tip electrode.electrode.
The elegant simplicity of this impedance measurement The elegant simplicity of this impedance measurement method method requires no special leadrequires no special lead,, allowing it to be used allowing it to be used with any pacing electrodewith any pacing electrode
The elegant simplicity of this impedance measurement The elegant simplicity of this impedance measurement method method requires no special leadrequires no special lead,, allowing it to be used allowing it to be used with any pacing electrodewith any pacing electrode
[email protected]@virgilio.itEP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.EP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.
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PhD: an « EXPERT SYSTEM »PhD: an « EXPERT SYSTEM »
MV activityMV activityMV activityMV activity
MV restMV restMV restMV rest
WorkloadWorkloadWorkloadWorkload
Info (time-continuous)Info (time-continuous)on functional statuson functional statusInfo (time-continuous)Info (time-continuous)on functional statuson functional status
Tomorrow:Tomorrow:ALERTALERTTomorrow:Tomorrow:ALERTALERT
Tomorrow:Tomorrow:Contractility (PEA)Contractility (PEA)Tomorrow:Tomorrow:Contractility (PEA)Contractility (PEA)
[email protected]@virgilio.itEP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.EP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.
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Rules & Metarules are applied EVERY DAY, to come to a conclusive diagnosis on that day:
• ALERT = OFF;• ALERT = Stand-By;• ALERT = ON (day-related)
PhD: algorithms to generate ALERTsPhD: algorithms to generate ALERTs
MVA
W
MVR
Last 90 days (day by day)
X: « W » ruleOO: « MVA » rule+: « MVR » rule
--------: ALERT on MVR metarule--------: ALERT on W metarule
[email protected]@virgilio.itEP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.EP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.
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Ottimizzazione Ottimizzazione
della stimolazione della stimolazione biventricolarebiventricolare
Ottimizzazione Ottimizzazione
della stimolazione della stimolazione biventricolarebiventricolare
Il sistema Home Monitoring nella Il sistema Home Monitoring nella gestione dei pazienti con gestione dei pazienti con
resincronizzazione cardiaca.resincronizzazione cardiaca.
Il sistema Home Monitoring nella Il sistema Home Monitoring nella gestione dei pazienti con gestione dei pazienti con
resincronizzazione cardiaca.resincronizzazione cardiaca.
[email protected]@virgilio.itEP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.EP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.
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CRT optimization: objectivesCRT optimization: objectives
Acute / chronic haemodynamic improvement
100% Bi-V pacing
[email protected]@virgilio.itEP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.EP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.
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LV
PR
ES
SU
RE
(m
mH
g)
55 115 1750
70
140
AAI
BiV
Optimal-BiV
[email protected]@virgilio.itEP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.EP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.
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Trans-mitralFlow
Stroke Volume(Aortic VTI)
Intra-VentricularSynchrony
A-V optimization
V-V optimization
OPTIMIZATION TARGETSOPTIMIZATION TARGETSOPTIMIZATION TARGETSOPTIMIZATION TARGETS
• EchocardiographyEchocardiography
• IEGM-basedIEGM-based
• Haemodynamic sensorHaemodynamic sensor
• EchocardiographyEchocardiography
• IEGM-basedIEGM-based
• Haemodynamic sensorHaemodynamic sensor
AV / VV optimization methodsAV / VV optimization methodsAV / VV optimization methodsAV / VV optimization methods
Echo-based: a very long Echo-based: a very long procedure …procedure …
Echo-based: a very long Echo-based: a very long procedure …procedure …
RV 40 RV 20 RV 0 RV – 20 RV – 40
AV = 80
AV = 100
AV = 120
AV = 140
AV = 160
AV = 180
30 different configurations
to be tested
[email protected]@virgilio.itEP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.EP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.
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Optimal AVD & VVD: a dynamic concept …Optimal AVD & VVD: a dynamic concept …Optimal AVD & VVD: a dynamic concept …Optimal AVD & VVD: a dynamic concept …
O’Donnell et al, PACE 2005; 28 (S1): S24-6O’Donnell et al, PACE 2005; 28 (S1): S24-6n = 40 CRT pts n = 40 CRT pts with 8 follow-up visits availablewith 8 follow-up visits available
O’Donnell et al, PACE 2005; 28 (S1): S24-6O’Donnell et al, PACE 2005; 28 (S1): S24-6n = 40 CRT pts n = 40 CRT pts with 8 follow-up visits availablewith 8 follow-up visits available
VVD (ms)AVD (ms)
LV, then RV
24h 2w 6w 3M 6M 9M
[email protected]@virgilio.itEP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.EP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.
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Effect of optimizing VV interval on LV contractility in CRTBerry M. van Gelder, Am J Cardiol 2004; 93 (12): 1500-3
Effect of optimizing VV interval on LV contractility in CRTBerry M. van Gelder, Am J Cardiol 2004; 93 (12): 1500-3
Effect of simultaneous Effect of simultaneous BIV and optimized BIV BIV and optimized BIV pacing on LV dP/dt pacing on LV dP/dt max in max in 41 pts with 41 pts with sinus rhythm + LBBBsinus rhythm + LBBB, , and:and:
- ischemic ischemic cardiomyopathy (IC): cardiomyopathy (IC): n = 26 n = 26
- idiopatic dilated cmp idiopatic dilated cmp (IDC): n = 15(IDC): n = 15
Effect of simultaneous Effect of simultaneous BIV and optimized BIV BIV and optimized BIV pacing on LV dP/dt pacing on LV dP/dt max in max in 41 pts with 41 pts with sinus rhythm + LBBBsinus rhythm + LBBB, , and:and:
- ischemic ischemic cardiomyopathy (IC): cardiomyopathy (IC): n = 26 n = 26
- idiopatic dilated cmp idiopatic dilated cmp (IDC): n = 15(IDC): n = 15
[email protected]@virgilio.itEP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.EP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.
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Sistema Home MonitoringTM Flusso dati
PM/ICD con Telemetria a Lunga Distanza
La trasmissione telemetrica avviene su una frequenza di 403.62 MHz, banda riservata per trasmissioni radio di dispositivi medici impiantabili.
Centro Servizi BIOTRONIKMedico
[email protected]@virgilio.itEP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.EP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.
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Sistema Home MonitoringTM Flusso dati
PM/ICD con Telemetria a Lunga Distanza
CardioMessenger
La trasmissione è captata entro un raggio di 2 metri da un dispositivo radiomobile.
La trasmissione avviene senza intervento del pazinete ad un’ora del giorno programmata, o immediatamente in caso di evento critico.
Centro Servizi BIOTRONIK
[email protected]@virgilio.itEP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.EP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.
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Sistema Home MonitoringTM Flusso dati
PM/ICD con Telemetria a Lunga Distanza
Il CardioMessenger lavora sulla rete di telefonia mobile GSM, triband.
Il segnale del PM/ICD viene trasmesso mediante pacchetto codificato di messaggi SMS al Centro Servizi di Berlino
Centro Servizi BIOTRONIK
ricezione, decodifica ed elaborazione automatiche dei [email protected]@virgilio.it
EP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.EP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.
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Sistema Home MonitoringTM Flusso dati
PM/ICD con Telemetria a Lunga Distanza
• I dati sono resi disponibili on-line.
• Il medico accede alla pagina web con la propia usergroup, username e password.
• Possibilità di controllare ovunque ed in ogni momento lo stato attuale dei pazienti.
[email protected]@virgilio.itEP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.EP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.
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Sistema Home MonitoringTM La pagina web di accesso
[email protected]@virgilio.itEP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.EP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.
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Sistema Home MonitoringTM Segnalazione eventi critici
Per ogni paziente individualmente, si possono selezionare i tipi di eventi critici dei quali vogliamo essere immediatamente informati.
Se attiviamo l’opzione, possiamo Se attiviamo l’opzione, possiamo ricevere messaggi SMS che ci ricevere messaggi SMS che ci informano degli eventi critici informano degli eventi critici [email protected]@virgilio.it
EP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.EP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.
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Sistema Home MonitoringTM Monitoraggio dello Scompenso Cardiaco
I parametri predittivi di peggioramento dello Scompenso Cardiaco:
• frequenza cardiaca media giornaliera e a riposo;
• attività extrasistolica ventricolare;
• ore di attività;
• tempo cumulativo di FA.
[email protected]@virgilio.itEP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.EP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.
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Efficacia e corretta programmazione della terapia di risincronizzazione cardiaca
• Funzione rate-responsive
• Stimolazione Biv continuativa
• Trigger sulle extrasistoli Ventricolari
Sistema Home MonitoringTM Monitoraggio della risincronizzazione cardiaca
[email protected]@virgilio.itEP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.EP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.
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Eventuali eventi tachicardici e relative terapie:
• Contatori degli episodi rilevati nelle diverse zone di riconoscimento
• Terapie erogate, efficaci e non efficaci
Sistema Home MonitoringTM Monitoraggio delle tachicardie
[email protected]@virgilio.itEP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.EP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.
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Marker eventi Atriali e Marker eventi Atriali e Ventricolari con classificazione Ventricolari con classificazione e durata intervallie durata intervalli
Sistema Home MonitoringTM Monitoraggio delle tachicardie: IEGM-Online®
[email protected]@virgilio.itEP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.EP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.
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Sistema Home MonitoringTM Monitoraggio dell’integrità del sistema
Stato ed integrità del sistema:
• Impedenze di stimolazione e shock
• Stato della batteria e del sistema
[email protected]@virgilio.itEP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.EP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.
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Sistema Home MonitoringTM Case Report: (1) sequenza di VF ripetute
[email protected]@virgilio.itEP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.EP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.
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Sistema Home MonitoringTM Case Report: (2) episodi in zona di VT
[email protected]@virgilio.itEP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.EP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.
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Sistema Home MonitoringTM Case Report: (3) 50% efficacia terapie ATP
[email protected]@virgilio.itEP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.EP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.
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Sistema Home MonitoringTM Case Report: (4) riduzione frequenza delle VES
[email protected]@virgilio.itEP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.EP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.
44
Sistema Home MonitoringTM Case Report: (5) riduzione freq. cardiaca media e a riposo
[email protected]@virgilio.itEP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.EP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.
45
Sistema Home MonitoringTM Case Report: (6) aumento delle ore di attività fisica
[email protected]@virgilio.itEP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.EP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.
46
FIRENZE (#8)
~ 600 KM
NAPOLI (#1)SALERNO (#2)
~ 2000 KM
BRASOW (#1)
FIGLINE V.NO (#3)
~ 30 KM
MONTELUPO (#1)SAN GIOVANNI V.NO (#1)
CRT-D Biotronik Lumax (N=19) dal gennaio 2007CRT-D Biotronik Lumax (N=19) dal gennaio 2007Lab. Elettrofisiologia e CardiostimolazioneLab. Elettrofisiologia e CardiostimolazioneAUOC – Careggi - FirenzeAUOC – Careggi - Firenze
TRASMISSIONE DATI [email protected]@virgilio.it
EP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.EP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.
~ 120 KM
Citta’ di Castello (#1)
~ 2000 KM
SOFIA (#1)
47
• Einthoven aveva costruito un ecgrafo che pesava 300 Kg e occupava due stanze. • Si faceva trasmettere i segnali dal vicino ospedale di Leiden (primario medico Nolen) a
distanza di circa 2 Km via telefono.• Inizialmente pagavano la bolletta in due, poi Nolen smise perché aveva capito che ogni
merito sarebbe andato (come fu) a Einthoven.
[email protected]@virgilio.itEP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.EP Lab-Dept. Heart and Vessels, University of Florence, Florence, Italy.