Cardiac Resynchronization Therapy for HF

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?????????????????? ??????? ??? ?????????
??????????????????????????????? ????????? ?
??????????
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InSync Model 8040
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InSync Model 8040

• ??????? ???????????? ?????
• ????? ???????????????? ????????? ? ????????????
  ????????
• ????? ????????? ???????????????? ? ?????????
  ?????????

?????????
4
???????????????? ???????InSync Model 8040

• ??? ?????? ??????? ???? ????????? ?? ??????? ??
  80-150 ?? ?? ??

??????. ???


VEGM


RV
LV
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InSync Model 8040???????????? ?? ????????????????
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InSync Model 8040???????????? ?? ????????????????
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InSync Model 8040???????????? ?? ????????????????

• ???????? ????????, ??????? ???????? PVARP
• ??????????????? PVC Response ?? OFF
• ??????????????? PMT Intervention ?? ON
• ??????????????? PVARP ?? 250 ms
• ??????????????? Mode switch ?? Off ????
  ??????????? ?????? ? ??????????? ????????????
• ????????? ????????? A-V ???????? (RAAV)
• ON
• Start Rate gt ??????????? ??????????
• Stop Rate 140 bpm
• Minimum AV 30 ms

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???????????? ?? ???????????????? (InSync Model
8040)

• Lower Rate ltlt??????????? ??????????? ???
• Upper Tracking Rate 140 BPM
• Ventricular Polarity Bipolar (???? ???
  ????????? ?????????)
• Ventricular Sensitivity gt ????????? P-?????
• SAV ???-??????????? ??? 100 ms
• Diagnostics ??????????? AV ?????????? ? ???????
  1
• 
  ???, ????? ??????????? ????????????
• 
  ???????
• Ventricular V amplitude ? 2 ???? ???? ?????? ???

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???????????????? ???????????????
??????????InSync Model 8040

• ??????????? ??????? (?????? ?????)
• ???????????? ?????????? ???????? ????????
  ???????????? ??????????
• ??? ??????? ???????? ???????? ???????
  ????????? ???????? ? ????????? ??????????
• ??????? ??????? ??????? (????? ??????? ??????)
• ??????????????? ??
• ????????? 
• Detection Rate 160 bpm
• Detection Number 6
• Termination Number 3
• Type Ventricular
• Episodes Rolling
• EGM OFF

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???????? ???????????? ?? ???????????????? InSync
Model 8040
????????? ????????????
Mode DDD (R/R as needed)
Mode Switch OFF (unless AF apparent)
LR ltlt Patients Intrinsic Rate
UTR 140 ppm
PAV Programmed SAV 30 ms
SAV As optimized via echo (or 100 ms)
RA-AV ON, start rate _at_ 100 ppm
PVARP 250 ms
PMT Intervention ON
PVC Response OFF
V Output 2 x higher of RV or LV threshold
Atrial Sensitivity 0.5 mV
Ventricular Sensitivity gt P Wave
A Polarity Bipolar
V Polarity Bipolar
NCAP ON
VSP ON
Diagnostics Rate histrogram for 1 month, then high rate diagnostics
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???????????????? ????? ???InSync Model 8040
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??? ???????? ????? ??? InSync Model 8040
?????? ??????? ?????? ??????
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??????????
?????? ??????? ?????? ??????
14
?????????? ?? ?????????

• ??????????? ????????? ??????????
• ?????? ???????????? ? ????????????? ??????? ???
• ?????? ???????????? ? ????????????? ???????
  ????????????????
• ?????????????? ??????? ?????? ??? ?????? ???????
  ??????????
• ?????? ??????????????? ?????
• ??????????? ???????
• ??????????

15
??????????? AV-???????? ?? ?????? ???????-?????
??????????? ??-????????

• ??????? ?????????? ????????????
• ???????? ????? ?????. ??????????1,2,3

1. Porciani et al. Eur Heart J Suppl 2000 2
   J23-J30
2. Nishimura et al. J Am Coll Cardiol. 1995 25281.
3. Walker et al. Europace 2000I(suppl D) abstract
   212/5

Click to Start/Stop
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??????????? ??-???????? ?? ?????? Ritter
??????? ??? 160 ms
???????? ??? 50 ms
??????????? ??? 100 ms
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????? ???????? ? ????? ???????????
MIRACLE Trial
Attain Family w/ OTW
??????
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????? ??????????? ????? CS ?????????
100
97
95
95
???????? ????????
90
85
80
Attain? Family With Attain OTW
MIRACLE
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InSync ICD Model 7272
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InSync ICD Model 7272

• ??????????? ??????? ??? ????????? ? ???
• ??????? ?????? ??
• ????? ??????? ??????? ???????????? ?????????????
• 34 ??
• ??????? ????? ???????
• ??????? ??????? ?????? ????????
• PR Logic
• ?????????????? ?????? ?????????
• ??????
• ??????? ????????????

21
InSync ICD Model 7272?????????

• ???????? ???????????? ??? ??? (NYHA III/IV) ?
• ?????????? ??????????? ???. ????????
• ???????????? ?????????????
• ??????? QRS ? 130 ms
• ??????????? ? ???
• ?? ? 35

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InSync ICD Model 7272

• ???????????? ???????? ????????
• ??????? ?????? ?? ???????? ?? ? ???? ???????
• ??????? ? ???????? ???????? VT/VF
• ????????? Gem II DR
• PR Logic 2-???????? ????????
• ????-?????????? ????????????????
• ??????????????? ???????

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InSync ICD Model 7272?????????? ??????????????
?????

66 ??³

???

117 ?

???????


87 x 57
x 16 ??

???????????? ???????
34 J

(50 tilt)

???? ??????
6.8 ???


100 ??????????? ???????, 75 ? ???, 400 ohm
?????????????? ????

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InSync ICD Model 7272

• ?????????? ?????????? ? ??????? ?? ??????????
• ??????????????? ?????????? ???????????? ???????
• ??? ???????? ?? ?? ?????????
• ??????? ???????????? ?????
• RV, LV ??? RVLV ?????????????????
• ????? ???
• RV ??? RVLV (?????????? ?????? LV)
• ????-???? ???
• RV, LV ??? RVLV
• ????????????
• RV, LV ??? RVLV

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InSync ICD Model 7272??????????? ? ???????? EGM

• ?????????????

EGM Sources for EGM 1 EGM Sources for EGM 1 EGM Sources for EGM 2 EGM Sources for EGM 2
Near Field Far Field Near Field Far Field
RVtip ? RVcoilAtip ?Aring Aring ?HVARVtip ?AtipAtip ?RVcoilLVtip ?RVcoilLVtip ?HVALVtip ?Atip RVtip ?RVcoil HVA ?RVcoilLVtip ?HVALVtip ?RVcoil
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InSync ICD Model 7272?????? ?????????????????
????? RV ? RVLV ???
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???????????? ????????????InSync ICD Model 7272
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InSync ICD Model 7272?????? ???????????

• ???????????????? RV ????????? ??? ????????????
  ?????? ?????????????
• ???????????????? LV ? RV ?????????? ?
  ???????????? ??????????? ????? ???? ??? CRT
• Te?? ?? ???????????? RV ? RV LV
• ??????????? ???????? ???????? ?? ????????? ??
  ???????????? ?????????????
• ???????????? ?????????? ???
• RV ??? RVLV (?? LV)
• ?????? ATP-???????
• RV, LV ??? RVLV

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InSync ICD Model 7272?????? ???????????

• ????????? ?????? ??????
• Attain OTW Model 4193, Attain LV Model 2187 ?
  Attain CS Model 2188
• ?????? ?????????
• Sprint 6932, 6943, 6944, or 6947 ????????
  ??????????
• Sprint 6942 and 6945 ??????????????? ??????????

In the InSync ICD, the ring in a true bipolar
RV lead is NOT active.
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InSync ICD Model 7272????? ????????? ???????

• ???????? ?????? ???????? ????????
• LV ????? ???
• EGM LV tip to HVA
• RV ????? ???
• EGM RV tip to RV coil

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InSync ICD Model 7272????? ????????? ???????
RV Testing
LV Testing
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InSync ICD Model 7272????? ????????? ???????
????? ???????
Defib Lead
5832 Cables
5832 Cables
5832 Cable
Analyzer
5832 Cables
Analyzer
Atrial Bipolar
LV Unipolar
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InSync ICD Model 7272Header Connection

• ??? ????? DF-1
• ??? ????? IS-1

???????? ????????? ????????? ????????????????
(??????????) ?????
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InSync ICD Model 7272???????????? ??
????????????????
Mode DDD/R
Lower Rate lt ?????????? ???
Upper Tracking Rate 140 bpm,
Mode Switch Off (???? ??? ??)
SAV ???-??????????? ??? 100 ??
PAV SAV 30 ms
RAAV ON, Start Rate 100 bpm
Ventricular Amplitude ? 2 ?? ????????? ? ??????? ???
SVT Criteria Sinus Tach, Afib/Flutter ON
Stored EGM EGM 1 (Atip to Aring) EGM 2 (RV tip to RV coil)
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InSync ICD ??????????
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InSync ICD Model 7272??????????

• ??????????? ? ???????????????
• ?????? ?????? ??? RV ? LV
• ???????? ??????? ???????????? ?????????? ????
  ????????????? ?????? ???
• ???????? Upper Tracking Rate ?? ????????
  ???????????? ??????????
• ????? ??????? LV ????????? ?? EGM ? ?????? ???
• ???? ???????? RV ????? 300 ohms, ????? RV LV
  ????????????

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InSync ICD Model 7272??????????
????? RV ? LV ?????? ??? ?????????
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InSync ICD Model 7272??????????
????? ??????? ??????? ? ????????? ??????
????? ???????????? ???
??????? ???????? ??????????
39
InSync ICD Model 7272??????????
40
????

• ?????????????????? ??????? ?????????????
  ?????????????? ??????????? ? ??????? ????????? ?
  ???????????? ????????????? ? ?????????? ???,
  ??????? ???????? ??????????? ??????? ???????????
  ?????????? ???. ???????

41
??????????? ??????
The results presented in these case studies are
specific to these individual patients. Patient
results will vary, not every response is the
same.
42
??????????? ??????????????
???????

• 57 ?????? ???????
• ??????????? ??????????????
• NYHA Class III ???

??????? ???????????

• ???????? ??????? ???????? ? 1995. ??????????????
  ?????????????? ?????????, ???? ? ?????????? ???
  ? 1995.
• ?????????????? ??????????? ??????? ?1995.
• ????? (Nov 1998) ?????????? ???, ?? ????? 20,
  ????????? ??
• ??? (Nov 1998) ??????????? ???. ???????????, 55
  ? ???, ??????? ????, QRS 152 msec.
• ??????? ? ?????? ?????????, 1998.
• ??????????????.
• ??? ????????? ??? ??????????? ??? ??? ???, ???
  ??????????? ??????????? ? ????????

Courtesy of Dr. Eric Burton, Southwest Florida
Heart Group, Fort Myers, Fl
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??????????? ??????????????
??????????????? ???????

• ???? lisinopril 20 mg ???? ??? ? ????
• ??? carvedilol 25 mg ?????? ? ????
• ????????? furosemide 40 mg ?????? ? ????
• Digoxin 0.25 mg ???? ??? ? ????
• ??????? isosorbide mononitrate 30 mg ???? ??? ?
  ????
• ??????? 81 mg ???? ??? ? ????
• ????????
• ???????? ??????? atorvastatin calcium 10 mg ????
  ??? ? ????

?????????????????? ???????

• InSync Model 8040 - ? Nov 1998 ? ??? ??????? ?
  ???????????? MIRACLE ????????????? ? ?????
  ???????? (??????? OFF) ? ? ??????? 1999 ????
  ???????? ?????????????????? ???????

Patient was enrolled in the initial phase in
which patients were randomized for three months
Courtesy of Dr. Eric Burton, Southwest Florida
Heart Group, Fort Myers, Fl
44
??????????? ??????????????
?????????? CRT
??????? (Nov 1998) 12-??? ????? ??????????? (Nov 1999)
????? ?? NYHA Class 6-??? ?????? ???. VO2 ??? ???????? ?? QRS ???????? 65 III 319 meters 12.2 ml/kg/min 619 seconds 23 160 ms ????????????? ????????? ?? ????????, ????????? ?????????? ???. ??????????, ?????????? 50 II 391 meters 13.9 ml/kg/min 702 seconds 28 120 ms ?????? ?? ?????? ???? ? ????, ??? 6-8 ? ? ?????, ???????? ????????, ??????? ? ????????????? ????. ?????? ? ?????????
Courtesy of Dr. Eric Burton, Southwest Florida
Heart Group, Fort Myers, Fl
45
????????????? ??????????????
???????

• 71-?????? ???????
• ?????????????? ????
• ??? NYHA Class III 

??????? ???????????

• ??? (Jan 2000) ?????? ?? ?????????????
  ???????????? ???, ?????????? ????????? ? ??
  25-30, ?????????? ???????? ?????????? ??.
• ????? (Jan 2000) ?? - 3.6 ??. ????????? ?? ?
  ??? 58 ??, ?? 30-35. ?????? ???????? ??????,
  ??? ????????? ????????.
• ??? (???? 2000) ????????? ????, ?????????? ???
  ?????, ?????, QRS 160 msec.
• ??????????????.
• ??? ????????? ??? ??????????? ??? ??? ???, ???
  ??????????? ??????????? ? ????????

Courtesy of Dr. David DeLurgio, Crawford Long
Hospital, Atlanta, Ga
46
????????????? ??????????????
??????????????? ???????

• ???? enalapril maleate 10 mg ???? ??? ? ????
• ??? carvedilol 6.25 mg ???? ??? ? ????
• ????????? furosemide 40 mg ???? ??? ? ????
• ???????? 0.125 mg ???? ??? ? ????
• ??????? 81 mg ???? ??? ? ????
• ???? ????? 20 mEq ???? ??? ? ????

?????????????????? ???????

• InSync Model 8040 ? ????? 2000 ? ???? ????????
  ? ???????????? MIRACLE ????????????? ? ?????
  ???????? (??????? OFF) ? ?????? ????????
  ?????????????????? ??????? ?????? ????? 3 ???.

Courtesy of Dr. David DeLurgio, Crawford Long
Hospital, Atlanta, Ga
47
????????????? ??????????????
?????????? CRT
??????? (March 2000) 12-??? ?????? (March 2001)
????? ?? NYHA Class 6-??? ?????? ???. VO2 ??????? ???????? ?? QRS ???????? 82 III 259 meters 15.7 ml/kg/min 215 seconds 34 160 ms ?????????? ?????? ? ?????????? ? ??????? ??????, ?????????? ???????? ? ?????, ????????????, ????????, ????. ?????, ????????????? ????????? ???????? ?????? 4 I 335 meters 16.39 ml/kg/min 478 seconds 39 160 ms ????????? ???. ??????, ??????? ????, ????????? ??? ??????, ????? ?? ?????
Courtesy of Dr. David DeLurgio, Crawford Long
Hospital, Atlanta, Ga