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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 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 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: 20 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/ 21 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/ 22 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/ 23 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 24 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