Review and History of ICD Treatment.


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Best mix of yield, size, life span, and charge time ... Life span at half DDD Pacing, 60 bpm, 3.0V, 0.4 ms, 500 O, semiannual charges, EGM ...
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Outline & History of ICD Therapy

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What is ICD Therapy? ICD Therapy comprises of pacing, cardioversion, and defibrillation treatments to treat brady and tachy arrhythmias. An outer developer is utilized to screen and get to the gadget parameters and treatments for every patient.

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Termination of ventricular tachycardia or fibrillation Treatment of co-morbidities of AT/AF and heart disappointment Prevention of life-debilitating scenes of VT/VF Goals of ICD Therapy TODAY FUTURE Reduction of sudden cardiovascular demise Improvement in quality of life Prolongation of life Expanding the comprehension and administration of sudden cardiovascular passing (SCD)

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Evolution of ICD Therapy

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1980 Large gadgets - Abdominal website First human inserts Thoracotomy, various cuts Primary implanter= heart top health spokesperson anesthesia Long doctor\'s facility stays Complications from real surgery Perioperative mortality up to 9% Nonprogrammable treatment High-vitality stun just Device life span  1.5 years Fewer than 1,000 inserts/year

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Today Small gadgets - Pectoral webpage First-line treatment for VT/VF patients Treatment of atrial arrhythmias Cardiac resynchronization treatment for Heart Failure Transvenous, single entry point Local anesthesia; cognizant sedation Short clinic stays and couple of confusions Perioperative mortality < 1% Programmable treatment choices Single-or double chamber treatment Battery life span up to 9 years More than 100,000 overall inserts/year

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Today Remote Follow-up is accessible Medtronic CareLink ™ Network is the main web based remote observing administration for patients with embedded heart gadgets. Gadgets presently accessible on the Network: GEM, GEM DR, GEM II DR/VR, GEM III DR/VR, Marquis DR/VR ICD, Maximo DR/VR, InSync ICD, InSync Marquis, InSync II Marquis

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209 cc 80 cc 120 cc 80 cc 72 cc 54 cc 36 cc 62 cc 49 cc 39.5 cc 39.5 cc Medtronic Implantable Defibrillators (1989-2003) 38 cc 39.5 cc 83% size decrease since 1989!

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Therapies Provided by Today\'s Dual-Chamber ICDs Atrium & Ventricle Bradycardia detecting Bradycardia pacing Atrium AT/AF tachyarrhythmia location Antitachycardia pacing Cardioversion Ventricle VT/VF discovery Antitachycardia pacing Cardioversion Defibrillation

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GEM ® III AT Total Arrhythmia Management in a Second Generation Device VT/VF Detection and Therapies AT/AF Detection and Therapies AT ™ Monitoring Episode Data, Marker Channel ™ and Stored EGM Atrial Episode Duration Histogram Ventricular Rate amid Atrial Episodes AT ™ Intervention Atrial Rate Stabilization (ARS) Post-Mode Switch Overdrive Pacing AT ™ Termination ATP (Ramp, Burst+ and 50 Hz Burst) Cardioversion stuns (programmed, coordinated and persistent actuated) Convenient patient administration with In-Check ™ AT Patient Assistant 30 Joule yield 39.7 cc, 78.1 g

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Maximo ® Family of ICDs Increase Clinical Productivity Ease-of-utilization elements Cardiac Compass long haul patterns Optimum Performance Package Best mix of yield, size, life span, and charge time Safety by Design Wavelet ™ Dynamic Discrimination basis, restrictive to Marquis VR and Maximo VR Enhanced Dual Chamber PR Logic ™ recognition conveys up to 95.2% PPV*** Expanded Patient Alert ™ Device Monitors Key Functions - Physician Manages Patient Charge Time*: 7.0 sec BOL/8.9 ERI Longevity**: 7.9 years Output: 35 Joules Size: 38.9 cc, 75 g, 15 mm * Maximo DR ** Longevity at half DDD Pacing, 60 bpm, 3.0V, 0.4 ms, 500 Ω, half-yearly charges, EGM pre-storgae OFF *** Willkoff JACC Abstract Feb 2001

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InSync II Marquis ® ICD & Cardiac Resynchronization System Powerful ICD & Resynchronization Therapy Powerful 30 J treatment Fast charge times Better, Faster & Easier Heart Failure Patient Management 14 months of patient particular information gave via Cardiac Compass ™ patterns Follow up proficiency with RapidRead ™ telemetry, Leadless ™ ECG, Painless High Voltage lead impedance Implant Confidence & Efficiency Most finish group of left-heart leads & conveyance frameworks Lead situation adaptability, upgraded telemetry separation, one-stop defibrillation testing Charge Times: 5.9 sec BOL/7.5 ERI Output: 30 Joules Size: 38 cc, 77 g, 14 mm

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Number of Worldwide ICD Implants Per Year Evolution of ICD Therapy and Adoption: 1980 to Present 2004-5 2000 ICDs with Cardiac Resynch SCD –HeFT 2002 1997/8 MADIT-II 1980 1989 Dual-Chamber ICDs Size Reduction AVID CASH CIDS 2003 First Human Implant COMPANION Transvenous Leads Biphasic Waveform 1985 FDA Approval of ICDs 1993 Smaller Devices 1988 1999 AT Therapies Tiered Therapy 1996 MUSTT MADIT Steroid-eluting Leads Increased Diagnostic and Memory

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Future ICD Technology Enhanced automaticity: Device programming that recommends programming choices to the clinician in view of the patient\'s history and demographics Continued diminishments in gadget size: Will require headways in battery, capacitor and hardware innovation or diminishing the conveyed vitality yield.

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Future ICD Technology Enhanced diagnostics: Monitoring of the movement of both arrhythmias and attending cardiovascular conditions Enhanced lead innovation: Thinner leads with expanded indicative abilities, e.g., weight detecting. Understanding follow-up changes : Broadly accessible developer innovation that empowers remote exchange of information, diminishing the requirement for in-facility visits.

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DISCLOSURE Indications Medtronic implantable cardioverter defibrillators (ICDs) are shown to give ventricular antitachycardia pacing and ventricular defibrillation for mechanized treatment of life-undermining ventricular arrhythmias. Contraindications Medtronic ICDs are contraindicated in: Patients with transient or reversible ventricular tachyarrhythmia or as the sole treatment of atrial arrhythmia. Notices/Precautions Changes in patient\'s ailment and/or solutions may adjust the viability of the gadget\'s customized parameters. Patients ought to avoid wellsprings of attractive and electromagnetic radiation, including MRI, diathermy, and electrosurgical units, to stay away from conceivable under location, improper treatment conveyance, and/or electrical reset of the gadget. Try not to put transthoracic defibrillation paddles specifically over the gadget. See the proper specialized manuals for point by point data with respect to directions for use, signs, contraindications, notices, safety measures, and potential unfavorable occasions. Alert : Federal law (USA) confines this gadget to deal by or on the request of a doctor.

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DISCLOSURE Indications The Medtronic GEM ® III AT framework is shown for use in ICD patients with atrial tachyarrhythmias, or who are at noteworthy danger of creating atrial tachyarrhythmias. The implantable cardioverter-defibrillator is planned to give ventricular antitachycardia pacing and ventricular defibrillation for robotized treatment of life-undermining ventricular arrhythmias. Moreover, the GEM ® III AT framework is additionally planned to give pacing, cardioversion, and defibrillation for treatment of patients with symptomatic, drug-stubborn, atrial fibrillation, and/or life-debilitating ventricular tachyarrhythmias . Contraindications Do not utilize the GEM III AT framework in patients whose tachyarrhythmias may have transient or reversible causes; patients with unremitting ventricular tachyarrhythmias; patients with endless atrial tachyarrhythmias and no attendant ventricular tachyarrhythmias; patients who have a unipolar pacemaker; or patients whose essential issue is bradyarrhythmias. Notices/Precautions: Changes in the patient\'s malady and/or pharmaceuticals may adjust the adequacy of the gadget\'s modified parameters. P atients ought to avoid wellsprings of attractive and electromagnetic radiation, including MRI, diathermy, and electrosurgical units, to stay away from conceivable underdetection, wrong treatment conveyance, and/or electrical reset of the gadget. Try not to put transthoracic defibrillation paddles specifically over the gadget. Utilization of the ICD framework ought not change the use of built up anticoagulation conventions. Taking after an ischemic or cerebrovascular mishap, handicap atrial defibrillation treatments until the patient has balanced out. Potential Complications incorporate, yet are not constrained to, inability to identify and/or end tachyarrhythmia scenes, quickening of tachyarrhythmia scenes, and lead framework confusions. See the fitting specialized manual for definite data in regards to guidelines for use, signs, contraindications, notices, precautionary measures, and potential confusions or unfriendly occasions. See guarantee card for guarantee data . Alert: Federal law (USA) confines this gadget to deal by or on the request of a doctor.

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For Medtronic leads are: • It has not been resolved whether the notices, safety measures, or complexities connected with injectable dexamethasone apply to its utilization in this gadget. • Do not endeavor to utilize the lead with any gadget other than an economically accessible implantable defibrillator framework with which it has been tried and exhibited to be protected and successful. Potential Complications Medtronic implantable cardioverter defibrillator frameworks incorporate, however are not constrained to, inability to identify and/or end tachyarrhythmia scenes, increasing speed of ventricular tachycardia, and lead framework intricacies. Identified with the utilization of transvenous leads incorporate, yet are not restricted to the accompanying patient-related conditions: cardiovascular puncturing, heart tamponade, constrictive pericarditis, embolism, endocarditis, fibrillation or different arrhythmias, heart divider crack, hemothorax, disease, pneumothorax, thrombosis, and tissue putrefaction. See the specialized manual for point by point utilizes, signs, contr

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