Les Implantables actifs: présent et futur. Pierre-Olivier Sémon

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1 Les Implantables actifs: présent et futur Pierre-Olivier Sémon

2 Présent

3 Solutions for Restoring Health Product Families Pacemakers Bradycardia

4 Indications Pacemakers Arrêt sinusal Bloc AV

5 Fonctionnement Pacemakers

6 ECG de pacemakers Pacemakers Simple Chambre Double-Chambre

7 Technologie Pacemakers Connecteur auriculaire Connecteur Connecteur ventriculaire Protection de défibrillation Hybride Quartz Contact à lamelle Pile (min. 5 ans) Antenne de télémétrie

8 Implantation Pacemakers Anésthésie locale Prophylaxie antibiotique Incision de 4-6 cm Poche Accès veineux Positionnement des sondes Tests Fermeture

9 Implantation Pacemakers Introduction des sondes Accès veineux Ponction Dénudation Fluoroscopie

10 Positionnement des sondes Pacemakers Stimulateur Sonde auriculaire Sonde ventriculaire

11 Implantation Pacemakers Poche Fermeture minutes!

12 Suivi Pacemakers

13 Nombre d implantations Pacemakers Die Entwicklung seit 2004 Anzahl Schrittmacher Anzahl Zentren Erstimplant. PM-Wechsel Impl.Zentren 0

14 Solutions for Restoring Health Product Families Pacemakers Defibrillators Bradycardia Sudden Cardiac Death

15 Indications Défibrillateurs Marquis DR

16 Magnitude Défibrillateurs

17 Fonctionnement Défibrillateurs

18 Dr M. Mirowski s dog Défibrillateurs

19 Technologie Défibrillateurs 1.Beeper A warning beeper indicates a low battery or another problem that a doctor should check out. There are no warnings to signal a large shock to the patient. 2.Battery The special batteries, made of lithium silver vanadium oxide, last six years or more, even though they have less energy than a standard laptop battery. 3. C.P.U. The processor chip analyzes electrical signals from the heart and determines whether any shocks are necessary. The chip runs at less than 100 kilohertz, making it more energy efficient 4. Antenna Communication between the I.C.D. and the programmer is made through low-frequency radio waves sent from the unit's antenna to a doughnutshaped receiver held over the patient's chest. 5. Connectors A lead with three connections provides sensing capabilities and a pathway for high-energy shocks to one of the heart s lower chambers. A second lead with only one connection provides sensing and pacing to an upper chamber. 6. Casing The I.C.D. is encased in titanium. Scar tissue grows around it, locking it in place. The device is sealed shut to prevent leakage, so when the battery dies, the entire device must be replaced 7. Memory The pattern of heart activity before, during and after disturbances is recorded 8. Leads Flexible wires convey sensing information to the I.C.D. and carry electric shocks to the heart. A patient may receive one or two leads depending on the nature of the heart problem. They are covered with silicone insulation. 9. Capacitors Similar to the ones used in camera flashes, capacitors can take up to 10 seconds to draw enough energy from the battery for a large jolt. Charge times for smaller shocks are much shorter. 10. Transformer For serious heart disturbances requiring a higher shock, a transformer converts low-voltage battery power into a higher voltage.

20 Nombre d implantations Défibrillateurs Erstimplantationen seit

21 Couts Défibrillateurs

22 Solutions for Restoring Health Product Families Pacemakers Defibrillators Cardiac Resynchronization Bradycardia Sudden Cardiac Death Heart Failure

23 Asynchronisme ventriculaire CRT (Cardiac Resynchronisation Therapy)

24 Fonctionnement CRT

25 Solutions for Restoring Health Product Families Bradycardia Sudden Cardiac Death Heart Failure Pacemakers Defibrillators Cardiac Resynchronization Monitoring

26 Implantable Loop Recorder Monitoring

27 Implantable Loop Recorder Monitoring

28 Futur

29 Surveillance de la Surcharge Pulmonaire Optivol La surveillance de l apparition d une surcharge pulmonaire repose sur l analyse des modifications de l impédance intrathoracique mesurée par le dispositif implanté

30 Surveillance de la Surcharge Pulmonaire Optivol Pulmonary Congestion As fluid accumulates in the lungs, intrathoracic impedance decreases

31 Surveillance de la Surcharge Pulmonaire Optivol Normal Lungs As the lungs clear, intrathoracic impedance increases

32 Intrathoracic Impedance Measurements Optivol The impedance is measured from the device can to the RV Coil every 20 minutes from noon until 5 pm

33 Fluid Trends Optivol OptiVol Threshold OptiVol Fluid Index: Accumulation of the difference between the Daily and Reference Impedance Reference Impedance adapts slowly to daily impedance changes Daily impedance is the average of each day s multiple impedance measurements

34 Remote Patient Management Medtronic CareLink Network CareLink network server UK based Wireless + conventional Telemetry Monitor connectivity analog phone line User interface: Carelibnk website Secure Login by clinic

35 Web Interface Medtronic CareLink Network

36 Web Interface Medtronic CareLink Network Chronic disease management, monitoring of comorbidities Device integrity monitoring Push of alert events to physician Via SMS,

37 Perspectives d avenir De thérapeutique de survie est devenu un traitement médical à part entière. Suivi de plus en plus complet avec possibilités diagnostiques étendues. Acte de plus en plus médical. Monitoring et télé-surveillance.

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