2014: nowadays the one shot technologies and the injectable monitor allow a wide and complete AF patient management. Why shouldn t we use them?
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1 2014: nowadays the one shot technologies and the injectable monitor allow a wide and complete AF patient management. Why shouldn t we use them? Gaetano Senatore DIVISION OF CARDIOLOGY HOSPITAL OF CIRIE & IVREA
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4 Pts n. Abl. AAD Follow-up CACAF % 6 % Daily TTECG RAAFT % 37% Event record for 1 month, symptoms Oral % 58% Daily TTECG Pappone % 22 % Daily event monitor Forleo % 43 % ECG and symptoms A4 study % 23 % ECG and 3 24h-Holter PABA-CHF 81 71% (88%) 0 % (AVN) Loop event monitor 2-6 m
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6 RESULTS Holter + ECG 86.1% TTECG 72.2 % Senatore G et al, J Am Coll Cardiol 2005
7 Hindricks G et al, Circulation 2005
8 Piorkowki et al, J Cardiovasc Electrophysiol 2005
9 CONCLUSIONS Intensive follow-up rather than symptom related follow-up is helpful in evaluating efficacy rate and incidence of asymptomatic AF recurrences
10 1987 pts (1083M, 904F), mean age 53.2yrs (29-81) -69.8%pts persistent AF -30% pts paroxysmal AF 5% with Cryoballon -0.2% pts permanent AF
11 Arya A et al, PACE 2007
12 Continuous vs Intermittent Monitoring Patients with PAF 7-day ECG 2/year 30-day ECG Arya (PACE 2007) Botto (JCE 2009) Ziegler (HR 2006) The NPV of 24-hour Holter (2/year), 1-week Holter, and 1-month Holter monitoring was very low and ranged from 53% to 64.6%. NPV = chance that a negative test result (= no AF detected) will be correct.
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14 ACTIVATOR FOR SYMPTOMS
15 Event Storage: 49.5 Minutes 6.5 min. 1.0 min. 3 most recent manual events: 7.5 minutes each AF MONITORING Patient Activated Episodes: 22.5 minutes patient activation Post patient activation, no further activations are recognized for 5 minutes Automatic Activated Episodes: 27 minutes Oldest episodes are always overwritten If storage memory is full, the oldest strip for an episode type (asystole, brady etc.) that has >3 strips already stored will be overwritten min. min. automatic detection 2.0 min. automatic detection Asystole Brady VT Fast VT AT AF
16 Kapa S et al, JCE 2013
17 Kapa S et al, JCE 2013
18 Kapa S et al, JCE 2013
19 Kapa S et al, JCE 2013
20 Kapa S et al, JCE 2013
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22 Tondo C et al, J Cardiovasc Electrophysiology 2013
23 CARE LINK Implantable devices ILR Remote Monitoring Diagnostic s data Pacemaker ICD
24 CARE LINK Routine Follow-up Symptomatic event
25 & CARE LINK Monthly follow-up Mean time for analysis 2.8 minutes
26 233 pts (105M, 80F), mean age 57.1 yrs (39-81) -post-ablation persistent AF -171 pts with remote monitoring
27 171 pts with remote monitoring Manganiello S, Senatore G, Gaita F PACE 2014
28 171 pts with remote monitoring: patient characteristics Variables All N=171 Age, years (SD) 64.5±9.6 Male, n (%) 122 (71.3) Type of atrial fibrillation, n (%) Paroxysmal 28 (16.4) Persistent 143 (83.6) Risk factors for thromboembolism, n (%) Cardiac failure 3 (1.7) Hypertension 124 (75.5) Diabetes mellitus 21 (12.2) Prior stroke/tia 9 (5.2) Vascular disease* 10 (5.8) LVEF, % (SD) 56.6±11.1 Follow up Mean duration of follow up, years 2,7 Manganiello S, Senatore G, Gaita F PACE 2014
29 Impossibile visualizzare l'immagine. AF MONITORING Long term follow up Manganiello S, Senatore G, Gaita F PACE 2014
30 Impossibile visualizzare l'immagine. AF MONITORING 50 patients had AF recurrences at traditional follow up Manganiello S, Senatore G, Gaita F PACE 2014
31 95 patients had AF recurrences at loop recorder Manganiello S, Senatore G, Gaita F PACE 2014
32 45 of 95 patients who suffered AF recurrences at loop recorder were asymptomatics Manganiello S, Senatore G, Gaita F PACE 2014
33 AF burden % at loop recorder Manganiello S, Senatore G, Gaita F PACE 2014
34 Variables Characteristics of patient population with AF recurrences (1) Asymptomatic patients N=45 Symptomatic patients N=50 P value Age, years (SD) 61.6± ± Type of atrial fibrillation, n (%) Paroxysmal 4 (11.4) 1 (2.5) Persistent 31 (88.6) 39 (97.5) Risk factors for thromboembolism, n (%) AF MONITORING Cardiac failure 0 (0) 1 (2.5) Hypertension 24 (68.6) 34 (85) Diabetes mellitus 3 (8.6) 5 (12.5) Prior stroke/tia 1 (2.8) 3 (7.5) Vascular disease* 1 (2.8) 5 (12.5) LVEF, % (SD) 58.4± ± Manganiello S, Senatore G, Gaita F PACE 2014
35 Characteristics of patient population with AF recurrences (2) Beta blockades 19 (54.3) 24 (60) Digitalis 1 (2.8) 4 (10) Calcium channel blockers 1 (2.8) 2 (5) Antiarrhythmic drugs 12 (34.3) 15 (37.5) Anticoagulants - - Antiplatelet agents 3 (8.6) 3 (7.5) Type of ablation PVI plus linear lesion 35 (100) 40 (100) - Follow up Duration of follow up, months 669.6± ± AF burden 8.0± ±26.9 <0.001 Max AF duration 18.9± ± Manganiello S, Senatore G, Gaita F PACE 2014
36 41 pz (31 M, 10 F) mean age 66 ±12 yrs
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39 Indication to PM Management ventricular rate Management AAD Scheduling cardioversion Management of symptoms New AF ablation procedure Stop anticoagulation
40 CASE REPORT Male 60 yrs AF refractory to AAD Patient underwent AF ablation β-blockers at discharge
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45 12 SSS undergoing implantation PM post AF ablation 83% PATHOLOGICAL PAUSES (66.6% ASYMPTOMATICS) 12 SSS 83% PERSISTENT AF 9.7 % OF AF ABLATION
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47 Asyptomatic registration
48 Indication to PM Management ventricular rate Management AAD Scheduling cardioversion Management of symptoms New AF ablation procedure Stop anticoagulation
49 CASE REPORT Female 61 yrs AF refractory to AAD Patient underwent AF ablation AF at discharge; cardioversion scheduled after 2 months β-blockers at discharge
50 Symptom F.P.
51 F.P.
52 F.P.
53 F.P.
54 Indication to PM Management ventricular rate Management AAD Scheduling cardioversion Management of symptoms New AF ablation procedure Stop anticoagulation
55 CASE REPORT Female 75 yrs AF refractory to AAD Patient underwent AF ablation Palpitations during follow-up D.R.
56 D.R.
57 D.R.
58 D.R.
59 D.R.
60 & CARE LINK CareLink e Reveal XT CONCLUSIONS Continuous monitoring Management of symptomatic events Quick follow-up (less than 3 minutes) Time & money save
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62 Miniaturized Reveal LINQ ICM Device Breakthrough Technology 3-year monitoring remote management* 87% smaller and wireless transmissions
63 Reveal LINQ Device Procedure Venue Data As simple as a holter, with the benefits of continuous monitoring and wireless connectivity!
64 Reveal LINQ ICM caratteristiche Parameter Reveal XT ICM Reveal LINQ ICM Longevity 3 years *3 years Electrode Spacing (inside-to-inside) 41 mm 38 mm Volume 9 cc 1.2 cc Mass 15 g 2.5 g Episode Storage 49 min 59 min Patient Symptom Mark Patient Assistant Patient Assistant Cardiac Compass Same Same MRI Compatibility MR Conditional MR Conditional Clinician Notification No Nightly Transmission / CareAlert Notifications Bi-Directional Telemetry B B Detection Algorithms Full View Full View + P-SENSE detection CareLink Network Yes Yes Wireless Telemetry No 1-Way, Transmit Only * Under the following usage scenarios: Average of 1 auto-detected episode per day Average of 1 patient-activated episode per month Less than or equal to 6 months shelf life (between device manufacture and insertion). Note: Under maximum shelf storage time (12 months), longevity is reduced by approximately 3 months. 64
65 Event Report Event
66 Event Summary Full CareAlert Details Current ECG Counters/Observation
67 Monitor MyCareLink LCD Display multiprovider connection GSM Roaming
68 Tipi di Trasmissione From LINQ to MyCareLink Wireless Automatic Manual
69 Indication to PM Management ventricular rate Management AAD Scheduling cardioversion Management of symptoms New AF ablation procedure Stop anticoagulation
70 CASE REPORT Male 62 yrs AF refractory to AAD Patient underwent AF ablation Asymptomatic P.C.
71 P.C.
72 No recurrences post AF ablation
73 CHADS 2 CHA 2 DS 2 -VASc Stroke Risk Factor Congestive Heart Failure Score Hypertension 1 Age (> 75 years) 1 Diabetes 1 Prior Stroke / TIA 2 Max Score 6 1 Stroke Risk Factor Congestive Heart Failure / LV Dysfunction Score Hypertension 1 Age (> 75 years) 2 Diabetes 1 Prior Stroke / TIA / thrombo-embolism Vascular Disease Age Sex Category (female) 1 Max Score 9
74 CONCLUSIONS Does every patient need an implantable device in the follow-up?
75
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Innehållet i denna fil får endast användas för privat bruk. Kopiering eller annan användning kräver tillstånd från Nils Edvardsson
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