Les Implantables actifs: présent et futur Pierre-Olivier Sémon
Présent
Solutions for Restoring Health Product Families Pacemakers Bradycardia
Indications Pacemakers Arrêt sinusal Bloc AV
Fonctionnement Pacemakers
ECG de pacemakers Pacemakers Simple Chambre Double-Chambre
Technologie Pacemakers Connecteur auriculaire Connecteur Connecteur ventriculaire Protection de défibrillation Hybride Quartz Contact à lamelle Pile (min. 5 ans) Antenne de télémétrie
Implantation Pacemakers Anésthésie locale Prophylaxie antibiotique Incision de 4-6 cm Poche Accès veineux Positionnement des sondes Tests Fermeture
Implantation Pacemakers Introduction des sondes Accès veineux Ponction Dénudation Fluoroscopie
Positionnement des sondes Pacemakers Stimulateur Sonde auriculaire Sonde ventriculaire
Implantation Pacemakers Poche Fermeture 60-90 minutes!
Suivi Pacemakers
Nombre d implantations Pacemakers Die Entwicklung seit 2004 Anzahl Schrittmacher 5000 4000 3000 2000 1000 3346 62 1053 3382 63 1248 68 71 69 3949 3498 3568 1536 1464 1439 80 70 60 50 40 30 20 Anzahl Zentren 10 0 2004 2005 2006 2007 2008 Erstimplant. PM-Wechsel Impl.Zentren 0
Solutions for Restoring Health Product Families Pacemakers Defibrillators Bradycardia Sudden Cardiac Death
Indications Défibrillateurs Marquis DR
Magnitude Défibrillateurs
Fonctionnement Défibrillateurs
Dr M. Mirowski s dog Défibrillateurs
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.
Nombre d implantations Défibrillateurs Erstimplantationen seit 2004 1000 900 800 700 823 913 700 627 600 500 453 400 300 200 100 0 2004 2005 2006 2007 2008
Couts Défibrillateurs
Solutions for Restoring Health Product Families Pacemakers Defibrillators Cardiac Resynchronization Bradycardia Sudden Cardiac Death Heart Failure
Asynchronisme ventriculaire CRT (Cardiac Resynchronisation Therapy)
Fonctionnement CRT
Solutions for Restoring Health Product Families Bradycardia Sudden Cardiac Death Heart Failure Pacemakers Defibrillators Cardiac Resynchronization Monitoring
Implantable Loop Recorder Monitoring
Implantable Loop Recorder Monitoring
Futur
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
Surveillance de la Surcharge Pulmonaire Optivol Pulmonary Congestion As fluid accumulates in the lungs, intrathoracic impedance decreases
Surveillance de la Surcharge Pulmonaire Optivol Normal Lungs As the lungs clear, intrathoracic impedance increases
Intrathoracic Impedance Measurements Optivol The impedance is measured from the device can to the RV Coil every 20 minutes from noon until 5 pm
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
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
Web Interface Medtronic CareLink Network
Web Interface Medtronic CareLink Network Chronic disease management, monitoring of comorbidities Device integrity monitoring Push of alert events to physician Via SMS, Email
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.