心脏起搏器培训资料：ICD and Lead Technology

1、ICD and Lead Technology SJM internal use ONLY SJM internal use ONLY St. Jude Medical ICDs Photon Released 2000 First dual chamber ICD for St. Jude Medical 73 x 62 x 12.7 mm 85 grams Photon Micro Released 2001 71 x 57 x 12 mm 74 grams SJM internal use ONLY St. Jude Medical ICDs Atlas Released 2002 36

2、 joule delivered 71 x 57 x 12 mm (V-240) 76 grams (V-240) Epic Released 2002 64 x 50 x 12.9 mm 70 grams SJM internal use ONLY St. Jude Medical ICDs Atlas + Released 2003 AF Suppression 36 joule delivered 67 x 50 x 14 mm 78 grams Epic+ Released 2003 AF Suppression 64 x 50 x 12.9 mm 70 grams SJM inter

3、nal use ONLY The II Family SJM internal use ONLY II Family SJM internal use ONLY Model Numbers Model DesignationModel NumberBrief Description Epic II + DRV-258Dual Chamber, AF Suppression Epic II DRV-255Dual Chamber, no AF Suppression Epic II VRV-158Single Chamber Epic II HFV-355Bi-V Atlas II + DRV-

4、268Dual Chamber, AF Suppression Atlas II DRV-265Dual Chamber, no AF Suppression Atlas II VRV-168Single Chamber Atlas II HFV-365Bi-V Model DesignationModel NumberBrief Description Epic II + DR V-258Dual Chamber, AF Suppression Epic II DRV-255Dual Chamber, no AF Suppression Epic II VRV-158Single Chamb

5、er Epic II HFV-355Bi-V Atlas II + DRV-268Dual Chamber, AF Suppression Atlas II DRV-265Dual Chamber, no AF Suppression Atlas II VRV-168Single Chamber Atlas II HFV-365Bi-V SJM internal use ONLY Features Fast telemetry Patient Notifier AT/AF burden trend Single button therapy enable / disable New termi

6、nology Significant user interface improvements SJM internal use ONLY Features Fast Telemetry 64K Telemetry Current devices are 8 K telemetry Retrieval of stored EGMs is approximately 5x faster Benefit Faster follow-ups Faster stored IEGM retrieval Faster programming SJM internal use ONLY Features Pa

7、tient Notifier Vibratory Stimulus Programmable Notifications Elective Replacement Indicator (ERI) Charge Time Limit Reached (28 sec) Possible High Voltage Circuit Damage Device Reset Pacing Lead Impedance Out of Range Programmable Vibration Duration Testing Patient Notification SJM internal use ONLY

8、 Features Diagnostics AT/AF Burden Trend has been added 28 weeks of data First in First out SJM internal use ONLY Features One button Disable/ Enable Tachy Therapy Expedites reprogramming needed for patients going to surgery or patients experiencing unnecessary shocks due to VT storms, etc. SJM inte

9、rnal use ONLY Improved User Interface This improved interface will be applied to previous devices Photon DR and forward Merlin Patient Care System Model 3510+ SJM internal use ONLY II Family ICDs Key Messages Technology that expects the unexpected DeFT Response technology SenseAbility technology DC

10、Fibber induction Comfort for patients Vibratory patient notification Current RF with InvisiLink Wireless Telemetry Current RF SJM internal use ONLY Current ICDs Key Messages Technology that expects the unexpected Wireless Communication DeFT Response technology SenseAbility technology DC Fibber induc

11、tion Comfort for patients Vibratory patient notification Lead Systems SJM internal use ONLY Low Voltage Leads Right atrial leads Optisense, Active, model 1699 Tendril ST, Active Atrial “J” model 1782 Tendril ST, Active model 1788 Tendril ST, Optim model 1882/1888 IsoFlex S, Atrial “J”, model 1642T I

12、soFlex P, Atrial “J”, model 1644T Passive Plus DX, Atrial “J”, model 1342T Tendril SDX, Active, model 1688TC Tendril SDX, Active, model 1488TC Tendril DX, Active, model 1388TC SJM internal use ONLY Low Voltage Leads Components Active or passive fixation Steroid eluting Provides sensing and pacing fo

13、r the atrium Used for SVT discrimination Epicardial leads SJM internal use ONLY High Voltage Leads Endocardial systems SPL/TVL Riata Family Riata Riata i Riata ST Riata ST Optim Epicardial systems Patches SJM internal use ONLY High Voltage Leads Components Sensing, pacing and shocking for the ventri

14、cle Active and passive fixation Single coil Dual coil (17 cm and 21 cm coil spacing) Steroid elution Integrated bipolar Dedicated (true bipolar) Varying lengths 60, 65, 75 cm SJM internal use ONLY Endocardial Lead Systems Passive fixation (tines) Active fixation (extendable/ retractable screw) SJM i

15、nternal use ONLY Integrated Bipolar System Integrated bipolar system Sensing Senses between the tip and the distal defibrillation coil Pacing Pacing between the tip and distal defibrillation coil 11 MM Tip to Coil spacing Sensing/Pacing Sensing/ Pacing SJM internal use ONLY Integrated Bipolar System

16、 Advantages RV shocking electrode closer to apex May help eliminate incidence of anodal stimulation in CRT-D systems Disadvantage Possible far-field sensing SJM internal use ONLY True Bipolar System Dedicated bipolar system Sensing Senses between the tip and ring Pacing Pacing between the tip and ri

17、ng (II Family HF paces only RV and LV to the distal coil* due to anodal stimulation) SJM internal use ONLY True Bipolar Sensing Advantages Does not use the defibrillation coil for sensing Thought to avoid “tissue stunning” phenomenon, coil further back from myocardium Theoretical benefits, helps avo

18、id post-shock redetection failure Reduces far-field sensing Disadvantage RV defibrillation is further back from the apex SJM internal use ONLY True Bipolar Leads In the Epic family and the Atlas+ the pacing and sensing is from the tip to ring Sensing and Pacing SJM internal use ONLY Lead Connectors

19、Single Coil TVL One DF-1, One IS-1 DF-1 (Shock) IS-1 (Pace/ Sense) SJM internal use ONLY TVL One DF-1, One IS-1 SJM internal use ONLY Lead Connectors Dual Coil Two DF-1, One IS-1 DF-1 (Shock) IS-1 (Pace/ Sense) SJM internal use ONLY Two DF-1, One IS-1 SJM Lead Families SJM internal use ONLY TVL Lead

20、 Systems TVL (not available) Single coil Passive fixation Integrated bipolar No steroid Lead model numbers RV06 - 67 cm length RV07 - 70 cm length Pace/Sense (IS-1 Bipolar) Defibrillation Connector (DF-1, 3.2mm) Connector labelling Lead Body Bifurcation Lead Body Suture Sleeve Sense/Pace Electrode (

21、Anode) Defibrillation Electrode Fixation Tines Sense/Pace Tip Electrode (Cathode) SJM internal use ONLY Single Pass Lead (SPL) Dual coil Passive fixation Integrated bipolar No steroid Models SP01 70 cm length 17 cm electrode spacing SP02 70 cm length 21 cm electrode spacing SP04 100 cm length 21 cm

22、electrode spacing SJM internal use ONLY TVL - ADX Lead Model number 1559 Single coil True bipolar Steroid eluting Active fixation Shock P/S Proximal P/S Distal SJM internal use ONLY SVC Leads SVC lead 8.5 French introducer All silicone Electrode area 550 mm2 Limited supply Defibrillation Connector (

23、DF-1, 3.2mm) Connector labelling Lead Body Suture Sleeve Defibrillation Electrode Riata Lead Families SJM internal use ONLY Riata Lead Family Riata Family Options Dual and single coil models Tined or ext/ retractable screw True and Integrated models Silicone or new Optim insulation Features Active m

24、apping collar Isodiametric Steroid eluting TiN for low polarization Oversized compression lumens Redundant cable technology Traffic light stylet SJM internal use ONLY Freedom of Choice Active Fixation Leads Integrated or True Bipolar Sensing Passive Fixation Leads SJM internal use ONLY Riata Family

25、Different sized hearts may require different electrode spacing St. Jude Medical offers two electrode spacing options in the Riata lead family, designed to prevent improper electrode position 17 cm21 cm SJM internal use ONLY Built for Reliability Redundant Conductors 5 Filar Inner Coil Multi-Strand C

26、able Redundant Conductor Cables (Defibrillation and Sensing) Designed for Double Security Fast-Pass Coating for Smooth Lead Positioning SJM internal use ONLY Built for Reliability Oversized Lumens Oversized Lumens Intended to Help Prevent Clavicle-First Rib- Crush SJM internal use ONLY Riata Stylets

27、 “Traffic Light Configuration” Red = X-Firm (.016) Yellow = Firm (.015) Green = Soft (.014) Light Green = X-Soft (.014 tapered) Riata and Riata i SJM internal use ONLY Riata Lead Family Riata Active collar for mapping on active fixation models All silicone with Fast-Pass Passive is a 6.7 French lead

28、 body Active is a 7.6 French lead body 8 French introducer without guide wire 10.5 introducer with guide wire SJM internal use ONLY Freedom of Choice Coil configurations and lead lengths Dual- and single-coil configurations Multiple lead lengths True Bipolar Active Fixation Integrated Bipolar Active

29、 Fixation True Bipolar Passive Fixation Integrated Bipolar Passive Fixation Dual Coil 17 cm1580-60/65/751590-60/65/751570-651560-60/65/75 Dual Coil 21 cm1581-60/65/751591-60/65/751571-651561-60/65/75 Single Coil1582-60/651592-60/65/751572-60/651562-60/65/75 Riata ST Family SJM internal use ONLY Riat

30、a ST Defibrillation Leads Riata ST Worlds thinnest defibrillation lead 6.3 French lead body that fits through a 7 French introducer Marketing messages Ease of implant Long-term reliability Freedom of choice Single- or dual-coil spacing Multiple lengths Active or passive fixation True or integrated b

31、ipolar sensing SJM internal use ONLY Riata ST Lead Features Small lead body St. Jude Medical 6.3 F Riata ST Lead Body 6.9 French at the Coils 7 French Introducer Medtronic 6.6 French Sprint Fidelis Lead Body 7 French Introducer Guidant 8.2 French Endotak Reliance G Lead Body 9 French Introducer SJM

32、internal use ONLY Riata ST Lead Features Long-term reliability Redundant conductors Oversized lumens Silicone back-filled coils New technology SJM internal use ONLY Riata ST Lead Features Built for long-term reliability Designed to help prevent tissue ingrowth The Riata ST lead provides flat wire an

33、d silicone back-filled, isodiametric shocking coils to help prevent tissue ingrowth SJM internal use ONLY Riata ST Lead Features Built for long-term reliability Pre-clinical evaluation of tissue ingrowth (3 - 6 months) Riata ST vs. Riata SJM internal use ONLY Riata ST Lead Features Freedom of choice Active and pas