版权说明:本文档由用户提供并上传,收益归属内容提供方,若内容存在侵权,请进行举报或认领
文档简介
PreventionandTreatmentofInfectionsDr.GeorgiosZervopoulosInfectionsAreIncreasinginFrequency&FasterThanImplants1ContributingFactorsforIncreaseOlderPatientsReceivingDevicesMorePatientComorbiditiesMixofCIEDsisChangingNumberofPulseGeneratorReplacements&UpgradesisIncreasingMoreResistantSaureus&Coagulase(-)StaphylococcusSpecies1.GreensponAetal.JAmCollCardiol201158(10)1001-1006.OverallInfectionRateat1Yearis3.1%
HighPowerRates>LowPowerRatesatAllTimePointsInfectionRateAcrossallProcedureTypes@1yearDataonFile–TruvenMarketscanResearchMortalitysignificantlyincreasesfollowingCIEDInfectionsinMedicareBeneficiariesPublishedinonNov.14,201111Sohailetal.ArchivesofInternalMedicine2011171(20),1821-18284.8to7.7FoldIncreaseInAdmissionMortality1.6to2.1FoldIncreasesLongTermMortality(27-36%@1Yr)P<0.001forallcomparisonsofwith/withoutinfectionClinicalNeed&StandardofCareClinicalNeed&StandardofCareClinicalProblemsCardiacImplantableElectronicDevice(CIED)relatedinfectionsareincreasinginfrequency&areexpensivetotreat1Specificpatientconditions&procedurecharacteristicssignificantlyincreasetheriskofCIEDinfections(e.g.,renalinsufficiency&failure,diabetesmellitus,multi-leaddevicepatients,replacement&revisionprocedures)2StandardtreatmentforCIEDinfectionrequiresadditionalhospitalstay,systemicantibiotics,&removalofallhardware,beforere-implantationcanoccur3CurrentStandardofCarehasImportantDeficiencies4Twomostcommonprophylacticantibiotics,IVcefazolin&ycin,areinadequate&havedistinctdeficienciesCefazolinhaspooractivityagainstCoagulase(-)Staphylococcus&MRSAycinhaspoortissuepenetration&noactivityagainstgram(-)rodsCurrentClinicalNeedAnadjunctiveprophylacticantibiotictherapyforCIEDimplantationGreensponAetal.JAmCollCardiol201158(10)1001-1006.Ellisetal.CombProdTher20111(1)003.WilkoffBetal.HeartRhythm20074(11)1467-1470.4.SanfordGuidetoAntimicrobialTherapy2012,42ndEditionSuggestedTreatmentforCIEDInfectionsCompleteextractionofallhardwareCompletedebridementoftheinfectedscartissueNoreimplantationatprimaryextractionprocedureSustainedantibiotictherapy(2to6weeks)ReimplantationatalternatesiteWilkoffBetal.HeartRhythm.2007;4(11):1467-1470CourtesyofSt.Luke’s-RooseveltHospitalCenterCourtesyofDr.RogerCarilloCourtesyofDr.RogerCarilloTreatingCIEDInfectionsisExpensiveTheestimatedmeancostofaCIEDinfectionis$50,0001
1.Ashanetal.Europace.2014.1-8.2.BasedonTYRXanalysisoftheMedicareStandardAnalyticFile(SAF)for2008inpatientclaims,performedinconjunctionwiththehealthcareconsultingfirmBraide-ForbesHealthResearch.
ClinicalExperienceInfectionPreventionMeasuresHeadCover*ShaveofthesurgicalareaScrubwithpuregasolineLocalDisinfection(Betadine)WayofSewingHeadCover*
HeadCover*WayofSewing
IPGmovedoutofplaceIPGmovedoutofplaceTheTYRX™Absorbable
AntibacterialEnvelopeTYRX™AbsorbableAntibacterialEnvelopeFeaturestheadvantagesoforiginalTYRXEnvelopeDesignedtostabilizeCIEDplacementMayhelppreventCIEDinfectionsAntibiotics(minocycline&rifampicin)eluteforaminimumof7daysSecondgenerationmultifilamentmeshsubstrateAbsorbsintothebodyin~9weeksNochangenecessaryinsurgicaltechniqueduringreplacement&revisionproceduresAfterabsorption,noforeignbodynidusforpotentialinfectionTimeSequenceSimulationDemonstratingElution&AbsorptionofTYRXAbsorbableEnvelope
AbsorbableEnvelopeafterimplantation:envelopeiselutingminocyclline&rifampicinAbsorbableEnvelopeat4weeks:envelopeisdissolvingintofragmentsAbsorbableEnvelopeat~9weeks:meshhasnophysicalpresenceandisfullyabsorbedMedtronicisGeneratingClinicalEvidenceMulti-CenterRetrospectiveRegistry(Completed)Single-CenterRetrospectiveStudy(Completed)Single-CenterRetrospectiveStudy(Completed)Multi-CenterProspectiveStudy(Closed)Multi-Center
RCTWRAP-IT(New)COMMANDVanderbiltValleyHealthPublished:PACEApril2014Citadel&CenturionClevelandClinic(Dr.BruceWilkoff,PI)642patients~900patients~2900patients~1000patients~7000patients10Centers1Center1Center~50centers~200centers1.05%vs3.56%(historicalcontrol)0.4%vs3.0%(control)1.1%vs3.7%
(control)0.1%vs1.67%&1.88%(historicalcontrol)TBDPublished:PACEFebruary2011Published:PACEMarch2013PresentedatHRS&EuroPaceLateBreakingTrials2013ToBeInitiatedVITATRONLEADS
ActiveFixationCRYSTALINEACTIFIX–ICQ09B/JBCRYSTALLINEACTFIX
ICFO9B/ICQ09BACTIVEFIXATIONLEADDownsizedleadbody
2.03mm/6F)ICF09B1.90mm/(5.7F)ICQ09BSteroideluting
collarPlatinumringPolyurethane(ICQ)orsilicone(ICF)outerinsulationExtendible/Retractable
helixCRYSTALLINEACTFIX
ICFO9B/ICQ09BCRYSTALCLEARSENSINGAshorttip-to-ringspacingreducesfar-fieldsensing,allowingbettertherapyanddiagnosticsforyourpatientsAllowsahighersensitivitysettingforimproveddetectionofatrialfibrillation10mmThehelix,orscrew,extendsintotheendocardialtissueAllowsforleadpositioninganywhereintheheart’schamberActivefixationleadsmaybeabetterchoicetopreventleaddislodgment.TheseleadsaresomewhateasiertoremoveTransvenousActiveFixationLeadsLeadExtensionConfirmation
25LocatingtheHisBundleforPacingIdentifytheHisbundlepotentialMappingwithEPcatheterMappingwiththe3830leadSeptumpacing2627PresentationTitle(EditonSlideMaster)|June1,2015|Confidential,forInternalUseOnlyTHANKYOUHis-BundlePacingLeads&CathetersHisbundlepacingclinicalevidenceLimitedDatawithnoLargeRandomizedClinicalTrialProcedureandFollow-Up
Procedureandfluorotimes~20minuteleadimplant&10minutefluoro1-4>75%ImplantSuccess1-4PacingCaptureThresholdsPacingCaptureThreshold1-2atimplant:SelectiveHis-BundlePacing:2.5V@0.5msNon-selectiveHis-BundlePacing:1.5V@0.5msAcuteInjuryCurrentpredictslowerchronicthresholds9Exitblock3.2-5.5%exitblock(PCT>5V@0.5ms)at20±10mF/U2SensingAcute2.9±2.0–6.8±5.3mV1-3esLimiteddatawithnolargerandomizedclinicaltrialNarrowPacedQRS3-7ImprovedandpreservedLVfunction3-6LowerHF-relatedhospitalizationinfrequentlypaced(>40%)patients3CorrectedLBBBincertainpatients7SuccessfullyPacedAVB(infra-nodalandintra-His)9Zanon,JCardiovascElectrophysiol.2006,17:29Huang.Europace.2015Zanon,PACE.2011,34:399Sharma,HeartRhythm.2015,305Deshmukh,Circulation.2000,101:869Catanzariti,Europace.2013,15:546Lustgarten,HeartRhythm.2015,12:1548Vijayaraman,PACE,2015,38:540Vijayaraman,JACC:EP,2015,1:571Note:Toviewthestudiesonline,gointopresentationmodeandclickonthestudyyou’dliketoview.30SelectSecureLeadOverviewModel3830leaddesign3830LeadSpecifications:4.1FRleadbodydiameterBipolarFixedscrewhelixSteroidelutingPolyurethaneouterinsulationCableinnerconductorCross-sectionalviewof3830lead3830Lead31C304GuideCatheterFamilyOverviewC304deflectablecatheterdesignC304DeflectableCatheterC304SpecsShapeDeflectableIntroducer9FrUsablelength30cm,40cm,and45cmInnerdiameter5.7FrOuterdiameter8.4FrIntegratedvalveNoManipulationArticulationhandleHydrophiliccoatingNoBraidYes,8x832PresentationTitle(EditonSlideMaster)|June1,2015|Confidential,forInternalUseOnlyC315CatheterFamilyOverviewShapeDescriptionCompatible3830lengthsLeadLocationH2020cm49cm
orlongerApex,triangleofKochforsmallerpatientsJ30cm59cm
orlongerBachmann’sbundle,highatrial
温馨提示
- 1. 本站所有资源如无特殊说明,都需要本地电脑安装OFFICE2007和PDF阅读器。图纸软件为CAD,CAXA,PROE,UG,SolidWorks等.压缩文件请下载最新的WinRAR软件解压。
- 2. 本站的文档不包含任何第三方提供的附件图纸等,如果需要附件,请联系上传者。文件的所有权益归上传用户所有。
- 3. 本站RAR压缩包中若带图纸,网页内容里面会有图纸预览,若没有图纸预览就没有图纸。
- 4. 未经权益所有人同意不得将文件中的内容挪作商业或盈利用途。
- 5. 人人文库网仅提供信息存储空间,仅对用户上传内容的表现方式做保护处理,对用户上传分享的文档内容本身不做任何修改或编辑,并不能对任何下载内容负责。
- 6. 下载文件中如有侵权或不适当内容,请与我们联系,我们立即纠正。
- 7. 本站不保证下载资源的准确性、安全性和完整性, 同时也不承担用户因使用这些下载资源对自己和他人造成任何形式的伤害或损失。
最新文档
- 大班下学期工作计划
- 国旗下讲话稿-未来属于自己
- 1+x无损检测试题含参考答案
- 2024年新人教版七年级数学上册教学课件 第二章 有理数的运算 2.2.2有理数的除法(第1课时)
- 沧州市泊头市2025届三年级数学第一学期期末质量检测试题含解析
- 构建“小”的艺术-从分子开关到分子马达
- 铁路监理实务复习试题及答案
- 人教版五年级数学下册导学案《第4课时 图形与几何(2)》
- 租赁合同禁止高空抛物的条款
- 模型制作相关行业投资规划报告范本
- 2024年六安市金寨县直事业单位选调历年高频500题难、易错点模拟试题附带答案详解
- 发电机组安装施工方案
- 年度框架合同英语
- 人教版小学音乐四年级上册(简谱)-唱歌-小螺号-全国公开课一等奖
- 浙江大学介绍
- 中建二测题库2024
- 人教版三-四年级体育与健康《3.2 运动前后的饮食卫生》说课稿
- 创新创业创造:职场竞争力密钥智慧树知到期末考试答案章节答案2024年上海对外经贸大学
- 小学中队长竞选竞聘
- 遗传学:朱军第三版:第10章-基因突变
- 2024年纪检监察综合业务知识考试题库附参考答案【达标题】
评论
0/150
提交评论