Unique Features

Implantable Cardiac Devices

Ensure CRT

Clinical Need

Cardiac Resynchronization Therapy

Detail - Cardiac Resynchronization Therapy

Cardiac resynchronization therapy (CRT) has become an accepted therapy for selected patients with advanced heart failure and can lead to improvements in New York Heart Association functional class and quality of life as well as reductions in morbidity and mortality.1-4

The maximum benefit of CRT is realized with over 92% biventricular (BiV) pacing.5

Atrial arrhythmias have been shown to be the #1 cause of reduced CRT. 6-8

Loss of BiV pacing can occur during ventricular sensed events and/or rapid atrioventricular (AV) conduction such as in atrial fibrillation.8 BiV pacers have developed algorithms for CRT devices to maintain BiV pacing when these clinical situations arise.9

References

  1. Abraham WT, Fisher WG, Smith AL, et al. MIRACLE Study Group. Cardiac resynchronization in chronic heart failure. N Engl J Med 2002;346:1845–1853.
  2. Bristow MR, Saxon LA, Boehmer J, et al. Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) Investigators. Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med. 2004;350:2140–2150.
  3. Cazeau S, Leclercq C, Lavergne T, et al. Multisite Stimulation in Cardiomyopathies (MUSTIC) Study Investigators. Effects of multisite biventricular pacing in patients with heart failure and intraventricular conduction delay. N Engl J Med 2001;344:873–880.
  4. Cleland JG, Daubert JC, Erdmann E, et al. The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med. 2005;352:1539–1549.
  5. Koplan BA, Kapla AJ, Weiner S, et al. Heart failure decompensation and all-cause mortality in relation to percent biventricular pacing in patients with heart failure: Is a goal of 100% biventricular pacing necessary? J Am Coll Cardiol. 2009;53:355-60.
  6. Stevenson WG, Stevenson LW. Atrial fibrillation in heart failure. N Engl J Med. 1999;341:910–911.5.
  7. Knight BP, Desai A, Coman J, et al. Long-term retention of cardiac resynchronization therapy. J Am Coll Cardiol. July 7, 2004;44(1):72-77.
  8. Ousdigian KT, Thompson D, Qi D, et al. A single day of AF with poor rate control predicts a subsequent week of reduced CRT. [abstract PO6-68]. Heart Rhythm. 2007;4(Suppl 5S):S379.
  9. Aktas MK, Jeevanantham V, Sherazi S, et al. Effect of biventricular pacing during a ventricular sensed event. Am J Cardiol. 2009.

Our Solutions

Medtronic offers a suite of features in our devices that work together to automatically ensure cardiac resynchronization therapy (CRT), even during Atrial Fibrillation (AF)

Important Safety Information

For CRT-Ds, certain programming and device operations may not provide cardiac resynchronization. Changes in patient’s disease and/or medications may alter the efficacy of the device’s programmed parameters.

Monitor Heart Failure Status and Verify CRT Remotely

Comprehensive Diagnostics Portfolio proven in multiple clinical studies with over 2,500 patients.1-7

Assess the impact of AF on the percentage of BiV pacing

Detail - Assess the impact of AF on the percentage of BiV pacing with 14 month trending

Assess the impact of AF on the percentage of BiV pacing

 

Assess the interrelationship between fluid status and AF

OptiVol Fluid Status Monitoring

Detail - OptiVol Fluid Status Monitoring

Heart Failure Management Report with 14 month trending

Detail - Heart Failure Management Report with 14 month trending

 
RecurrenceofAF-bth

Detail - Assess rate control and atrial fibrillation burden with 14 month trending

Assess rate control and atrial fibrillation burden

 

Automatically Ensures Cardiac Resynchronization Therapy, Even during Atrial Fibrillation

Sense Response works in tandem with Conducted AF Response to ensure CRT

Detail - Ventricular Sense Response works in tandem with Conducted AF Response to ensure CRT

Ventricular Sense Response (VSR) with Conducted AF Response (CAFR)

Ventricular Sense Response (VSR) pacing, is an algorithm that delivers a BiV pacing stimulus immediately after sensing a right ventricular event, thereby maintaining CRT when ventricular sensing occurs. The algorithm appears to have an aortic VTI response that is significantly better compared with intrinsic conduction without pacing.8

 

Ventricular Sense Response works in tandem with Conducted AF Response (CAFR) to ensure cardiac resynchronization therapy, even during Atrial Fibrillation

200802653ENCondAF-bth

Detail - Conducted AF Response operation – Comparison of ON vs. OFF

CAFROffOn-bth

Detail - Rate histogram illustrating therapy benefit of Conducted AF Response On vs. Off.

 
Complete Capture Management

Detail - Ensure capture in all heart chambers with Complete Capture Management feature

Complete Capture Management feature

Ensure capture in all heart chambers with Complete Capture Management® feature.

Ensures pacing outputs remain at safe levels while actively managing battery current drain with automatic threshold measurements.

 
200802653ENLVCM-bth

Detail - LV Capture Management automatically determines energy amount for pacing capture and adjusts output

Left Ventricular Capture Management (LVCM)

  • Clinically proven to be safe, accurate, and highly reliable9
  • Adapts to changing patient needs
  • Automatically determines energy amount for pacing capture and adjusts output
  • Minimizes diaphragmatic stimulation
  • Potentially saves time in testing and measuring LV pacing thresholds during follow-up visits
  • Additional tool to monitor lead performance
Wireless patient alerts automatically notify clinician of atrial fibrillation issue

Wireless patient alerts automatically notify clinician of atrial fibrillation issue

Wireless Patient Alerts Automatically Notify Clinician of Atrial Fibrillation Issue

Conexus® Wireless telemetry

References

  1. Small RS, Wickemeyer W, Germany R, et al. Risk of hospitalizations for acute decompensated heart failure: clinical utility of implanted device monitoring without changes in intrathoracic impedance are associated with a subsequent patient alert. J Card Fail. August 2009;15(6):475-481. [FAST Study]
  2. Vollmann D, Nägele H, Schauert P, et al. Clinical utility of intrathoracic impedance monitoring to alert patients with an implanted device of deteriorating chronic heart failure. Eur Heart J. August 2007;28(15):1835-1840. [InSync Sentry Observational Study]
  3. Catanzariti D, Lunati M, Landolina M, et al. Clinical utility of intrathoracic impedance monitoring to alert patients with an implanted device of deteriorating chronic heart failure. PACE. March 2009;32(3):363-370. [Italian Clinical Service OptiVol-CRT Group]
  4. Whellan DJ, Al-Khatib SM, Kloosterman EM, et al. Changes in intrathoracic fluid index predict subsequent adverse events: Results of the multi-site Program to Access and Review Trending INformation and Evaluate CoRrelation to Symptoms in Patients with Heart Failure (PARTNERS HF) Trial. J Card Fail. 2008;14(9):799. [PARTNERS HF]
  5. Perego GB , Landolina M, Vergara G, et al. Implantable CRT device diagnostics identify patients with increased risk for heart failure hospitalization. J Interv Card Electrophysiol. December 2007;23(3):235-242. [OptiVol-CRT Clinical Service Observational Study]
  6. Abraham WT, Compton S, Haas G, et al. Superior performance of intrathoracic impedance-derived fluid index versus daily weight monitoring in heart failure patients: results of the Fluid Accumulation Status Trial. Late Breaking Clinical Trials. J Card Fail. November 2009;15(9):813. [OFISSER]
  7. Yu CM, Wang L, Chau E, et al. Intrathoracic impedance monitoring in patients with heart failure: correlation with fluid status and feasibility of early warning preceding hospitalization. Circulation. August 9, 2005;112(6):841-848. [MID-Heft]
  8. Aktas MK, Jeevanantham V, Sherazi S, et al. Effect of biventricular pacing during a ventricular sensed event. Am J Cardiol 2009.
  9. Crossley GH, Mead H, Kleckner K, et al. Automated left ventricular capture management. Pacing Clin Electrophysiol. October 2007;30(10):1190-1200.
Last updated: 22 Sep 2010

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