‘It’s not reallyyy scary’ Implantable Devices (C )(ICDs)

26 Pages·2010·1.47 MB·English

‘It’s not reallyy scaryy’
Implantable Devices
((ICCDs))
Angelic Delaney
Pacing Services Manager
TThhee NNaattiioonnaall AAuuddiitt ooff CCaarrddiiaacc RReehhaabbiilliittaattiioonn
Annual Statistical Report 2009 -beating heart disease together
WWhhiicchh ppaattiieenntt ggrroouuppss aarree eexxcclluuddeedd ffrroomm CCRR??
(cid:132) What did we find? A significant number of programmes explicitly exclude people with certain heart
problems. A quarter of programmes excluded people with heart failure or with a pacemaker and
nearly a fifth excluded people with an implanted cardiac defibrillator or angina.
(cid:132) Why is this important? Research has shown that people with heart failure, implanted cardiac
devices and people with chronic stable angina would also benefit from CR.
Number and percentage of centres who reported a policy of not accepting certain diagnoses for Phase
IIIIII rreehhaabbiilliittaattiioonn
Diagnosis N (%)
Pacemaker 84 26%
HHeeaarrtt ffaaiilluurree 8811 2255%%
ICD 71 22%
Angina 66 20%
ACS 45 14%
CCaarrddiiaacc aarrrreesstt 4433 1133%%
Surgical 32 10%
PCI 24 7%
Valve surgery 24 7%
(cid:133) Number of Phase III programmes, N=322
Incidence of SCD
SCD is a worldwide epidemic:
(cid:131)(cid:131)
UUSSAA 330000//440000.000000
death/year
(cid:131)
Europe 350.000
ddeeaatthh//yyeeaarr
1st cause of death amongst
developped countries
Myerburg RJ, et al. Heart disease : a text book of Cardiovascular Medecine, 6thedition; 2001 : 890-931
TTyyppiiccaall SSeeqquueennccee ooff SSCCDD
(cid:131)
Has electrical foci so rapid that the heart turns into a twitching
muscle with effectively no cardiac output
(cid:131)
Within seconds the patient becomes unconscious; within
minutes the patient dies
Patient profile courtesy of M. Akhtar, M.D., Sinal-Samaritan Medical Center, Milwaukee, WL.
ICD NICE Guidelines
WWhhaatt ddooeess aann IICCDD hhaavvee ttoo ddoo??
Sinus
VVFF
Tachycardia
100 - 200
AAFF - 117700+
VT 140 - 180+
Sinus
Bradycardia
30 - 60
Sinus
RRhhyytthhmm
50-100
Ventricular Tachycardia
VT RATE = 140 - 220 per min
AVERAGE RATE = 60 - 70 per min
Ventricular Tachycardia
VVenntrricuulaarr Taachyycaarrdiaac trreaated wwith
ATP
burst
Ventricular Fibrillation
VF RATE = >300 per min
AVERAGE RATE = 60 - 70 per min