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Biventricular_Pacing_Presentation

Biventricular_Pacing_Presentation - Biventricular Pacing...

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Biventricular Pacing Joanne Olecko Michael Breninford BME 501: Section 29280 Dr. Hsiai, November 28, 2007 Sneider et al., “Radiographic Appearance of Biventricular Pacing for the Treatment of Heart Failure Cascade. Fig. 4, pp. 1449
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2 Topics of Discussion Introduction 1 min, MB Biventricular Pacing Defined 2 min, JO Clinical Aspects of Biventricular Pacing 6 min, MB Biventricular Pacing Technology 6 min, JO Concluding Remarks 1 min, Team Questions 4 min, Class
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3 BIVENTRICULAR PACING
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4 Biventricular Pacing Device and Leads
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5 Biventricular Pacemaker vs. standard pacemaker Pacemaker Biventricular Pacing Device Symptoms treated Bradycardia • Heart Failure (moderate to severe ) • Arrhythmias Placement of leads 1 or 2 leads: RA (+ RV) 2 or 3 leads: LV, RV (+ RA) A notable Weakness RV stimulation, by itself, may lead to cardiac remodeling Lags pacemakers with regards to advanced algorithms and programmability. Controller unit Shared technology Pulse generator, battery, programmability, etc. Typical Pace/sense Many combinations, but further complicated with 3 rd lead VDD = sensing of RV and RA events, pacing of ventricles DDD = sensing of RV and RA events, pacing of RA and ventricles
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6 CLINICAL DISCUSSION
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7 Clinical Aspects of Biventricular Pacing Conditions Affecting Cardiac Output Dyssynchronous and Arrhythmic Behavior Result in Low Cardiac Output Contractility Effects of BVP on Hemodynamics Results in Improvements Pressure Volume (PV) Loop Cardiac Output and Contractility Increased Ejection Fraction (EF) Normal Contractility Increased Contractility Decreased Contractility LV EDV (Preload) CardiacOutput Frank­Starling Relationship
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8 Conditions Affecting Cardiac Output Ventricular Tachycardia Ventricular Fibrillation Asystole (Sudden Cardiac Death) Ventricular Arrhythmias Dilated Cardiomyopathy Left Bundle Branch Block Enlarged Left and Right Ventricles
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9 PV Loop – Healthy Subject Key Concepts CO = HR x SV SV = EDV – ESV EF = SV/EDV Contractility 40 80 120 200 160 40 80 120 240 200 160 240 Contractility LV Volume (ml) LV Pressure (mm Hg) ESPVR (Active) EDPVR (Passive) Compliance SV EDV ESV A B C D Healthy Subject
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10 PV Loop – Left Bundle Branch Block Key Concepts OE Contractility OE SV = EDV – ESV OE CO = HR x SV Ø EDV (Vol. Load) OE ESV (Press. Load) OE EF = SV/EDV LV Volume (ml) 40 80 120 200 160 40 80 120 240 200 160 240 Contractility LV Pressure (mm Hg) ESPVR
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