Transcript Document
EP Sale’s Training
Summary
EP Summary - Agenda
• Diagnostic Catheters – EP Study • Ablation Catheter Features • Blazer II™ Ablation Catheter –
AVNRT
• Blazer XP™ Ablation Catheter –
A Flutter
• Chilli II ™ Cooled Ablation Catheter –
A Fib BSC Confidential – For Internal Use Only – Do Not Copy or Distribute
Diagnostic Catheters
EP Study
Sinus Rhythm: regular slim QRS P before Q P: > 90 ms PQ: 120 – 200 ms QRS: < 120 ms QT: ca. 440ms
R T P Q S
P – Q QRS Q - T
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Diagnostic Catheters
EP Study
High Right Atrium (near sinus node) His (near AV node) Coronary Sinus (left AV groove) (used for left AVRT, Flutter and A fib) Right Ventricle Apex
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Diagnostic Catheters
EP Study
CLINICAL REQUIREMENTS
Access from the femoral vein Stability upper posterior of RA for signal fidelity and pacing capture Timing of conduction at HRA
CATHETER FEATURES
Pushablity and trackability of proximal tubing.
Distal tubing material and braid reinforcement 5mm or 10mm bipoalr or quadripolar spacing
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Diagnostic Catheters
EP Study
CLINICAL REQUIREMENTS
Access from femoral vein Access to the septal portion of the TV from the IVC Stablity at the TV for signal fidelity
CATHETER FEATURES
Pushablity and trackability of proximal tubing.
Multipurpose curve Distal tubing material and braid reinforcement Minimal trauma to the AV Node and HIS Timing and Morphology of conduction from RA to RV, including HIS signal Non braided distal tubing 2 mm quadripolar or hexapolar spacing
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Diagnostic Catheters
EP Study
CLINICAL REQUIREMENTS
Access from the femoral vein
CATHETER FEATURES
Pushablity and trackability of proximal tubing.
Access to the CS ostium from IVC Trackability over the "lip" at the entrance to the CS Trackability to push the catheter to the distal posterior section of the CS Morphology and timing along the length of the CS, including the CS ostium.
Standard Steerable Curve Pushability and torqueability of proximal tubing & steering of catheter.
Pushablity and trackability of proximal tubing.
2.5 - 5 - 2.5 or similar decapolar spacing
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Diagnostic Catheters
EP Study
CLINICAL REQUIREMENTS
Access from the femoral vein Cross the TV from the IVC Stability at the Apex of the RV for signal fidelity and pacing capture Minimize perforation of the RV Apex Timing of conduction at RVA
CATHETER FEATURES
Pushablity and trackability of proximal tubing.
Josephson/Cournand Curve Distal tubing material and braid reinforcement Non braided distal tubing 5mm or 10mm bipoalr or quadripolar spacing
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Diagnostic Catheters
Clinical Applications
CATHETER FAMILIES Fixed
Explorer Explorer 360 Explorer 360jr Explorer 5f ST Explorer 6f ST
Steerable
Polaris Dx Polaris X SteeroCath-Dx
HRA
HEART LOCATION
CS HIS RVA
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Josephson Cournand Multipurpose
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Conduction
Steerable
Standard (180º) Standard (270º) Longest
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Diagnostic Catheters
Fixed Curve
CURVE SHAPES CONNECTORS DISTAL TUBING
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Diagnostic Catheters
Fixed Curve Features
Features TUBING FRENCH SIZE
6f 5f
DISTAL TUBING FIRMNESS
High Performance Less Traumatic
RING ELECTRODE SPACING
Bipolar Quadripolar Decapolar
DISTAL FIXED CURVE SHAPES
Josephson Cournand Multipurpose Conduction
PROXIMAL TUBING CONNECTOR
High Performance Pins Rotary - 4 pin QC - 4 pin QC - 10 pin
Explorer FIXED CURVE FAMILIES Explorer 360 Explorer 360 Jr Explorer 5f ST Explorer 6f ST
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Diagnostic Catheters
Steerable
POLARIS X STEEROCATH DX POLARIS Dx
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Diagnostic Catheters
Steerable Features
Features STEERABLE FAMILIES Polaris Dx Polaris X Steerocath - Dx TUBING FRENCH SIZE
7f 6f
DISTAL TUBING FIRMNESS
High Performance Less Traumatic
RING ELECTRODE SPACING
Quadripolar Hexapolar Octapolar Decapolar
DISTAL FIXED CURVE SHAPES
Standard (270º) Standard (180º) Longest
PROXIMAL TUBING
High Performance
CONNECTOR
Rotary - 4 pin QC - 6 pin QC - 8 pin QC - 10 pin
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Diagnostic Catheters
Conclusion
The purpose of diagnostic catheters is to facilitate understanding the mechanism of arrythmias and appropriate ablation location.
Diagnostic Catheter can be classified into two main groups: Fixed Catheters Steerable Catheters Both type of catheters present a wide range of configurations (i.e. curve type, electrode numbers, electrode spacing etc.). The main difference between fixed and steerable catheters is the CLINICAL ease of use: the target for steerable catheters is mapping difficult sites, like the CS.
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Ablation Catheter Features
Handle
• Tension Control •Bi-wing Steering •Handle Ergonomics
Distal Segment
• Length & Curve Shape • Performance • Active Steering
Tip Electrode
•Tip Size •Cooling •Temperature Sensor
Proximal Shaft
•Torqueability •Pushability •Trackability
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Blazer II™ Ablation Catheter
AVNRT
Summary • Symptoms – Lightheadedness – Rapid palpitations – Pulsations in the neck • Regular rhythm with narrow QRS – No visible P wave (may be buried at end of QRS) – A and V stimulate simultaneously (reentry <50msecs) – Ventricular rates between 160 – 200 bpm • Paroxsysmal – Starts and stops suddenly • Most common SVT • Treated by ablating the slow pathway of the AV Node
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Blazer II™ Ablation Catheter
Feature Summary
DISTAL SHAFT CHARACTERISTICS CATHETER FAMILY CONFIGURATIONS Blazer II™ Blazer II™ HTD Blazer II XP™ Blazer II XP™ HTD Chilli II™ Tubing Lengths
Standard Medium Extended
Tubing Firmness
Standard Torque High Torque
Curve Shapes
Small Standard Large Asymmetric
Cooling
Passive Active
Tip Electrode
7f/4mm 8f/8mm Str 8f/8mm VM
Temperature Sensor
Exposed Imbedded Thermistor Thermocouple
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Blazer II™ Ablation Catheter
Positioning
DISEASE AVNRT FLUTTER AFIB CATHETER Blazer II Blazer XP CHILLI II AVNRT CLINICAL REQUIREMENTS
Sharp electrograms to differentiate A + HIS + V as well as fast and slow AVNODE path ways
CATHETER FEATURES
4mm Tip Electrode Micromovement of catheter from TV to AV Node and from fast to slow pathway Bi-Wing Steering Knob and Mechanical Steering Mechanism Contact over slow pathway during ablation Reach the TV and AV Node HTD Distal + Proximal and Tension Control Knob Normal Sized Hearts = Standard Curve and for Enlarged Hearts = Large Curve
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Blazer II™ Ablation Catheter
How to Use
General Settings for AVNRT: Power 45-50w Temperature 50-55°C Time 120sec Stop based on ECG evaluation Impedance Max 120ohm Fluro 9 o’clock on LAO view ECG keys AVNRT is successfully treated (fast pathway ablation) when A-H Jump is absent
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Blazer II™ Ablation Catheter
Conclusion
Blazer II Positioning Clinical Needs Catheter Features Customer Evaluation AVNRT
•Sharp Electrograms •Micromovement •Tip Contact •Reach Anatomy •7f/4mm tip electrode •Bi-wing knob and steering mechanism •HTD distal & proximal •St’d curve = normal & K2 = Large •Min 2 AVNRT Cases •BSC Generator •STD or HT Distal?
•STD or K2 Curve?
•Order per List
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Blazer II XP™ Ablation Catheter
Atrial Flutter
Summary
• Symptoms – Palpitations – Dizziness – Short of Breath • Rhythm – Narrow QRS – Variable conduction between the atrium and ventricle – Atrial cycle length of 200 - 250 msecs – Typical = counter clockwise around the right atrium • Paroxysmal – Initiates and terminates spontaneously • Ablation – Line from the TV to the IVC through the Eustachian ridge – Bi-directional block along with cycle lengths confirms success
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Blazer II XP™ Ablation Catheter
Feature Summary
DISTAL SHAFT CHARACTERISTICS CATHETER FAMILY CONFIGURATIONS Blazer II™ Blazer II™ HTD Blazer II XP™ Blazer II XP™ HTD Chilli II™ Tubing Lengths
Standard Medium Extended
Tubing Firmness
Standard Torque High Torque
Curve Shapes
Small Standard Large Asymmetric
Cooling
Passive Active
Tip Electrode
7f/4mm 8f/8mm Str 8f/8mm VM
Temperature Sensor
Exposed Imbedded Thermistor Thermocouple
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Blazer II XP™ Ablation Catheter
Positioning
DISEASE
AVNRT FLUTTER AFIB
CATHETER
Blazer II Blazer XP CHILLI II FLUTTER CLINICAL REQUIREMENTS CATHETER FEATURES
Deep lesion due to thick tissues in the RA between the IVC and TV (Eustachian Ridge) 8f, 8mm --- 8f for RF heating area and 8mm for passive cooling for higher power levels Micromovement to create linear lesion from TV to IVC Bi-Wing Steering Knob and Mechanical Steering Mechanism Stable tip contact throughout linear lesion Reach the TV HTD Distal + Proximal tubing Normal Sized Hearts = Large Curve and for Enlarged Hearts = Large Curve + Sheath (5890ST)
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Blazer II XP™ Ablation Catheter
How to Use
General Settings for FLUTTER: Power 65-70w Temperature Time 65-75°C 120 sec - Stop based on ECG evaluation - Drag lesions will need multiple ON/OFF Fluro 6 o’clock on LAO view ECG keys Bidirectional isthmus block Impedance Max 120ohm
Blazer II XP ™ Ablation Catheter
Conclusion
Blazer II XP Positioning Clinical Needs Catheter Features Customer Evaluation Flutter
•Deep Lesion •Linear Ablation •Tip Contact •Reach Anatomy •8f/8mm Tip Electrode •Bi-wing knob and mechanical steering •HT distal and proximal tubings •Large Curve •Min 2 AFL Cases •BSC Generator •Straight or VM Tip?
•STD or HT Distal?
•K2 or STD Curve?
•Order per List
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Chilli II ™ Cooled Ablation Catheter
Atrial Fibrillation
Summary
• Symptoms – Palpitations – Dizziness – Short of Breath • Rhythm – Narrow QRS – Irregular – Paroxysmal, Persistant and Permanent • Ablation – Encirclement of the Pulmonary Veins – Possible other left atrial connecting lesions
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Chilli II ™ Cooled Ablation Catheter
Feature Summary
DISTAL SHAFT CHARACTERISTICS CATHETER FAMILY CONFIGURATIONS Blazer II™ Blazer II™ HTD Blazer II XP™ Blazer II XP™ HTD Chilli II™ Tubing Lengths
Standard Medium Extended
Tubing Firmness
Standard Torque High Torque
Curve Shapes
Small Standard Large Asymmetric
Cooling
Passive Active
Tip Electrode
7f/4mm 8f/8mm Str 8f/8mm VM
Temperature Sensor
Exposed Imbedded Thermistor Thermocouple
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Chilli II™ Cooled Ablation Catheter
Positioning
DISEASE
AVNRT FLUTTER AFIB
CATHETER
Blazer II Blazer XP CHILLI II ATRIAL FIBRILLATION CLINICAL REQUIREMENTS CATHETER FEATURES
Reduce risks of secondary complications of coagulum/thrombus formation that may result in ITAs or strokes.
Cooled 7f,4mm tip electrode Reduce risk of secondary complications associated with fluid overload such as pulmonary insufficiency, etc.
Closed Loop, reciruculating cooling fluid Micromovement to create linear lesion Stable tip contact throughout linear lesion Bi-Wing Steering Knob and Mechanical Steering Mechanism HTD Distal + Proximal tubing Access and movement around the LA Deep lesions for the Roof, Foot, and MV of the LA where the Atrial Tissue is thick Proximal tubing + Bi-directional Steering Cooled 7f,4mm tip electrode
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Chilli II™ Cooled Ablation Catheter
How to Use
Arrhythmia AFIB FLUTTER Generator Maximum Values POWER
35W
TEMP
47ºC
TIME
30sec 45W 47ºC 30sec
Cardiac Tissue Coronary Sinus Scar Tissue Thick Tissue Generator Initial Settings Hi Flow POWER Lo Flow/ Coag TEMP
15W ---- 41ºC
TIME
30 sec 30W 30W 25W 25W 47ºC 47ºC 30sec 30sec
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Chilli II ™ Cooled Ablation Catheter
Conclusion
Chilli II Positioning Clinical Needs Catheter Features Customer Evaluation AFIB
•Minimize Coagulum •Minimize secondary complications •Linear Ablation •Tip Contact •Access Anatomy •Deep Lesion •Cooled 7f/4mm Tip •Closed loop cooling •Bi-wing Knob & mechanical steering •HT Distal and Proximal •Active Steering & proximal tubing •Cooled 7f/4mm •1 x AFL + 1 x AFIB Cases •BSC Generator •STD & K2 backup •Order per List
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EP Summary
Clinical Summary
Sinus Rhythm AVNRT Rate (average)
60 - 80 bpm
Regular Rhythm
yes 160 - 200 bpm yes
P before QRS
yes no
Narrow QRS Testing
yes yes EP Study AH jump, AV < 50msecs
AVRT A Flutter V Tach A fib
160 - 200 bpm yes a=200 250msec regular in atrium no (p after q) yes 150-250 bpm yes no a >200 msecs irregular no p wave either AV time > 50 msecs yes Bidirectional block no yes EP Study Isolated PVs
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