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Devices Journal Articles, Videos And Insights

Devices: FEATURED Articles

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Devices: Latest Articles

Devices: INSIGHTS

The touchCARDIO website provides a selection of resources to inform clinicians and patients about the latest developments in the field. The following are quick, non peer-reviewed, opinion-based updates addressing current trends and opinion on the most recent advances in the area of cardio:

Devices: FEATURED VIDEOS

Editor's choice

John Greenwood talks about the rationale behind the CE-MARC 2 trial and the efficacy and safety endpoints. FILMED AT THE EUROPEAN SOCIETY OF CARDIOLOGY (ESC) ANNUAL MEETING, AUGUST 2016 WHAT IS THE RATIONALE BEHIND THE CE-MARC 2 TRIAL? 00:10 – At the current time we’re aware that invasive coronary angiography is often performed quite early in the diagnostic pathway for patients with suspected coronary heart disease. And from studies that have been published in the US, and other comparable studies in Europe, we can see that the rate of coronary angiography that don’t find any obstructive disease is around about 60%. So one could argue that a significant portion of those would be considered unnecessary. And so the CE-MARC 2 was a British Heart Foundation funded prospective multi-centre randomised control trial of three different diagnostic strategies in patients with suspected coronary heart disease to see whether we could reduce the rates of unnecessary coronary angiography in that patient group. WHY ARE INVASIVE STRATEGIES SO COMMONLY EMPLOYED WHEN NON-INVASIVE STRATEGIES ARE AVAILABLE? 00:58 – Part of the reason comes around some of the pre-test likelihood models that have been used to estimate patients’ risk. So for example, when we look at the NICE 2010 guidelines that were produced in the UK, we can see that they broadly stratified the patients into three groups: low risk, who they suggested might benefit from anatomical imaging; intermediate risk for more functional imaging; and then high risk, anyone with a pre-test probability of over 60% would be potentially scheduled direct for coronary angiography. And it’s this labelling of patients’ high risk and stratifying them towards direct to a catheter-based investigation that seems to, or potentially produces a lot of unnecessary coronary angiography, and that was the purpose of the CE-MARC 2 trial. WHAT STRATEGIES ARE BEING INVESTIGATED IN THE THREE STUDY ARMS? 01:50 – So we picked three different strategies: cardiovascular magnetic resonance imaging, as we believe this is one of the better functional imaging tests; myocardial perfusion scintigraphy which is the most commonly used functional test around the world. And we put those head to head against the UK NICE guidelines to see whether we could reduce the rates of unnecessary angiography in patients with suspected coronary heart disease. WHAT ARE THE EFFICACY AND SAFETY ENDPOINTS OF THE TRIAL? 02:21 – So the primary endpoint, as I said, was the reduction of unnecessary coronary angiography as defined by an invasive FFR measurement, or QCA where that wasn’t physically possible. And we had some safety endpoints also built into the trial and those included the rates of detection of positive angiography and also the rates of major adverse cardiovascular events. WHAT ARE THE MAIN FINDINGS OF THE TRIAL? 02:47 – The results of the trial were highly statistically significant. And we showed that a strategy involving cardiovascular magnetic resonance, significantly reduce the rates of unnecessary angiography compared to the UK NICE guidelines. And in fact those findings were comparable also for myocardial perfusion scintigraphy. Both the CMR and perfusion scintigraphy were the same at reducing those unnecessary angiography rates. And in terms of the secondary endpoints, there was no penalty for using functional imaging as a gatekeeper to the cath lab in terms of we didn’t find any higher rates of major adverse cardiovascular events.
Pier Lambiase (Institute of Cardiovascular Science, University College London, London) discusses the implantation of first- and second-line subcutaneous defibrillators and patient suitability for implantation. Implantation is mainly suitable for any patient that does not require a lead in their heart. The main contraindications for implantation are if the patient has a unipolar pacemaker, or if they have a recurrent monomorphic ventricular tachycardia which is responsive to ATP. Patients are screened through the use of ECG and an automated screening tool, which compares the patient's results to an electronic template to see if the patient would pass screening with the device implanted. There are three vectors that can be used - ideally, two vectors are preferred to allow for some reserve but it is acceptable to have one vector for the patient. Filmed at EHRA 2018, Barcelona. Questions: 1. Please outline the key factors indicating patient suitability for first- and second-line subcutaneous defibrillator implantation. 0:07 2. What are the key contraindications for implantation of a subcutaneous defibrillator? 0:43 3. How do you screen patients ahead of subcutaneous defibrillator implantation? 1:05 4. What measures do you take to refine your patient selection criteria? How can data from patient registries help? 2:01

Devices: Latest Videos

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Latest Videos

Pier Lambiase (Institute of Cardiovascular Science, University College London, London) discusses the implantation of first- and second-line subcutaneous defibrillators and patient suitability for implantation. Implantation is mainly suitable for any patient that does not require a lead in their...
Marek Malik (Imperial College, London) gives his opinion on the new mobile and electronic health technologies. He warns against considering all the available technologies to be equally useful. He outlines three goals for implementing this new technology going forward: 1. public education that...
Erik Wissner discusses the development of cardiac device therapy, and the most pressing needs in cardiac electrophysiology currently.
John Greenwood talks about the rationale behind the CE-MARC 2 trial and the efficacy and safety endpoints. FILMED AT THE EUROPEAN SOCIETY OF CARDIOLOGY (ESC) ANNUAL MEETING, AUGUST 2016 WHAT IS THE RATIONALE BEHIND THE CE-MARC 2 TRIAL? 00:10 – At the current time we’re aware that invasive...
Haran Burri discusses the remote monitoring of cardiac resynchronisation therapy, the ACUITY X4 multipolar leads and the outcomes of the RALLY-X4 study. FILMED AT THE CARDIOSTIM ANNUAL MEETING, JUNE 2016 WHAT ARE THE ADVANTAGES OF THE ACUITY X4 MULTIPOLAR LEADS? 00:10 – So these are...
Heart rhythm disorders may be treated using Implantable Cardiac Electronic Devices. These would include pacemakers, cardiac resynchronization therapy (CRT), implantable cardiac defibrillator (ICD) and loop recorder.

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