1. Technologies to watch for,
What’s New in the EP Lab
Technologies to watch for,
Technologies already here
Susan Williams RN
Interim Director, Electrophysiology Lab
Washington Hospital Center

2. Pulmonary Vein Isolation (PVI)
Majority of AF ablation procedures target PV isolation

3. 3D Mapping Systems
Endocardial Solutions Inc (ESI)
Carto 3

4. EnSite™ Velocity Cardiac Mapping System
1999
Endocardial Solutions, Inc. (ESI) Array introduced to market, providing extraordinary ability to map complicated arrhythmias
2004
Introduction of contact mapping, expanding feasibility and ease-of-use of system
2005
ESI acquired by St. Jude Medical
EnSite System Version 5.1: MultiPoint mapping, EnSite Verismo™ Segmentation Tool
2006
EnSite System Version 6: Multiple Surfaces, CFE mapping

5. EnSite™ Velocity Cardiac Mapping System
2007
EnSite System Version 7: Field scaling, catheter catalog
EnSite Fusion™ Registration Tool
2008
EnSite System Version 8: Reentrant and propagation maps; Visualization tools
2009
EnSite Velocity™ System: New User Interface and hardware; OneMap™tool; Real Review™ function

6. EnSite™ Velocity Cardiac Mapping System
Map any arrhythmia
EnSite NavX™ Navigation and Visualization Technology – for more conventional/anatomic procedures
EnSite Array™ catheter – for more complex, non-sustained, multi-focal arrhythmias and for hemodynamically unstable patients
Only the EnSite Velocity System supports both contact and non-contact mapping techniques
Open platform
3D navigation of essentially all diagnostic and ablation EP catheters
Compatible with leading ablation generators and recording systems
Ideal for helping define optimal therapy delivery strategy
High level of chamber model detail
Flexibility to facilitate all popular treatment strategies
Advanced tools to guide ablation

7. EnSite™ Velocity Cardiac Mapping System
Amplifier
128 channels – the most available in any cardiac mapping system
Visualize and navigate more electrodes and catheters
2 kHz sampling rate – on par with leading recording systems
Broad filters for improved signal acuity
Display Workstation
Twin quad processors for rapid system performance
1 TB hard drive with separate partitions for system and patient data
Vibrant graphic display capabilities
Multiple display monitor options

8. EnSite NavX™ Methodology
Surface-based
8 kHz current signal emitted from three pairs of surface electrodes
Each catheter electrode located 102 times per second
Simultaneously view up to 128 electrodes on virtually unlimited catheters
Supports real-time catheter navigation in any chamber

9. EnSite Array Technology Summary
EnSite Array™ Catheter
9 French, 110cm body, open lumen
7.5ml balloon, stainless steel mesh
64 microelectrodes on a 1.8 x 4.5cm array

10. Pulmonary Vein Isolation (PVI)
Majority of AF ablation procedures target PV isolation

11. CARTO 3

12. CARTO 3 Uses 6 patches, 3 in front, 3 at the back
-Patches must surround the heart
-should not overlap other patches or be on bones or ICD/Pacemaker

13. CARTO 3
Advanced Catheter Localization -able to see different catheters
Fast Anatomical Mapping -able to map and draw contours as you move the catheters
Connection of Choice – Any catheter can be used

14. Carto 3
PIU & COM in one unit

15. Advanced Catheter Location Fast Anatomical Mapping
Carto 3
ACL
Advanced Catheter Location
FAM
Fast Anatomical Mapping
Connection of Choice™
ACCURACY
SPEED
EFFICIENCY
EFFICIENCY

16. Advanced Catheter Location
CARTO 3
ACL
Advanced Catheter Location
Magnetic Technology
Linear fields
Not affected by biological changes
Current based + Magnetic navigation = Accuracy

17. Fast Anatomical Mapping
Carto 3
FAM
Fast Anatomical Mapping
Fast Anatomical Mapping (FAM) is a new and unique way of mapping CARTO® 3 System.
Move the sensor catheter in the chamber, a volume info is taken with one push of a button
No Freeze/Accept
The entire chamber including veins can be created in one workflow
FAM provides highly detailed maps with speed

18. Carto 3
Connection of choice
To this
From this….

19. Pulmonary Vein Isolation (PVI)
Majority of AF ablation procedures target PV isolation

20. ARCTIC Front CryoAblation
Arctic Front® is the world's first Cryoballoon
catheter indicated for the treatment of
paroxysmal atrial fibrillation.
Arctic Front is inserted over a guide wire through
the FlexCath®Steerable Sheath into the left
atrium, where it can be inflated and
advanced to the target vein. Nitrous
oxide is delivered via an injection
tube to the inner surface of the
balloon. As the refrigerant vaporizes,
it absorbs the heat from the surrounding
tissue and is vacuumed back
into the CryoConsole.

21. Outer balloon
Safety feature to contain the
refrigerant in the unlikely
event that the inner balloon
is compromised. The outer
balloon is maintained under
constant vacuum.
Inner balloon
Refrigerant is delivered into the inner
balloon and vacuumed back into the
console to achieve the freezing process.
Pull wires
Help deflect the catheter
45 degrees in either direction.
Thermocouple
Monitors the temperature of
the vaporized refrigerant.
Injection tube
Refrigerant is delivered towards the
balloon surface through the injection
tube into the inner balloon.

22. How the CryoAblation System Works
Liquid N2O is Delivered from the CryoConsole Through an injection tube to the inner balloon
Inside the balloon the liquid N2O vaporizes and absorbs heat from the surrounding tissue. The vapor is returned to the console through a lumen maintained under vacuum.
The CryoConsole controls safe delivery of N2O to the catheter and return of the vapor.
Numerous safety systems mitigate potential hazards.

23. Angel Med The Guardian System
Pacemaker-like device that monitors ST segment elevation only. Warns of an imminent or impending myocardial infarction. Does not pace the heart.
The Guardian System
The Product: An implantable device that monitors the heart 24-hours/day, 7-days/week.
The Goal: Provide clear and timely notification to seek medical attention when conditions indicate that a heart attack may be imminent: even in the 30-35% of cases where symptoms are atypical or non-existent.
For Whom: Patients who are at high risk of heart attack.
Caution: Investigational Device. Limited by United States law to investigational use.

24. The Guardian System The AngelMed Guardian System is designed to:
Detect acute ST elevation changes
Alert patients to seek medical attention
Store ECG traces for later analysis
Key Features of the AngelMed Guardian System:
Engineered to detect ST shift - a rapid change in ST - deviation - which may indicate:
Acute coronary occlusions
Progression of heart failure
Monitors ECG signals in real time, 24/7, for ischemic events at normal, low, and irregular heartbeat.
Intended to warn patients to seek immediate medical care using vibratory, auditory, and visual alerts - often before symptoms manifest.
Stores ECG traces and a wide spectrum of statistics including bpm, ST shift, ST deviation (instantaneous and long-term) for later retrieval and evaluation.
Provides continuous ECG monitoring and analysis compared to patient's baseline signal, updated every 24 hours.

26. Cameron Health Subcutaneous Implantable Defibrillator (S-ICD)
SQ-RX™ Pulse Generator 
The SQ-RX Pulse Generator is a component of the Cameron Health S-ICD System, which is prescribed for patients when cardiac arrhythmia management is warranted. Implanted with the Q-TRAK Subcutaneous Electrode, the device detects cardiac activity and provides defibrillation therapy.
Q-TRAK™ Electrode
The Q-TRAK Subcutaneous Electrode is a component of the Cameron Health S-ICD System, which is implanted subcutaneously, with the distal portion positioned parallel to the left sternal border and the proximal end of the electrode connected to the SQ-RX Pulse Generator.

28. Revo MRI SureScan Pacing System Now your patients can get proven cardiac pacing care with MRI access. Revo MRI™ is specifically engineered for MRI safety – the first MRI pacing system FDA-approved for use with MRI. The Revo MRI SureScan pacing system is MR Conditional designed to allow patients to undergo MRI under the specified conditions for use. A complete system, consisting of a Medtronic Revo MRI SureScan IPG implanted with two CapSureFix MRI™ SureScan leads is required for use in the MRI environment.