Andrew Weintraub, M.D., FACC, associate director, of the Interventional Cardiology and Vascular Center, medical director of the Vascular and Structural Heart Center, Tufts Medical Center, discusses the use of temporary pacing in transcatheter aortic valve replacement (TAVR) patients. Implantation of TAVR valves can cause pressure from the valve against the septal wall of the heart, causing conduction delays. These delays do not necessarily mean the patient needs a permanent pacemaker.

Instead, Tufts Medical Center uses temporary pacing leads, a small catheter with two electrodes, placed in the right ventricle of the heart through a vein in the groin or neck. The lead is then connected to an external pacemaker allowing a physician to monitor and control a patient’s heart rate for up to several days.  The center uses the BioTrace Medical Tempo Lead, which incorporates a novel active fixation mechanism, bipolar electrodes and a soft tip. Stabilizers provide secure fixation and maintain stable pace capture. An elastomeric balloon may be inflated to aid passage of the lead through the venous vasculature and into the right ventricle, and  aids in wall apposition during deployment of the stabilizers. This design helps secure and stabilize the cardiac pacing lead with the goal of reducing complications and allowing patients to ambulate sooner after procedures.

Related Content:

VIDEO: Overview of the TAVR Program at Tufts Medical Center — Interview with Andrew Weintraub, M.D.

VIDEO: The Expansion of TAVR Following the FDA Clearing its Use in All Patients — Interview with Torsten Vahl, M.D.

VIDEO: Overview of the Structural Heart Program at Tufts Medical Center — Interview with Charles D. Resor, M.D.,

Find more content on Tufts Medical Center

This video illustrates how the Micra AV leadless pacemaker is delivered via catheter and enables atrioventricular (AV) synchrony. The device was cleared by the U.S. Food and Drug Administration (FDA) in January 2020, expanding the number of potential candidates who can receive leadless, catheter delivered pacemakers in the U.S.

The device is the world’s smallest pacemaker with atrioventricular (AV) synchrony. It is indicated for the treatment of patients with AV block, a condition in which the electrical signals between the chambers of the heart (the atria and the ventricle) are impaired. It is similar to the single chamber Micra TPS pacemaker that has been on the market since 2016. However, the Micra AV has several additional internal atrial sensing algorithms which detect cardiac movement, allowing the device to adjust pacing in the ventricle to coordinate with the atrium, providing “AV synchronous” pacing therapy to patients with AV block. The device senses when blood is flowing through the right ventricle. 

Related Micra Leadless Pacemaker Content:

FDA Clears Medtronic Micra AV to Treat AV Block

VIDEO: Current State of Leadless Pacemaker Technology — Interview with Vivek Reddy, M.D.

Novel Mechanical Sensor in Medtronic Micra Transcatheter Pacing System Detects Atrial Contractions, Restores AV Synchrony

VIDEO: How to Implant the Micra Leadless Pacemaker

New Algorithms in Medtronic Micra Pacemaker May Improve Synchrony and Cardiac Function in AV Block

FDA Approves World's Smallest Pacemaker for U.S. Patients

Safety, Performance of the World's Smallest Pacemaker Reinforced in Real-world Patients

One-Year Results for Micra TPS Pacemaker Trial Presented at ESC 2016

Leadless Pacemaker Gains Medicare Reimbursement

Wireless and Leadless Pacemaker Being Developed by Texas Heart Institute With Federal Grant
 

Interview with Navin Kapur, M.D., FAHA, FACC, FSCAI, executive director, The CardioVascular Center for Research and Innovation (CVCRI), director, Acute Mechanical Circulatory Support Program; director, interventional research laboratories; director of Cardiac Biology Research Center, Molecular Cardiology Research Institute (MCRI), Tufts Medical Center. He explains the Door-to-Unloading (DTU) Trial, which is using Impella hemodynamic support to unload the heart 30 minutes prior to percutaneous coronary intervention (PCI) in ST-elevated myocardial infarction (STEMI) patients. 

Data from a pilot trial and pre-clinical testing showed early hemodynamic support prior to PCI helps reduce or eliminate the ischemia and limits myocardial damage due to ischemia. It also appears to help reduce the no-reflow phenomenon, reperfusion injury that  occurs in some heart attack patients who are revascularized, but the restoration of blood flow does not immediately help the patient. The DTU Trial is investigating if immediate hemodynamic support improves outcomes in STEMI patients. If it does, this could be a paradigm shift in therapy for these patients.

Related Door-to-unloading Content:

FDA Approves Initiation of STEMI DTU Pivotal Randomized Controlled Trial

VIDEO: The Door-to-Unloading (DTU) STEMI Safety and Feasibility Trial — Interview Nevin Kapur, M.D.

VIDEO: The Importance of Ventricular Unloading in AMI and Cardiogenic Shock — Interview Nevin Kapur, M.D.

VIDEO: Tufts Uses a Hemodynamic Support Algorithm to Determine What Devices to Use — Interview Nevin Kapur, M.D.

VIDEO: Hemodynamic Support Protocols at Henry Ford Hospital — Interview with William O'Neill, M.D. 

Find more content on Tufts Medical Center 

Interview with Carey Kimmelstiel, M.D., FACP, FACC, director, cardiac catheterization laboratory, director, interventional cardiology, Tufts Medical Center, and professor of medicine at Tufts University School of Medicine. He explains how septal ablation is used to treat hypertrophic cardiomyopathy (HCM). The Tufts Medical Center HCM program is the largest in New England. 

Tufts Medical Center performs septal ablation to treat medication-refractory HCM. They use a heart team approach to determine which patients are best served by surgical septal myectomy or alcohol septal ablation.

When drug treatments are ineffective, the center offers several procedures to treat HCM:
   
   • Implantable cardioverter defibrillators (ICDs) to prevent sudden cardiac death in high risk patients. 

   • Surgical septal myectomy for patients who experience significant limitation during physical activity and are unresponsive to medical drug treatment. This operation may be performed along with the Maze procedure to lessen the chances of recurrent atrial fibrillation.

   • Alcohol septal ablation for patients who are generally not ideal candidates for the myectomy operation. This procedure takes place in the catheterization laboratory without general anesthesia, and mimics the beneficial effects of surgery. 

   • Ablation for recurrent atrial fibrillation performed in the catheterization laboratory to lessen the likelihood for additional episodes.

   • Heart transplant for the some patients without obstruction who experience severe symptoms and are unresponsive to drug treatment.

Find more content on Tufts Medical Center 

This video shows the first robotic percutaneous coronary interventions (PCI) performed in Germany with the Robocath R-One robotic catheter guidance system. The first procedures were performed by Professor Michael Haude, director of Medical Clinic I at Rheinland Klinikum Neuss Lukaskrankenhaus, and his team. read more in the article First Robotic Coronary Angioplasties Performed With Robocath System in Germany.

Related Robocath Content:

Robocath Successfully Carries Out First Robotic Coronary Angioplasties in Humans

Robocath Receives $1.5 Million in Capital for Advancement of R-One Robotic System 

The Consumer Electronic Show (CES) is the world's gathering place for consumer technologies, with more than 175,000 attendees and more than 4,400 exhibiting companies. New healthcare technologies are among the top trends at CES. This video offers a quick look at the trends specific to healthcare technology.

Artificial intelligence (AI) is one of the hottest technology trends across all product across the CES floor this year. There is also discussion by key note speakers that the internet-of-things (IOT) concept introduced at CES nearly a decade ago is now morphing into a new meaning for the interconnectivity-of-things. This can be seen in healthcare products shown here and across all types of consumer and business products. 

The device technology at CES include many examples of how integrated wearables can digitally enable healthcare. The future of healthcare will include system where consumers are continuously monitored with sensors, software and services that can pinpoint digital biomarkers — earlier warning signs that predict health events. This is the prediction of Leslie Saxon, M.D., executive director of the University of Southern California (USC) Center for Body Computing (CBC), is speaking as a panelist about digital health trends and challenges in the session “Proving the Impact of Transformative Technology.” 

Saxon is a board-certified cardiologist and digital health expert who understands how developing technologies can more accurately assess wellness and human performance among elite athletes, military personnel and patients. She explained this digital healthcare model of the future is a vast contrast to the current point-of-care model.

Richard Botto, CVT, RCSA, chief cardiovascular technologist, division of cardiology, cardiac cath lab, and Melissa Smith, RT, at Tufts Medical Center, Boston, explain the use of technology to remotely access data and waveforms on patients' temporary hemodynamic support system control consoles. 

Tufts Medical Center was one of the first hospitals to begin using the Abiomed Impella Connect technology, which enables remote smartphone access to Impella consoles. This allows a quick, remote check on patients using temporary hemodynamic support. The technology also is connected to a support center at Abiomed, so if a console or patient is experiencing issues out of the ordinary, techs can remote into the patient's Impella control console to take a look. Tuft's intensivists in the cardiac care unit (CCU) use the app to check on their patients' consoles without needing to walk into each room. 

Find VIDEOS and articles on Tufts cardiology program

James Carr, M.D., chair of the Department of Radiology, Northwestern University, and incoming 2020 President of the Society of Cardiac Magnetic Resonance (SCMR), explains why MRI is an ideal cardiac imaging modality, at the 2019 Radiological Society of North America (RSNA) meeting.

Heart MRI offers advantages over computed tomography (CT) and echocardiography because of its excellent soft tissue delineation and its ability to offer information beyond anatomical imaging, such as perfusion, morphology and metabolism. MRI can be technically challenging and the exams requiring a long time, but recent advances have helped cur cardiac imaging times down significantly. Automation and artificial intelligence (AI) also is making post-processing and quantification mush faster, brining it closer to the time it takes to scan and post-process CT imaging.

Northwestern is was one of the early adopters of cardiovascular MRI. Carr said heart MRI was not common in regular clinical use until the past decade at some luminary centers. In 2005, Carr was given the opportunity to develop a clinical cardiac MRI program at Northwestern.
 
He said MRI scanners have improved, and now much faster than a decade ago. They are also more optimized for cardiac imaging. While heart MRI is well known in large hospital centers, Carr said it still needs to develop and expand to community hospitals and rural hospitals outside major population centers. 

Artificial intelligence is playing a significant role in cardiac MRI automation of speeding workflow and quantification. Carr said these technologies will become mainstream in the next few years. AI also will play an increasing role in risk prediction based on new image analysis algorithms in development.

For more information on cardiac MRI, visit SCMR's website www.heartmri.org.

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VIDEO: Dedicated Cardiac MRI Use at the Baylor Scott White Heart Hospital

Advantages and New Applications of Cardiac MRI

Will Cardiac MRI Expand?

VIDEO: Use of Cardiac MRI in Congenital and Women's Heart Disease — Karen Ordovas, M.D., 
 

Mahadevappa Mahesh, Ph.D., chief of medical physicist and professor of radiology and medical physics, Johns Hopkins University, Baltimore, treasurer of the American Association of Physicists in Medicine (AAPM),a board member of the American College of Radiology (ACR), presented a late-breaking study on how medical imaging radiation dose has started to drop over the past decade. He is the co-chair of the National Council on Radiation Protection and Measures Report (NCRP), and presented the most recent NCRP data analysis at the 2019 Radiological Society of North America (RSNA) meeting.

The new NCRP 184 report covers the period between 2006 and 2016, the period of the most current CMS data. It shows a decrease of about 20 percent in the radiation dose the U.S. population receives from medical imaging, compared to the NCRP 160 that covered the period of up to 2006.

Key findings of the study include:

   • CT dose dropped about 6 percent, despite a 20 percent increase CT scans since 2006;

   • Drop of more than 50 percent for nuclear imaging scans, mainly due to fewer procedures begin performed;

   • A 15-20 percent decrease across X-ray imaging modalities.

Mahesh says this shows the impact of using "as low as reasonably achievable" (ALARA) principals, new dose guidelines outlined jointly by numerous medical societies, and dose reduction initiatives like Image Wisely, Image Gently, and the American College of radiology (ACR) Dose Index Registry.

He said there was growing concern a decade ago when the last council report was published, which show a steep increase in radiation dose. This was mainly due to a rapid increase in the use of computed tomography (CT) and other types of X-ray based and nuclear radiotracer medical imaging. This prompted the ACR top create the Image Wisely program and push for the use of more thoughtful imaging doses based on patient size, using the "as low as reasonably achievable” (ALARA) principle. While CT dose was lowered, he said the biggest decline was in nuclear imaging.

DAIC Editor Dave Fornell and Imaging Technology News (ITN) Consulting Editor Greg Freiherr offer a post-game report on the trends and technologies they saw on the expo floor of 2019 Radiological Society of North America (RSNA) annual meeting. This includes artificial intelligence (AI), augmented reality, holographic imaging, cybersecurity, and advances in digital radiography (DR) with a glassless detector plate, X-ray tomosynthesis, dual-energy X-ray and dynamic DR imaging. 

Find RSNA news and other videos

Piotr J. Slomka, Ph.D., FACC, research scientist in the Artificial Intelligence in Medicine Program, Department of Medicine at Cedars-Sinai, and professor of medicine in-residence of the David Geffen School of Medicine, UCLA. He explains how his team at Cedars-Sinai is working on intelligent patient risk prediction algorithms that will automatically extract information from medical imaging. He spoke on artificial intelligence (AI) development for medical imaging in sessions at the 2019 American Society of Nuclear Cardiology (ASNC) annual meeting. 

Find more articles and video on AI

Rupa Sanghani, M.D., FASNC, associate professor, Rush Medical College, director of nuclear cardiology and stress laboratory, Rush University Medical Center, and associate director, Rush Heart Center for Women, explains how to create a high-volume cardiac positron emission tomography (PET) imaging program. She spoke on this topic at the 2019 meeting of the American Society Nuclear Cardiology (ASNC) and led a tour for attendees of the PET-CT system at Rush, which was located close to the conference. 

Sanghani said the advantages of PET myocardial perfusion imaging include faster exam times and allowing additional information from coronary reserve flow assessments to better understand if revascularization will help a patient's heart recover. The 16-slice CT scanner is used not only to attenuate the PET images, but to perform a CT calcium scoring exam to assess the patient's risk for future cardiovascular events. The Rubidium-82 radiotracer used for PET exams only has a 75 second half life, so it can help increase the number of exams a center is able to perform each day. At higher volume centers, PET is optimized to handle all the patients who require pharmacological stress exams. 

In the video, Sanghani  outlines what Rush did to design its room, covers basics on training, what to look for in a scanner and other considerations when creating a PET program.

Read the article How to Start a Cardiac PET-CT Imaging Program, which includes more information from the Rush PET program.
 

Find more coverage of the ASNC

Find more news on nuclear imaging

Sunil Rao, M.D., chief of cardiology, Durham VA Health System and a professor at Duke University, and Prashant Kaul, M.D., director of the cath lab, Piedmont, Atlanta, discuss trends in radial access at the 2019 Transcatheter Cardiovascular Therapeutics (TCT) annual meeting. They discuss how radial access adoption has grown rapidly in the past few years and now makes up between 40-50 percent of percutaneous coronary intervention (PCI) procedural volume in the United States. They also discuss recent clinical trial data and the new concept of using distal radial access. 

Related Radial Access Content:

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Incorporating Distal Radial Artery Access Into Clinical Practice

VIDEO: New Frontiers in Radial Access — Interview with Mladen I. Vidovich, M.D.

Find more news and on transradial access technique and technology

Radial Access Adoption in the United States
 

Roxana Mehran, M.D., FACC, FACP, FCCP, FESC, FAHA, FSCAI, professor of medicine and director of interventional cardiovascular research and clinical trials at the Zena and Michael A. Wiener Cardiovascular Institute at Mount Sinai School of Medicine, explains the use of short dual antiplatelet therapy (DAPT) in minorities from the PLATINUM Diversity Trial. The first trial data was released in 2017, and she presented new data from the study at the 2019 Transcatheter Cardiovascular Therapeutics (TCT) meeting. 

The study looked at use of the Promus Element Plus Post-Approval Study and the clinical impact of dual-antiplatelet therapy (DAPT) cessation within 12 months of drug-eluting stent implantation in caucasians and minorities. It is one of the first large trials to stress the importance of diversity in clinical trials, which tent to reflect a population of older white men.

Find more news and videos from TCT 2019

Vivian Ng, M.D., assistant professor of medicine and an interventional cardiologist at the NewYork-Presbyterian/Columbia University Medical Center Structural Heart and Valve Center, helped organize the first Women in Structural Heart (WISH) event at the 2019 Transcatheter Cardiovascular Therapeutics (TCT) meeting. The evening session was standing room only and highlighted structural heart case presentations and discussion panels made up of all women. The session panelists and presenters were a whose-who of well known women in cardiology. The event was organized as a way to break the glass ceiling in the subspecialty of interventional cardiology, where women make up less than 5 percent of the operators.

Previous Video Interviews With Speakers and Panelists Involved in the WISH Session:

VIDEO: The Importance of the Neo-LVOT in Transcatheter Mitral Valve Replacement — Interview with Dee Dee Wang, M.D.

VIDEO: The Value of the Cardiovascular Service Line — Interview with Linda Gillam, M.D.,

VIDEO: Can We Live in 3-D Echo? — Interview with Lissa Sugeng, M.D.

VIDEO: Tricuspid Valve Imaging and Interventions Developing Hand-in-hand — Interview with Rebecca Hahn, M.D.

VIDEO: Strategies to Avoid Acute Kidney Injury Caused by Cath Lab Contrast — Interview with Roxana Mehran, M.D.,

Find more news and videos from TCT 2019

Roxana Mehran, M.D., FACC, FACP, FCCP, FESC, FAHA, FSCAI, professor of medicine and director of interventional cardiovascular research and clinical trials at the Zena and Michael A. Wiener Cardiovascular Institute at Mount Sinai School of Medicine, explains insights from the Ticagrelor With Asprin or Alone in High-Risk patients after Coronary Intervention (TWILGHT) Trial. She presented this late-breaking study at the 2019 Transcatheter Cardiovascular Therapeutics (TCT) meeting. Here is a link to the article on the TWILIGHT Trial.

Related Short DAPT Content:

VIDEO: Overview of Short DAPT in High-risk Bleeding Patients Who Receive Stents — Interview with AHA President Robert Harrington, M.D. at TCT 2019 

Onyx ONE: A Randomized Trial of a Durable-Polymer Drug-Eluting Stent vs a Polymer-Free Drug-Coated Stent in Patients at High Risk of Bleeding Treated With 1-Month DAPT - TCT 2019 late-breaker

IDEAL-LM: A Randomized Trial of a Bioabsorbable Polymer DES With 4-Month DAPT vs a Durable Polymer DES With 12-Month DAPT in Patients With Left Main Coronary Artery Disease - TCT 2019 late-breaker 

EVOLVE Short DAPT: A Single Arm Study of 3-Month DAPT in Patients at High Bleeding Risk Treated a Bioabsorbable Polymer-Based Everolimus-Eluting Stent - TCT 2019 late-breaker 

New Directions and Trends in Coronary Metallic Stents

Questions Remain on DAPT Prolongation

Find more TCT late-breaking news and video

American Heart Association President Robert Harrington, M.D., interventional cardiologist and the Arthur L. Bloomfield Professor of Medicine and chairman of the Department of Medicine at Stanford University, explains the reasons for shorter duration dual-antiplatelet therapy (DAPT) in high-risk bleeding patients. Newer-generation drug-eluting stents are designed for faster vessel healing and endothelialization, so the time required for DAPT can be reduced from 12 months to a shorter time period. At the 2019 Transcatheter Cardiovascular Therapeutics (TCT) meeting there were several late-breaking trials that looked at shorter duration DAPT or use of mono-therapy with ticagrelor. 

Related Short DAPT Content:

TWILIGHT: A Randomized Trial of Ticagrelor Monotherapy vs Ticagrelor Plus Aspirin Beginning at 3 Months in High-risk Patients Undergoing PCI - TCT 2019 late-breaker

Onyx ONE: A Randomized Trial of a Durable-Polymer Drug-Eluting Stent vs a Polymer-Free Drug-Coated Stent in Patients at High Risk of Bleeding Treated With 1-Month DAPT  - TCT 2019 late-breaker

IDEAL-LM: A Randomized Trial of a Bioabsorbable Polymer DES With 4-Month DAPT vs a Durable Polymer DES With 12-Month DAPT in Patients With Left Main Coronary Artery Disease - TCT 2019 late-breaker

EVOLVE Short DAPT: A Single Arm Study of 3-Month DAPT in Patients at High Bleeding Risk Treated a Bioabsorbable Polymer-Based Everolimus-Eluting Stent  - TCT 2019 late-breaker

Chandan Devireddy, M.D., offers insights about what he saw as the top take aways from the 2019 Transcatheter Cardiovascular Therapeutics (TCT) annual meeting. He is cath lab director at Emory University Hospital Midtown, associate professor of medicine of interventional cardiology at Emory University, and chairperson for the Society of Cardiovascular Angiography and Interventions (SCAI) Communications Committee. 

Devireddy said his key take aways from TCT 2019 were:

   • The poor results of the Boston Scientific Acurate Neo self-explaining TAVR system compared to the current devices on the U.S. market;

   • Results of the Abbott Portico TAVR system;

   • Levant Trial shows no increased mortality due to use of a paclitaxel-coated balloon; and

   • CT study of TAVR valve leaflet thrombosis.

Find more TCT late-breaking news and video

A discussion with Ruth Fisher, MBA, vice president of the Henry Ford Hospital structural heart program, and Janet Wyman, NP, program manager. They explain how Henry Ford has been able to build its program and work with hospitals throughout Michigan, including those with their own transcatheter aortic valve replacement (TAVR) programs. They said building relationships with referral centers as partners and ensuring the patients go back to their local physicians for followups and regular care is key. 

Watch the related VIDEO: Overview of the Henry Ford Hospital Structural Heart Program.

(Editor's note - this article was originally published in April 2019 and was revised Oct. 1, 2019)

Additional articles and videos on Henry Ford Hospital 

A discussion with William O’Neill, M.D., director of the Henry Ford structural heart program, Ruth Fisher, MBA, vice president of the program, and Janet Wyman, NP, program manager. Henry Ford Hospital has built a large, high-volume structural heart program that includes use of cutting edge new technologies and devices. 

Watch the related VIDEO: How to Get Referral Patients Into a Structural Heart Program — Henry Ford Hospital shares insights from its program.
 

Additional articles and videos on Henry Ford Hospital 
 

(Editor's note - this video was originally published in September 2018 and was revised September 2019)