The first patients have been successfully implanted with Biotronik’s Itrevia HF-T QP cardiac resynchronisation defibrillator (CRT-D) devices. Itrevia HF-T QP includes the Closed Loop Stimulation (CLS) algorithm, capable of adapting heart rate in response to physiological demands independent of body movements or respiratory rate.
Itrevia HF-T QP was recently approved by the Food and Drug Administration (FDA) for use with IS4 compatible left ventricular leads. The CRT-D device has a quadripolar header, which gives more left ventricular pacing options to optimise the CRT therapy.
“This device meets standards of other devices in the market and then adds CLS,” says Alexander Mazur, clinical associate professor from the University of Iowa in Iowa City, USA. “My patients with heart failure have greater risk of falling due to the incidence of orthostatic hypotension and it is beneficial to have the option of using CLS to treat them.”
Orthostatic hypotension occurs in 30–50% of elderly patients with disease or medication risk factors and is associated with falls, syncope and hospitalisation. The CLEAR study shows a 75% reduction in the prevalence of orthostatic hypotension with the CLS algorithm compared to an accelerometer-mechanisms that sense physical activity and require patients to be in motion before increasing their heart rate-which most other CRT-D devices use. Yet, patients need appropriate rate response regardless of whether they are actively moving or completely still. Biotronik says that CLS mimics the human nervous system more closely, responding to the patient’s metabolic changes and acute mental stress and adjusting the heart rate without relying on motion, as an accelerometer does. CLS, available in Biotronik pacemakers since 2003, has been clinically proven to be more responsive in activities of daily living than accelerometers.
Itrevia HF-T QP includes additional advanced therapies such as morphology discrimination, atrial capture control, improved ATP optimisation and more left ventricular pacing vectors. Combined, they deliver more effective therapeutic options while reducing unnecessary shocks. All devices include Biotronik Home Monitoring, the first remote monitoring system and the only system with automatic daily transmission, which has been shown to reduce all-cause mortality by more than 50% in heart failure patients.
