Keeping Pace

In early August the cardiac team at CJW Medical Center's Levinson Heart Hospital, in Richmond, VA, performed the first implantation of Boston Scientific's COGNIS CRT-D. Claimed by Boston Scientific as the world's smallest, thinnest defibrillator device – coming in at 9.9mm thin – the COGNIS CRT-D is a full-featured device, which offers improved safety design, enhanced diagnostics, flexible programming options, and increased battery life for patients experiencing heart failure.

Patients with heart failure have problems keeping the left and right sides of their heart beating in synch. A CRT-D device paces both sides of the heart to restore synchrony and help the heart pump more efficiently. It also monitors for dangerous arrhythmias and delivers a shock to restore a normal rhythm as needed by the patient. The surgery to implant the first device was led by Electrophysiologist, Dr. David Gilligan.

"This is an exciting advance for the medical community and our patients who require internal defibrillators," Gilligan says. "In the past we had to make compromises between the features, battery life and size of the device. This latest generation of CRT-D means that the patient gets the best of everything."

"We are proud to be the first to use this innovative new device and thrilled that the patient is doing so well," says Lee Higginbotham, administrator of CJW Medical Center's Levinson Heart Hospital.

Key features of the COGNIS CRT-D include:

• SmartDelay
• Bi-V Trigger
• Electronic Repositioning

smallest, Thinnest, High-Energy

At 9.9mm thin and only 32.5cc, the COGNIS CRT-D is a full-featured device, offering improved safety design, enhanced diagnostics, and more flexible programming options – while providing excellent device longevity.

SmartDelay AV Optimization

Designed to deliver the accuracy of a pressure catheter without the invasiveness

• In a CRTAVO study, SmartDelay optimization for atrial sensing was 98% correlated to the accurate and reliable invasive pressure measurement LV dP/dtmax. For atrial pacing, the correlation was 96%.
• Designed to recommend an optimal AV delay to maximize LV dP/dtmax in 2.5 minutes or less.
• Independently determines paced and sensed AV delays based on three inputs:
  1. Intrinsic conduction characteristics (sensed and paced AV intervals)
  2. Interventricular timing
  3. LV lead location

Atrial Arrhythmia Management

Designed to provide additional support for biventricular pacing during atrial arrhythmias.

• Biventricular (BiV) Trigger helps deliver resynchronization therapy as prescribed.
• When used with VRR (Ventricular Rate Regulation), BiV Trigger can increase the percent of ventricular pacing during conducted atrial tachycardias and AF episodes.

Enhanced Cardiac Resynchronization Therapy

Engineered as part of an advanced therapy system to promote the delivery of customized therapy.

• Works with a broad portfolio of LV leads designed to provide stability for a wide variety of venous anatomies.
• Four LV lead fixation designs have an overall implant success rate of 97%.
• Expanded Electronic Repositioning provides even more options to clinically manage CRT pacing post-implant, including six pacing vectors with a bipolar LV lead and two pacing vectors with a unipolar LV lead.

Assurance

The CRT-D is designed with patient safety and reliability in mind.

• Designed, built and tested through Aurora, Boston Scientific Cardiac Rhythm Management's continuous quality improvement program.
• Engineered for safety with rigorously tested self-correcting software and Safety Core redundant back-up hardware.