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• Optical Coherence Tomography (OCT)/ Intravascular Ultrasound (IVUS) intervention 

What is OCT?

Optical Coherence Tomography (OCT) is an advanced, catheter-based imaging technique that
utilizes near-infrared light to generate high-resolution images of the coronary arteries and
stents. It is a valuable tool for diagnosing and managing coronary artery disease (CAD).

How OCT Works

A catheter is inserted into the coronary artery and guided to the area of interest.

Near-infrared light is used to capture detailed cross-sectional images of the artery’s inner layers.

Compared to intravascular ultrasound (IVUS), OCT provides significantly higher resolution,
allowing for precise assessment of arterial health.

What OCT Reveals

OCT enables cardiologists to visualize the microstructure of coronary arteries with exceptional
clarity, including:

Plaque Composition: Differentiates between lipid-rich, calcified, and fibrotic plaques.

Plaque Characteristics: Identifies high-risk, vulnerable plaques prone to rupture.

Stent Apposition and Expansion: Evaluates stent positioning, expansion, and potential
malapposition.

Thrombus Detection: Identifies blood clots within the arterial lumen.

Clinical Applications
Helps pinpoint culprit lesions and assess plaque burden in coronary artery disease.

Percutaneous Coronary Intervention (PCI): Optimizes stent deployment and ensures proper
apposition for improved outcomes.

Research: Advances the understanding of atherosclerosis and acute coronary syndromes by
providing detailed imaging insights.
With its superior imaging capabilities, OCT plays a crucial role in guiding interventional
cardiology procedures, improving patient outcomes, and enhancing our understanding of
coronary artery disease.

• Intravascular Lithotripsy (IVL)

What is Intravascular Ultrasound (IVUS)?
Intravascular Ultrasound (IVUS) is an advanced imaging technique that utilizes sound waves to
create detailed, real-time images of the inside of blood vessels, particularly the coronary
arteries. It plays a vital role in diagnosing artery blockages and guiding interventional
procedures like angioplasty and stenting.

How IVUS Works
1. A thin catheter with an ultrasound probe is inserted into a blood vessel, typically through the
wrist or groin, and guided to the coronary arteries.
2. The ultrasound probe emits high-frequency sound waves, which reflect off the artery walls
and surrounding tissues.
3. These reflections are converted into real-time cross-sectional images, allowing precise
visualization of the vessel’s structure.

Why IVUS is Used
● IVUS provides a comprehensive assessment of coronary artery disease by offering
insights into:
● Plaque Composition and Severity – Identifies different types of plaques and measures
their extent.
● Stent Placement and Expansion – Ensures optimal positioning and full expansion of
stents during angioplasty.
● Stent Function and Long-Term Monitoring – Detects complications such as restenosis
(re-narrowing) or malapposition.

Key Benefits of IVUS
● Enhances precision in coronary interventions.
● Provides real-time imaging for accurate clinical decision-making.
● Improves treatment outcomes by guiding optimal stent placement and post-procedure
monitoring.
By offering a detailed and accurate view of the coronary arteries, IVUS is an essential tool in
interventional cardiology, ensuring safer procedures and better patient outcomes.

• Bioresorbable Stents

• Rotablation

The principle behind rotablation is differential cutting. A rotablator is a flexible catheter with a
tiny diamond-coated burr at the tip. As the diamond-coated burr spins rapidly, it drills into the
tough, calcified plaque blocking the artery, breaking it down. The artery’s flexible walls shift
aside as the burr works, helping to protect surrounding tissue and reduce the risk of damage.
This precise approach clears the blockage while keeping the artery safe.
Since 95% of the particles created during rotablation are smaller than 5 microns, the body’s
natural clean-up system, called the reticuloendothelial system, is able to remove them safely.

• Orbital artherectomy

• Laser Angioplasty

Laser Angioplasty is an advanced and sophisticated technology to open up blocked heart
vessels. It is a lifesaving procedure for patients who had a heart attack.
It is the only technology currently available to dissolve clots within heart blood vessels. Many
blood vessel treatments that had been declared untreatable with the angioplasty can now be
treatable with Laser Angioplasty.
Laser Angioplasty aims to reduce the chance of open heart surgery and boosts the quality of life
for patients by improve clinical outcomes and reducing the time of stay at the hospital
● Precision with utmost care
● State of the art technology
● Improved quality of life
● Avoids the need for bypass surgery (open heart surgery)

Excimer Laser System

A safe and effective technique as an adjunct to conventional PCI
Excimer laser coronary angioplasty may help to solve some of the problems associated with
treating chronic total occlusions.
Excimer laser catheter can be used to ablate tissue.
Usually, the fat deposition in the coronary blood vessels are treated by Angioplasty where a
balloon will be inserted into the artery and then inflated resulting to expand and loosen the fat
deposits.In Laser Angioplasty, using lasers the plagues are vaporized.

Leadless

Overview:
A leadless pacemaker is one which is implanted directly into the heart chamber through a vein
in the leg, eliminating the need for chest incisions or leads (wires). It is designed to be smaller,
more efficient, and less invasive than traditional pacemakers, making it a breakthrough in
cardiac rhythm management.

Key Features of the LEADLESS Pacemaker:
Long Battery Life: With an estimated battery life of up to 12 -19 years, the LLP offers
long-term reliability and reduces the need for frequent replacements.
Automatic Heart Rate Adjustment: The pacemaker features adaptive pacing, meaning it
automatically adjusts the heart rate based on the patient’s activity levels, ensuring optimal
cardiac function.
Implantation in the Right Ventricle: The pacemaker is positioned in the right ventricle, where it
delivers electrical pulses to regulate the heartbeat.
Secure Fixation: The device is anchored to the heart tissue ensuring stability without damaging
heart tissue.

Benefits of the LEADLESS Pacemaker:
✔ Fewer Complications:
No leads, reducing the risk of lead fractures or infections.
Lower chance of pocket-related complications (such as infections or skin erosion).
✔ Faster Recovery:
No chest incision, leading to a quicker recovery and fewer post-procedure restrictions.
✔ Improved Quality of Life:

Conventional

• Single Chamber Pacemakers

• Dual-Chamber Pacemakers

• Left Bundle Pacing

• AICD

An Automatic Implantable Cardioverter-Defibrillator (AICD) is a small, implanted device that
monitors and corrects abnormal heart rhythms (arrhythmias). It functions as both a defibrillator
to treat life-threatening arrhythmias and, in many cases, as a pacemaker to regulate slow
heartbeats.

What is an AICD?
✔ Purpose:
Designed to detect and treat dangerous heart rhythm disorders, such as ventricular tachycardia
and ventricular fibrillation, which can lead to sudden cardiac arrest.
✔ How It Works:
● Continuously monitors the heart’s electrical activity for irregular rhythms.
● If a life-threatening arrhythmia is detected, it can deliver an electric shock to restore a
normal heartbeat.
● If the heart beats too slowly, some AICDs can function as a pacemaker, sending small
electrical pulses to stimulate heartbeats.

Types of AICDs:
1. Traditional ICD:
Leads (wires) are implanted inside the heart to monitor and correct rhythms.
2. Subcutaneous ICD (S-ICD):
Placed under the skin with no leads inside the heart, reducing lead-related complications.

Key Benefits of AICD Therapy:
✔ Prevents sudden cardiac death by delivering life-saving shocks when needed.
✔ Continuously monitors heart rhythms, ensuring rapid response to dangerous arrhythmias.
✔ Can function as a pacemaker to regulate slow heartbeats if necessary.
✔ Improves survival rates in patients at high risk of life-threatening arrhythmias.
Conclusion:
An AICD is a critical device for individuals at risk of severe cardiac arrhythmias, offering
continuous monitoring, automatic intervention, and pacemaker support when required. It plays a
vital role in preventing sudden cardiac death and improving overall heart health.

• CRT-D

Overview:
A Cardiac Resynchronization Therapy (CRT) pacemaker, also known as a biventricular
pacemaker, is a specialized device used to treat heart failure by improving the synchronization
of the heart's ventricles (lower chambers). By delivering precisely timed electrical impulses, CRT
enhances the heart’s pumping efficiency and alleviates heart failure symptoms.

How CRT Works:
CRT is designed for patients experiencing delayed electrical conduction in the ventricles, often
indicated by a wide QRS complex on an electrocardiogram (ECG). The device sends mild
electrical signals to coordinate the contractions of both ventricles, ensuring they beat in sync,
which improves cardiac output and overall heart function.

Key Features of CRT Pacemakers:
● Three Leads for Optimal Synchronization:
● One lead is placed in the right atrium.
● One in the right ventricle.
● One in the left ventricle (via the coronary sinus) to stimulate both ventricles
simultaneously.
Biventricular Pacing:
The CRT device ensures that both ventricles contract together, reducing inefficiencies in heart
function.

Two Types of CRT Devices:
1. CRT-P (Pacemaker Only): Provides pacing therapy to improve ventricular coordination.
2. CRT-D (Pacemaker + Defibrillator): Includes a built-in defibrillator to treat life-threatening
arrhythmias in high-risk patients.
3. BIV LOT Pacemaker+ defibrillator with additional left bundle pacing leads

Implantation Procedure:
● The CRT device is implanted just below the collarbone through a small incision.
● Leads are carefully positioned in the heart chambers and secured
● The device is programmed to optimize ventricular synchronization.

Benefits of CRT Therapy:
✔ Improved Heart Function: Enhances pumping efficiency and cardiac output.
✔ Symptom Relief: Reduces fatigue, shortness of breath, and fluid retention.
✔ Enhanced Quality of Life: Increases the ability to perform daily activities and exercise.
✔ Fewer Hospitalizations: Lowers the risk of heart failure-related complications and admissions.

Who Should Consider CRT?
CRT is recommended for patients with:
Moderate to severe heart failure symptoms despite optimal medical treatment.
A wide QRS complex (suggesting delayed electrical conduction).
Reduced left ventricular function (weakened heart pumping ability).

Conclusion:
Cardiac Resynchronization Therapy (CRT) is a life-improving technology for heart failure
patients experiencing ventricular dyssynchrony. By optimizing heart contractions, CRT
enhances cardiac efficiency, alleviates symptoms, and improves overall patient outcomes.

• Subcutaneous ICD

• Impella

Continuous ECG Monitoring

• Holter monitoring
• Implantable Loop Recorder

Device closure for congenital heart diseases (ASD, PDA, VSD)