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Frequently Asked Questions - Professionals

Questions about the use and benefits of Synchromax®.

What is Synchromax?

Synchromax®is the first and only equipment for non-invasive evaluation of cardiac electrical synchronicity.

Ventricular dyssynchrony delays the activation of the left ventricle from the right ventricle (they should normally be activated simultaneously). This leads to deterioration of heart function that can lead to heart failure in severe cases.

Synchromax®is based on a simple principle: the processing of the surface ECG signal by a unique and patented software produces aSynchromax Index and two Synchromax Curves.

In what situations is Synchromax useful?

Before, during and after the implantation of any device (pacemaker, defibrillator, resynchronizer)

Before the implant
To evaluate the degree of synchrony of the patient to better decide if an implant will correct the problem.

During implantation
As a guide to find the optimal stimulation site and achieve the best possible ventricular synchrony.

After implantation
For optimal device programming.

Are there other tools to evaluate heart synchrony?

The only accepted non-invasive method for this is echocardiography. But it requires specialized personnel and equipment, takes up much of the time available in the room, is not reproducible, is not always reliable, and is operator dependent.

Are there any types of patients that cannot be evaluated by Synchromax?

Any patient who needs a synchrony evaluation or is indicated for device implantation can benefit from the Synchromax®technique.

There is documented evidence that septal stimulation is extremely valuable for patients. Optimal septal stimulation is easily achieved with Synchromax®on any device. Good stimulation, sensing and defibrillation thresholds are obtained.

Who uses it?

Synchromax is intended primarily for the electrophysiologist in the situations described above; but it is also useful to the clinical cardiologist, who may be able to better diagnose his patients and decide when to refer them to a specialist.

The cardiologist may also evaluate the degree of synchronicity before and after the implant. Synchromax®is also useful for the implant surgeon who no longer depends on his colleagues for the best stimulation site

What are the benefits for the Synchromax user?

For the doctor

  • To offer your patients the best option in terms of cardiac synchrony.
  • Save operating time1 and X-ray exposure.
  • Avoid the use of special accessories.
  • Delegate the handling of Synchromax®to a technician (more time saving)
  • Better income in your private practice by becoming a specialist who offers different procedures than your colleagues.
  • If incorporation into the vade mecum is achieved, the physician can bill the procedure as a Cardiac Synchrony Evaluation or Synchrony Analysis Guided Implant. Both deserve higher fees than conventional diagnostics or implants.
  • Easily identify those who will be non-responders to resynchronization
  • Implanting defibrillators in the septal region (less time, no accessories, safe implants) an approach that was not available until now.

For the Health System

  • Avoid buying expensive resynchronizers from non-responders.
  • Resolve patient dyssynchrony with a standard pacemaker in the septal area instead of a resynchronizer that is worth 10 times more.
  • Synchromax®facilitates parahisian implants without the need for special catheters or sheaths whose cost is sometimes similar to that of a pacemaker.
  • Optimize time and resources through faster procedures, with less need for infrastructure and in many cases less human resources.
  • Lower the likelihood of complications.

1. Physiologic pacing is a trending topic all around. Instead of the traditional pacing site in the right ventricular apex, physicians are now pacing the His bundle (HBP) which can be selective or non-selective. This latter is also called septal pacing. Regular selective HBP takes from 90 to 120 minutes while a Synchromax-guided non-selective (or para-Hisian) implant is performed in 30 minutes.

Is there a real benefit in using Synchromax for the evaluation and/or programming of those patients who are considered "non-responders" to cardiac resynchronization therapy (patients with dilated cardiomyopathy, Heart Failure, NYHA functional class III/IV or IV/V, with normal QRS and PR)?

Yes, of course. It is precisely for this and many other reasons that Synchromax®was conceived as a diagnostic tool that allows the physician to evaluate, prior to implantation, whether the patient really needs resynchronization therapy or not.

As for patients with narrow QRS and hemodynamic failure, the study of synchrony based on the Synchromax®technique is an excellent tool that allows screening this type of patients, they can be treated with both hisian and parahisian implants, which would allow an improvement in ventricular function without losing the basal morphology of their QRS.

This is a theoretical speculation, since dyssynchrony in narrow QRS and heart failure is a very recent finding, found although in a high percentage (63%), not in the totality of this type of patients, demonstrating it on the basis of calculating acute IV or Dp/Dt pressures, thus confirming the benefit of therapy before implanting a device.

Is there an increased risk of complications when performing a Synchromax-guided Ventricular (Parahisian) electrode implant?

The risk of complications associated to this implant site is very reduced since the Septum has a muscle mass that is even safer than that of free wall. No adverse effects have been reported to date.

By definition the calculation for the evaluation of ventricular synchrony using the Synchromax is based on the D2 and V6 curves. In relation to this, there is no overall evaluation in relation to all walls, but rather only to the septal and lateral walls.

Synchromax®performs a cross-correlation between DII and V6 because what we wanted to correct in patients with LBBB was the delay in the activation of the LV lateral wall, a situation that can cause mitral insufficiency, pulmonary hypertension and other anomalies.

The analysis of the amplified DII and V6 shunts allows us to observe that there are frequently intramuscular conduction anomalies with nicked and fragmented QRS (like a "W"), which are corrected by stimulating the parahisian region, transforming into curves that, although wide, have a sinuous inscription.

This may lead to the conclusion that a clear correction for the defect has been obtained, however, this has not been clinically evaluated and is under study if it produces an improvement in the ejection fraction in the future.