Alert Internal Cardioversion System

Alert™ Catheter being positioned in the heart prior to shocking

The Alert™ Catheter should only be used by physicians who have been appropriately trained in the use of the The Alert™ Catheter. The following instruction serves only as a reminder of specific points for those physicians already trained in this procedure.

The Alert™ Catheter maybe introduced via the femoral or bracchial arteries using an 8F standard introducer sheath. Catheters can also be introduced via the jugular and subclavian veins though this is less common. Under fluoroscopic guidance the Alert™Catheter can be guided in to the right atrium where the balloon may be inflated with air using the 2cc syringe provided in the package.

The Alert™ Catheter should then be rotated and pushed forward such that the tip passes through the tricuspid valve and up in to the outflow tract of the right ventricle. By keeping forward pressure on the catheter whilst twisting the Alert™Catheter clockwise and anticlockwise, the inflated balloon will often progress up the inside of the outflow tract and in to the pulmonary artery. Because of the curvature on the catheter it has a tendency to favour the Right PA. Internal Cardioversion with the distal tip in this position is often  successful but not as successful as placing the tip in the Left PA. To move the catheter to the Left PA, a curved stylet should be inserted in the clear ported lumen and pushed to the hilt of the stylet. The stylet will not exit the distal end of the catheter and will stop about 1cm from the tip. The whole catheter should then be eased backwards until the Alert™Catheter reaches the Left PA junction. It should then be pushed forward and in to the left PA. The stylet should then be removed and the proximal array positioned against the right atrial free wall (see fluoro schematic below)

If the stylet is difficult to move forwards or backwards in the body of the catheter, it usually means that the catheter has excessive curvature and the remedy is simply to straighten the catheter somewhat before moving the stylet again. Under no circumstances should the stylet be forced forwards or backwards as this may result in a tear to the fabric of the catheter.

The Alert™Catheter should then be connected to the Companion™ Energy Delivery System and a shock delivered according to the instructions provided with the Companion™.