Spinal Cord Stimulation Hani N. Sabbah, Ph.D., FACC, FCCP, FAHA Professor of Medicine Wayne State University & Director of Cardiovascular Research
|
|
|
- Ezra Holmes
- 5 years ago
- Views:
Transcription
1 Spinal Cord Stimulation Hani N. Sabbah, Ph.D., FACC, FCCP, FAHA Professor of Medicine Wayne State University & Director of Cardiovascular Research Henry Ford Health System
2 Disclosure Information ESC 2011 Scientific Sessions Spinal Cord Stimulation H.N. Sabbah: Research Grants from and Consultant to: Boston Scientific Corp., and BioControl Medical, Ltd.
3 Increased HR NO Dys- Regulation CHF Sympathetic Overdrive & Parasympathetic Withdrawal Impaired AR Signaling Pro- Arrhythmic
4 HR Reduction (VNS & BAT) Modulate NOS (VNS & BAT) VNS-BAT-SCS Restore Autonomic Balance Reduce Sympathetic Drive Increase Parasympathetic Drive Improved AR Signaling (VNS & BAT) Anti- Arrhythmic (VNS & BAT) VNS=Vagus Nerve Stimulation BAT=Baroreflex Activation Therapy SCS=Spinal cord Stimulation
5 CardioFit VNS Device Vagus Electrode Stimulator Intracardiac Electrode
6 VNS Treatment Effect in Dogs with CHF LV End-Diastolic Volume (ml) 8 8 LV End-Systolic Volume (ml) Control VNS LV Ejection Fraction (%) Control Sabbah et al. Heart Failure Reviews 2011;16: VNS Control VNS
7 Rheos TM Electrical Activation Carotid Baroreflex System
8 15 10 BAT Treatment Effect in Dogs with CHF Control BAT 5 0 * # -5 * -10 EDV (ml) ESV (ml) EF (%) Sabbah et al, Circulation Heart Failure. 2011;4:65-70 SV (ml)
9 Cardiovascular System Innervation C 8 Cervical Nerves T 12 Thoracic Nerves L 5 Lumbar Nerves S 5 Sacral Nerves Both the Vagus nerve and spinal cord are anatomical sites where electrical stimulation can manipulate the Autonomic Nervous System.
10 Current SCS Indications Failed Back Surgery Syndrome (FBSS) - predominant radiculair leg pain Complex Regional Pain Syndrome (CRPS) - Dystrophy Refractory Angina Pectoris (not US approved, CE Marked in Europe) SCS Complications Infection: 4% 13% Dislocation electrode: 10% 22% Dura puncture: 0.5 7%
11 SCS Implantation in Epidural Space
12 Spinal Cord Stimulation in Dogs with Post-Infarction Heart Failure 1. SCS lead implanted at midline T4/T5 level 2. ICD implantation 3. AMI (intracoronary microspheres) + Rapid ventricular pacing (240 ppm) 4. Stimulation Protocol: Frequency = 50 Hz Pulse width = 0.2 ms Duty cycle 2 hrs ON 3 times daily 0.4 to 1.0 Volts Adapted from Lopshire et al., Circulation 2009;120:
13 SCS in Dogs with Post AMI Heart Failure Ambulatory Heart Rate (bpm) MEDS=Carvedilol + Ramipril SCS SCS + MEDS MEDS Control 60 HF-Baseline 10 Wk SCS Adapted from Lopshire et al., Circulation 2009;120:
14 SCS in Dogs with Post AMI Heart Failure LV End-Systolic Dimension (cm) MEDS=Carvedilol + Ramipril * HF-Baseline SCS SCS+ MEDS MEDS Control 10 Wk SCS Adapted from Lopshire et al., Circulation 2009;120:
15 SCS in Dogs with Post AMI Heart Failure LV Ejection Fraction (%) SCS SCS + MEDS MEDS Control MEDS=Carvedilol + Ramipril HF-Baseline 10 Wk SCS Adapted from Lopshire et al., Circulation 2009;120:
16 SCS in Dogs with Post AMI Heart Failure Serum Norepinephrine (pg/ml) MEDS=Carvedilol + Ramipril HF-Baseline SCS SCS + MEDS MEDS Control 10 Wk SCS Adapted from Lopshire et al., Circulation 2009;120:
17 SCS in Dogs with Post AMI Heart Failure Ischemic Tachyarrhythmias During 1 hour Circumflex Coronary Artery Occlusion No. Spontaneous Nonsustained VT SCS (RX for 5 weeks Carvedilol Control Percent of Dogs with Events (VT, VF) SCS (Rx for 5 weeks) Carvedilol Control Adapted from Lopshire et al., Circulation 2009;120:
18 Pilot SCS Study in Dogs with HF 8 Dogs with Coronary Microembolization-Induced HF (LV Ejection Fraction ~35%) Dogs Randomized into 3 study groups Control (n=4) GROUP 1: Therapy: 10 minutes On / 50 minutes Off (n=4) GROUP 2: Therapy: 90 minutes On / 90 minutes Off (n=4) All dogs treated or followed for 3 months (no background therapy)
19 Fluoroscopic Image of Implant in Epidural Space Cranial Single, Linear ST 50cm 8 Contact Lead Epidural Access: L2/L3 or L3/L4 Lead Placement: T3-T5 Stimulation: Bipolar Frequency: 50 Hz Pulse Width: 200 µs Amplitude: Set to 90% Motor Threshold (0.2 to 1.9 ma) Note: Midline Electrode Location T3-T5 Electrodes 1 and 3: Cathodes, 50% Electrodes 6 and 8: Anodes, 50%
20 Pilot SCS Study in Dogs with HF LV End-Diastolic Volume (ml) PRE-Treatment POST-Treatment LV End-Systolic Volume (ml) PRE-Treatment POST-Treatment Control Group 1 Group 2 30 Control Group 1 Group LV Ejection Fraction (%) Control Group 1 PRE-Treatment POST-Treatment Group 2
21 Comparison of the Effects of VNS, BAT and SCS on LVEF in Dogs with Coronary Microembolization-Induced Heart Failure 10 LV Ejection Fraction Treatment Effect (%) VNS BAT SCS
22 SCS for Heart Failure Stimulation n=12 65 ± 8 yrs CAD Refractory Angina n=7: CHF Symptoms NYHA Class II Multiple Crossover Phase A SCS 3X2 hr/day Phase B Conventional Output 24 hr/day Phase C 24 hr/day 0.1 volt Phase D - Control (*p = for A vs D; p = for C vs D) Control Eddicks S et al. Heart 2007;93:
23 SCS for HF in Man n=4 NYHA Class III-IV Dual site stimulation T1-T3 T9-T12 50 Hz, 0.2 msec, bipolar, output current amplitude at 90% of initial parasthesias Stimulation 2 hrs 3 times a day No echo changes were observed at 3 months Siller J, Alo KA, Torres-Aminone G et al (Abstract). HFSA 2010;16:S67
24 Determining the Feasibility of Spinal Cord Neuromodulation for the Treatment of Chronic Heart Failure (Defeat-HF) Multi-center, randomized (3:2 randomization) 30 study centers; 195 subjects (NYHA Class III; EF 35%; LVEDD = mm; QRS < 120 msec; Creatinine 3.0 mg/ml) Two arm: Treatment vs. Control 6 month follow-up (controls cross to SCS and follow-up at 12 months) Stimulation 12 hrs/day Maximally tolerated stimulation near T3-T5 Stimulation Parameters: Rate = 50 Hz, Pulse width = 0.2 ms Study Endpoints Cardiac remodeling (LV dimensions) Exercise tolerance (change in maximal oxygen uptake) Biomarker (BNP)
25 CONCLUSIONS Limited pre-clinical results in large animal models of heart failure suggest that chronic SCS therapy can improve LV systolic function and prevent progressive LV remodeling. Additional study are needed. Very small studies in patients with heart failure suggest a possible improvement in QOL indicators following SCS therapy. Phase II clinical trial underway.
26 CONCLUSIONS The results favor the continued development of SCS therapy as an adjunct to the treatment regimen of patients with chronic heart failure.
Autonomic regulation therapy for heart failure
Autonomic regulation therapy for heart failure Pre-clinical and Clinical Evidence Supporting Vagus Nerve Stimulation For Treatment of Heart Failure Inder Anand, MD, FRCP, D Phil, (Oxon.) Professor of Medicine,
Evidence of Baroreflex Activation Therapy s Mechanism of Action
Evidence of Baroreflex Activation Therapy s Mechanism of Action Edoardo Gronda, MD, FESC Heart Failure Research Center IRCCS MultiMedica Cardiovascular Department Sesto S. Giovanni (Milano) Italy Agenda
The Effect of Vagus Nerve Stimulation in Heart Failure: Primary Results of the INcrease Of VAgal TonE in chronic Heart Failure (INOVATE-HF) Trial
The Effect of Vagus Nerve Stimulation in Heart Failure: Primary Results of the INcrease Of VAgal TonE in chronic Heart Failure (INOVATE-HF) Trial Michael R Gold, Brett J Berman, Martin Borggrefe, Sanja
Cardiac devices beyond pacemaker and ICD Prof. Dr. Martin Borggrefe
Cardiac devices beyond pacemaker and ICD Prof. Dr. Martin Borggrefe Mannheim CRT studies Patient selection CRT: NYHA III-IV, EF 35%, SR, QRS 120ms, LVEDD>55mm (25-45)% Non-Responder The Concept: Cardiac
Baroreflex Activation Therapy: Integrated Autonomic Neuromodulation for Heart Failure and Hypertension
Baroreflex Activation Therapy: Integrated Autonomic Neuromodulation for Heart Failure and Hypertension Robert S. Kieval, VMD, PhD Founder & Chief Technology Officer, CVRx, Inc. Financial Disclosure I,
Μη φαρμακευτική θεραπεία στην Χρόνια Καρδιακή Ανεπάρκεια Νεότερες συσκευές. Ξυδώνας Σωτήριος, MD, PhD, FESC
ΠΑΝΕΛΛΗΝΙΑ ΣΕΜΙΝΑΡΙΑ ΟΜΑΔΩΝ ΕΡΓΑΣΙΑΣ 2017 ΟΜΑΔΑ ΕΡΓΑΣΙΑΣ ΚΑΡΔΙΑΚΗΣ ΑΝΕΠΑΡΚΕΙΑΣ Μη φαρμακευτική θεραπεία στην Χρόνια Καρδιακή Ανεπάρκεια Νεότερες συσκευές Ξυδώνας Σωτήριος, MD, PhD, FESC Καρδιολογικό Τμήμα,
BackBeat Cardiac Neuromodulation Therapy (CNT) for Immediate, Substantial and Sustained Lowering of Blood Pressure. Daniel Burkhoff MD PhD
BackBeat Cardiac Neuromodulation Therapy (CNT) for Immediate, Substantial and Sustained Lowering of Blood Pressure Daniel Burkhoff MD PhD Director Heart Failure, Hemodynamics and Mechanical Support Research
ICD Guidelines: who benefits from an ICD?
ICD Guidelines: who benefits from an ICD? Matthew Bennett Cardiac Electrophysiologist Vancouver Coastal Health, Device Lead Associate Professor, UBC Matthew.bennett@vch.ca Disclosures I have research collaborations
ESC Stockholm Arrhythmias & pacing
ESC Stockholm 2010 Take Home Messages for Practitioners Arrhythmias & pacing Prof. Panos E. Vardas Professor of Cardiology Heraklion University Hospital Crete, Greece Disclosures Small teaching fees from
Dialysis-Dependent Cardiomyopathy Patients Demonstrate Poor Survival Despite Reverse Remodeling With Cardiac Resynchronization Therapy
Dialysis-Dependent Cardiomyopathy Patients Demonstrate Poor Survival Despite Reverse Remodeling With Cardiac Resynchronization Therapy Evan Adelstein, MD, FHRS John Gorcsan III, MD Samir Saba, MD, FHRS
Innovation therapy in Heart Failure
Innovation therapy in Heart Failure P. Laothavorn September 2015 Topics of discussion Basic Knowledge about heart failure Standard therapy New emerging therapy References: standard Therapy in Heart Failure
Cardiac Devices CRT,ICD: Who is and is not a Candidate? Who Decides
Cardiac Devices CRT,ICD: Who is and is not a Candidate? Who Decides Colette Seifer MB(Hons) FRCP(UK) Associate Professor, University of Manitoba, Cardiologist, Cardiac Sciences Program, St Boniface Hospital
The Role of ICD Therapy in Cardiac Resynchronization
The Role of ICD Therapy in Cardiac Resynchronization The Korean Society of Circulation 15 April 2005 Angel R. León, MD Carlyle Fraser Heart Center Division of Cardiology Emory University School of Medicine
Introducing the COAPT Trial
physician INFORMATION Eligible patients Symptomatic functional mitral regurgitation 3+ Not suitable candidates for open mitral valve surgery NYHA functional class II, III, or ambulatory IV Introducing
Device Therapy for Heart Failure
Device Therapy for Heart Failure Dr. Shelley Zieroth FRCPC Assistant Professor, Cardiology, University of Manitoba Director of Cardiac Transplant and Heart Failure Clinics St Boniface General Hospital,
Do All Patients With An ICD Indication Need A BiV Pacing Device?
Do All Patients With An ICD Indication Need A BiV Pacing Device? Muhammad A. Hammouda, MD Electrophysiology Laboratory Department of Critical Care Medicine Cairo University Etiology and Pathophysiology
The Role of Ventricular Electrical Delay to Predict Left Ventricular Remodeling With Cardiac Resynchronization Therapy
The Role of Ventricular Electrical Delay to Predict Left Ventricular Remodeling With Cardiac Resynchronization Therapy Results from the SMART-AV Trial Michael R. Gold, MD, PhD, Ulrika Birgersdotter-Green,
Devices and Other Non- Pharmacologic Therapy in CHF. Angel R. Leon, MD FACC Division of Cardiology Emory University School of Medicine
Devices and Other Non- Pharmacologic Therapy in CHF Angel R. Leon, MD FACC Division of Cardiology Emory University School of Medicine Disclosure None University of Miami vs. OSU Renegade Miami football
CRT-P or CRT-D From North Alberta to Nairobi
CRT-P or CRT-D From North Alberta to Nairobi Dr Mzee Ngunga Aga Khan University Hospital Nairobi KCS Congress: Impact through collaboration CONTACT: Tel. +254 735 833 803 Email: kcardiacs@gmail.com Web:
CHRONIC HEART FAILURE : WHAT ELSE COULD WE OFFER TO OUR PATIENTS? Cardiac Rehabilitation Society of Thailand
CHRONIC HEART FAILURE : WHAT ELSE COULD WE OFFER TO OUR PATIENTS? Cardiac Rehabilitation Society of Thailand ENHANCED EXTERNAL COUNTER PULSATION Piyanuj Ruckpanich, MD. Cardiac Rehabilitation Center Perfect
Cardiac Resynchronization ICD Therapy: What is New?
Cardiac Resynchronization ICD Therapy: What is New? Emile Daoud, MD Section Chief, Cardiac Electrophysiology Professor of Medicine The Ohio State University Normal Activation, Narrow QRS Synchrony Abnormal
MADIT Studies: CRT in the Non-LBBB Patient and Other Findings. Arthur J. Moss, MD
MADIT Studies: CRT in the Non-LBBB Patient and Other Findings Arthur J. Moss, MD University of Rochester Medical Cntr. Rochester, NY 13 th Annual New Frontiers in Heart Failure Rx NYC, NY January 26, 2013
Vagus nerve stimulation: A new approach to reduce heart failure
NEW DRUGS AND TECHNOLOGIES IN CARDIOLOGY Cardiology Journal 2010, Vol. 17, No. 6, pp. 638 643 Copyright 2010 Via Medica ISSN 1897 5593 Vagus nerve stimulation: A new approach to reduce heart failure Helmut
Thoranis Chantrarat MD
Device Therapy in Heart Failure Thoranis Chantrarat MD 1 Scope of presentation Natural history of heart failure Primary and secondary prevention ICD and its indication CRT and its indication 2 Severity
Chapter 9, Part 2. Cardiocirculatory Adjustments to Exercise
Chapter 9, Part 2 Cardiocirculatory Adjustments to Exercise Electrical Activity of the Heart Contraction of the heart depends on electrical stimulation of the myocardium Impulse is initiated in the right
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE Implantable cardioverter defibrillators for the treatment of arrhythmias and cardiac resynchronisation therapy for the treatment of heart failure (review
Therapeutic Targets and Interventions
Therapeutic Targets and Interventions Ali Valika, MD, FACC Advanced Heart Failure and Pulmonary Hypertension Advocate Medical Group Midwest Heart Foundation Disclosures: 1. Novartis: Speaker Honorarium
EHRA Accreditation Exam - Sample MCQs Cardiac Pacing and ICDs
EHRA Accreditation Exam - Sample MCQs Cardiac Pacing and ICDs Dear EHRA Member, Dear Colleague, As you know, the EHRA Accreditation Process is becoming increasingly recognised as an important step for
Catheter-based mitral valve repair MitraClip System
Percutaneous Mitral Valve Repair: Results of the EVEREST II Trial William A. Gray MD Director of Endovascular Services Associate Professor of Clinical Medicine Columbia University Medical Center The Cardiovascular
Focus on Rehabilitation, Exercise and Surgical Coronary Revascularization
Focus on Rehabilitation, Exercise and Surgical Coronary Revascularization Sam Haddad, MD Kenneth O Reilly, MD Disclosure of Commercial or Pharma Support NTD Learning Objectives At the conclusion of this
Bi-Ventricular pacing after the most recent studies
Seminars of the Hellenic Working Groups February 18th-20 20,, 2010, Thessaloniki, Greece Bi-Ventricular pacing after the most recent studies Maurizio Lunati MD Director EP Lab & Unit Cardiology Dpt. Niguarda
Percutaneous Mitral Valve Repair
Percutaneous Mitral Valve Repair MitraClip: Procedure, Data, Patient Selection Chad Rammohan, MD FACC Director, Cardiac Cath Lab El Camino Hospital Mountain View, California Mitral Regurgitation MitraClip
Cardiac Resynchronization Therapy Guidelines and Missing Groups
Cardiac Resynchronization Therapy Guidelines and Missing Groups Frank Pelosi, Jr., MD, FACC, FHRS Director, Cardiac Electrophysiology Fellowship Associate Professor of Medicine University of Michigan Health
New in Heart Failure SGK autumn session 2012
New in Heart Failure SGK autumn session 2012 Roger Hullin Cardiology Department of Internal Medicine Centre Universitaire Hospitaler Vaudois University of Lausanne ESC Heart Failure Guidelines 2012 Classes
Take-home Messages from Recent Heart Failure Trials: Heart Rate as a Target
Take-home Messages from Recent Heart Failure Trials: Heart Rate as a Target JEFFREY S. BORER, M.D. Professor and Chairman, Department of Medicine and Chief, Division of Cardiovascular Medicine; Director,
Aldosterone Antagonism in Heart Failure: Now for all Patients?
Aldosterone Antagonism in Heart Failure: Now for all Patients? Inder Anand, MD, FRCP, D Phil (Oxon.) Professor of Medicine, University of Minnesota, Director Heart Failure Program, VA Medical Center 111C
CRT-D or CRT-P: HOW TO CHOOSE THE RIGHT PATIENT?
CRT-D or CRT-P: HOW TO CHOOSE THE RIGHT PATIENT? Alessandro Lipari, MD Chair and Department of Cardiology University of Study and Spedali Civili Brescia -Italy The birth of CRT in Europe, 20 years ago
New devices in heart failure: an European Heart Rhythm Association report
Europace Advance Access published November 20, 2013 Europace doi:10.1093/europace/eut311 EHRA STATEMENT New devices in heart failure: an European Heart Rhythm Association report Developed by the European
Heart Failure Overview. Dr Chris K Y Wong
Heart Failure Overview Dr Chris K Y Wong Heart Failure: A Growing, Global Health Issue Heart Failure 23 Million Afflicted Global Impact Worldwide ~23 million peopleworldwide afflicted with CHF 1 Exceeds
Controversies in Cardiac Pharmacology
Controversies in Cardiac Pharmacology Thomas D. Conley, MD FACC FSCAI Disclosures I have no relevant relationships with commercial interests to disclose. 1 Doc, do I really need to take all these medicines?
Can point of care cardiac biomarker testing guide cardiac safety during oncology trials?
Can point of care cardiac biomarker testing guide cardiac safety during oncology trials? Daniel J Lenihan, MD Professor, Division of Cardiovascular Medicine Director, Clinical Research Vanderbilt University
All in the Past? Win K. Shen, MD Mayo Clinic Arizona Controversies and Advances in CV Diseases Cedars-Sinai Heart Institute, MFMER
ICD for NICM All in the Past? Win K. Shen, MD Mayo Clinic Arizona Controversies and Advances in CV Diseases Cedars-Sinai Heart Institute, 2017 2017 MFMER 3686275-1 DISCLOSURE Relevant Financial Relationship(s)
Primary prevention of SCD with the ICD in Nonischemic Cardiomyopathy
Primary prevention of SCD with the ICD in Nonischemic Cardiomyopathy Michael R Gold, MD, PhD Medical University of South Carolina Charleston, SC USA Disclosures: Consulting and Clinical Trials Medtronic
Atrial Fibrillation Ablation in Patients with Heart Failure
Atrial Fibrillation Ablation in Patients with Heart Failure Eleftherios M. Kallergis, MD, PhD, FESC Cardiology Department, Heraklion University Hospital Since auricular fibrillation so often complicates
1. LV function and remodeling. 2. Contribution of myocardial ischemia due to CAD, and
1 The clinical syndrome of heart failure in adults is commonly associated with the etiologies of ischemic and non-ischemic dilated cardiomyopathy, hypertrophic cardiomyopathy, hypertensive heart disease,
His Bundle Pacing in Bundle Branch Block May 11, 2017
His Bundle Pacing in Bundle Branch Block May 11, 2017 Gopi Dandamudi, MD FHRS System Medical Director, IUH Cardiac EP Program Director, IUH Atrial Fibrillation Center Assistant Professor of Clinical Medicine
TRATTAMENTO INTERVENTISTICO. Dr. Antonio Sagone
TRATTAMENTO INTERVENTISTICO Dr. Antonio Sagone 1 Heart Failure Prevalence & Prognosis Over 26 million people worldwide suffer from heart failure, a chronic, progressive condition in which the heart muscle
Heart Failure Overview. Dr Chris K Y Wong
Heart Failure Overview Dr Chris K Y Wong Heart Failure: A Growing, Global Health Issue Heart Failure 23 Million Afflicted Global Impact Worldwide ~23 million peopleworldwide afflicted with CHF 1 Exceeds
Transcatheter Mitral Valve Repair and Replacement: Where is the Latest Randomized Evidence Taking US Mitral-Fr, COAPT
Transcatheter Mitral Valve Repair and Replacement: Where is the Latest Randomized Evidence Taking US Mitral-Fr, COAPT and Saibal Kar, MD, FACC, FSCAI Professor of Medicine Director of Interventional Cardiac
Baroreflex Stimulation Devices
Medical Policy Manual Surgery, Policy No. 183 Baroreflex Stimulation Devices Next Review: September 2019 Last Review: September 2018 Effective: November 1, 2018 IMPORTANT REMINDER Medical Policies are
How to treat Cardiac Resynchronization Therapy complications? C. Leclercq Departement of Cardiology Centre Cardio-Pneumologique Rennes, France
How to treat Cardiac Resynchronization Therapy complications? C. Leclercq Departement of Cardiology Centre Cardio-Pneumologique Rennes, France Presenter Disclosure Information Christophe Leclercq, MD,
8/8/2011. CARDIAC RESYCHRONIZATION THERAPY for Heart Failure. Case Presentation. Case Presentation
CARDIAC RESYCHRONIZATION THERAPY for Heart Failure James Taylor, DO, FACOS Cardiothoracic and Vascular surgery San Angelo Community Medical Center San Angelo, TX Case Presentation 64 year old female with
Heart 101. Objectives. Types of Heart Failure How common is HF? Sign/Symptoms, when to see a doctor? Diagnostic testing
EXAMING HEART FAILURE: HOW TO RECOGNIZE AND TREAT THE WEAK HEART What is Heart Failure? Treatment of Heart Failure End Stage Heart Failure Munir S. Janmohamed M.D. FACC Assistant Clinical Professor of
Arthur J. Moss, MD Professor of Medicine/Cardiology University of Rochester Medical Center Rochester, NY. DISCLOSURE INFORMATION Arthur J.
Saving Lives and Preventing Heart Failure: The MADIT Family of Trials Arthur J. Moss, MD Professor of Medicine/Cardiology University of Rochester Medical Center Rochester, NY Update in Electrocardiography
Supplementary Online Content
Supplementary Online Content Inohara T, Manandhar P, Kosinski A, et al. Association of renin-angiotensin inhibitor treatment with mortality and heart failure readmission in patients with transcatheter
BENEFIT OF CRT IN MILDLY SYMPTOMATIC HEART FAILURE RECENT DATA FROM MADIT-CRT AND RAFT
BENEFIT OF CRT IN MILDLY SYMPTOMATIC HEART FAILURE RECENT DATA FROM MADIT-CRT AND RAFT Ilan Goldenberg MD Professor of Cardiology Sheba Medical Center and Tel Aviv University, Israel University of Rochester
Risk Stratification of Sudden Cardiac Death
Risk Stratification of Sudden Cardiac Death Michael R Gold, MD, PhD Medical University of South Carolina Charleston, SC USA Disclosures: None Sudden Cardiac Death A Major Public Health Problem > 1/2 of
Ventricular Assist Device: Are Early Interventions Superior? Hamang Patel, MD Section of Cardiomyopathy & Heart Transplantation
Ventricular Assist Device: Are Early Interventions Superior? Hamang Patel, MD Section of Cardiomyopathy & Heart Transplantation Objectives Current rationale behind use of MCS Patient Selection Earlier?
How to Approach the Patient with CRT and Recurrent Heart Failure
How to Approach the Patient with CRT and Recurrent Heart Failure Byron K. Lee MD Associate Professor of Medicine Electrophysiology and Arrhythmia Section UCSF Update in Electrocardiography and Arrhythmias
HEART FAILURE AN OMINOUS DISEASE
HEART FAILURE AN OMINOUS DISEASE Conflicts of Interest I Have No Conflicts of Interest to Disclose Objective At the conclusion of this presentation, the participants will be able to identify benefits and
IMPLANTABLE DEVICE THERAPY FOR HEART FAILURE
IMPLANTABLE DEVICE THERAPY FOR HEART FAILURE Nora Goldschlager, M.D. MACP, FACC, FAHA, FHRS Cardiology San Francisco General Hospital UCSF Disclosures: None LEADING CAUSES OF DEATH IN US Sudden cardiac
Beta-blockers in Patients with Mid-range Left Ventricular Ejection Fraction after AMI Improved Clinical Outcomes
Beta-blockers in Patients with Mid-range Left Ventricular Ejection Fraction after AMI Improved Clinical Outcomes Seung-Jae Joo and other KAMIR-NIH investigators Department of Cardiology, Jeju National
Catheter Based Denervation for Heart Failure
Catheter Based Denervation for Heart Failure David E. Kandzari, MD, FACC, FSCAI Chief Scientific Officer Director, Interventional Cardiology Piedmont Heart Institute Atlanta, Georgia david.kandzari@piedmont.org
Properties of Pressure
OBJECTIVES Overview Relationship between pressure and flow Understand the differences between series and parallel circuits Cardiac output and its distribution Cardiac function Control of blood pressure
PHYSICAL AND SEXUAL ACTIVITIES
Forgotten problems in HF PHYSICAL AND SEXUAL ACTIVITIES Massimo F Piepoli, MD, PhD, FESC, FACC Heart Failure Unit, Guglielmo da Saliceto Hospital, Piacenza m.piepoli@alice.it No disclosures Massimo Speaker
This is What I do to Improve CRT Response for CRT Non-Responders
This is What I do to Improve CRT Response for CRT Non-Responders Michael R Gold, MD, PhD Medical University of South Carolina Charleston, SC Disclosures: Steering Committees (unpaid) and Clinical Trials,
AS Level OCR Cardiovascular System
AS Level OCR Cardiovascular System Learning Objectives The link between the Cardiac Cycle and the Conduction system of the heart. The relationship between Stroke volume, Heart rate and Cardiac Output.
THE CARDIOVASCULAR SYSTEM. Heart 2
THE CARDIOVASCULAR SYSTEM Heart 2 PROPERTIES OF CARDIAC MUSCLE Cardiac muscle Striated Short Wide Branched Interconnected Skeletal muscle Striated Long Narrow Cylindrical PROPERTIES OF CARDIAC MUSCLE Intercalated
HEART FAILURE. Ali Mehr, MD, FACC
HEART FAILURE Ali Mehr, MD, FACC Advanced Heart Failure and Transplant Cardiologist Director, Echocardiography Lab Phoenix VA Health Care System Associate Professor of Medicine University of Arizona, COM,
Ventricular Arrhythmias
Presenting your most challenging cases Venice Arrhythmias Ventricular Arrhythmias Gioia Turitto, MD Presenter Disclosure Information A questionable indication for CRT-D in a patient with VT after successful
Novel Approaches to VT Management Glenn M Polin MD
Novel Approaches to VT Management Glenn M Polin MD Medical Director, Electrophysiology Laboratory John Ochsner Heart and Vascular Institute New Orleans, LA Disclosures Pfizer Speaker Bureau Bristol Myers
NT-proBNP: Evidence-based application in primary care
NT-proBNP: Evidence-based application in primary care Associate Professor Rob Doughty The University of Auckland, Auckland City Hospital, Auckland Heart Group NT-proBNP: Evidence in Primary Care The problem
Qu attendre de la technologie pour un meilleur suivi? (traitement) D Gras, MD, Nantes, France
Qu attendre de la technologie pour un meilleur suivi? (traitement) D Gras, MD, Nantes, France New Technologies in CRT How do they impact daily clinical practice? Septal CRT Dual-Site LV CRT Quadripolar
Randomized Trial to Optimize the Dose and Efficacy of Beta-Blocker in Systolic Heart Failure: Japanese Chronic Heart Failure (J-CHF) Study
82th AHA Meeting Nov 17, 2009 Orlando, USA Presenter Disclosure Information Randomized Trial to Optimize the Dose and Efficacy of Beta-Blocker in Systolic Heart Failure: Japanese Chronic Heart Failure
Association between RV Function in PPCM and LV Recovery & Clinical Outcome
Association between RV Function in PPCM and LV Recovery & Clinical Outcome Lori A Blauwet, MD, MA Associate Professor of Medicine Co-Director, Cardio-OB Clinic Mayo Clinic Rochester, MN USA 2016 MFMER
Left Ventricular Ejection Fraction >35%
Controversies in Cardiac Resynchronisation Therapy Left Ventricular Ejection Fraction >35% Professor John GF Cleland University of Hull Kingston-upon-Hull United Kingdom Conflict of Interest: I have received
Heart Failure Management. Waleed AlHabeeb, MD, MHA Assistant Professor of Medicine Consultant Heart Failure Cardiologist
Heart Failure Management Waleed AlHabeeb, MD, MHA Assistant Professor of Medicine Consultant Heart Failure Cardiologist Heart failure prevalence is expected to continue to increase¹ 21 MILLION ADULTS WORLDWIDE
New Agents for Heart Failure: Ivabradine Jeffrey S. Borer, MD
New Agents for Heart Failure: Ivabradine Jeffrey S. Borer, MD Professor of Medicine, Cell Biology, Radiology and Surgery Director, The Howard Gilman Institute for Heart Valve Disease and the Schiavone
Managing the Low Output Low Gradient Aortic Stenosis Patient
Managing the Low Output Low Gradient Aortic Stenosis Patient R A Nishimura MD Judd and Mary Leighton Professor of CV Mayo Clinic No disclosures Valvular Stenosis Severity of Aortic Stenosis Mean gradient
Implantable cardioverter-defibrillators and cardiac resynchronization therapy
Implantable cardioverter-defibrillators and cardiac resynchronization therapy Johannes Holzmeister, MD University Hospital Zurich, Zurich, Switzerland Frontiers of heart failure controversies, ESC - Paris
Chronic. Outline. Congestive^ Heart Failure: Update on Effective Monitoring and Treatment. Heart Failure Epidemiology. Michael G.
Chronic Congestive^ Heart Failure: Update on Effective Monitoring and Treatment Michael G. Shlipak, MD, MPH Professor of Medicine, UCSF Chief, Division of General Internal Medicine, SFVA Medical Center
Sudden Cardiac Death What an electrophysiologist thinks a cardiologist should know
Sudden Cardiac Death What an electrophysiologist thinks a cardiologist should know Steven J. Kalbfleisch, M.D. Medical Director Electrophysiology Laboratory Ross Heart Hospital Wexner Medical Center Sudden
Autonomic imbalance characterized by. Electrical vagus nerve stimulation for the treatment of chronic heart failure
HANI N. SABBAH, PhD, FACC, FCCP, FAHA Department of Medicine, Division of Cardiovascular Medicine, Henry Ford Heart & Vascular Institute, Henry Ford Hospital, Detroit, MI Electrical vagus nerve stimulation
Fibrillazione atriale e scompenso: come interrompere il circolo vizioso.
Alessandria, September 23 th 2017 Fibrillazione atriale e scompenso: come interrompere il circolo vizioso. Professor Fiorenzo Gaita Chief of the Cardiovascular Department Città della Salute e della Scienza
Chronic. Outline. Congestive^ Heart Failure: Update on Effective Monitoring and Treatment. Heart Failure Epidemiology
Chronic Congestive^ Heart Failure: Update on Effective Monitoring and Treatment Michael G. Shlipak, MD, MPH Professor of Medicine, UCSF Chief, Division of General Internal Medicine, SFVA Medical Center
During exercise the heart rate is 190 bpm and the stroke volume is 115 ml/beat. What is the cardiac output?
The Cardiovascular System Part III: Heart Outline of class lecture After studying part I of this chapter you should be able to: 1. Be able to calculate cardiac output (CO) be able to define heart rate
Atrial Fibrillation Ablation in Patients with Heart Failure
Atrial Fibrillation Ablation in Patients with Heart Failure Eleftherios M. Kallergis, MD, PhD, FESC Cardiology Department, Heraklion University Hospital Since auricular fibrillation so often complicates
Reshape/Coapt: do we need more? Prof. J Zamorano Head of Cardiology University Hospital Ramon y Cajal, Madrid
Reshape/Coapt: do we need more? Prof. J Zamorano Head of Cardiology University Hospital Ramon y Cajal, Madrid Patient records 76 y.o. male Hypertension. Dyslipidemia. OPLD. Smoked in the past. Diabetes
Sinus rhythm with premature atrial beats 2 and 6 (see Lead II).
Cardiac Pacemaker Premature Beats When one of ectopic foci becomes irritable, it may spontaneously fire, leading to one or more premature beats. Atrial and junctional foci may become irritable from excess
ICD. Guidelines and Critical Review of Trials. Win K. Shen, MD Professor of Medicine Mayo Clinic College of Medicine Mayo Clinic Arizona Torino 2011
ICD Guidelines and Critical Review of Trials Win K. Shen, MD Professor of Medicine Mayo Clinic College of Medicine Mayo Clinic Arizona Torino 2011 Disclosure Relevant Financial Relationship(s) None Off
First question: Does CRT Work in AF?
CRT in AF Does it work and when to ablate AF versus AV node Maurizio Gasparini Chief EP and Pacing Unit Humanitas Research Hospital, Rozzano - Milano, Italy First question: Does CRT Work in AF? As any
Rationale for Prophylactic Support During Percutaneous Coronary Intervention
Rationale for Prophylactic Support During Percutaneous Coronary Intervention Navin K. Kapur, MD, FACC, FSCAI Assistant Director, Interventional Cardiology Director, Interventional Research Laboratories
HF and CRT: CRT-P versus CRT-D
HF and CRT: CRT-P versus CRT-D Andrew E. Epstein, MD Professor of Medicine, Cardiovascular Division University of Pennsylvania Chief, Cardiology Section Philadelphia VA Medical Center Philadelphia, PA
Effects of heart rate reduction with ivabradine on left ventricular remodeling and function:
Systolic Heart failure treatment with the If inhibitor ivabradine Trial Effects of heart rate reduction with ivabradine on left ventricular remodeling and function: results of the SHIFT echocardiography
Heart failure and sudden death
Heart failure and sudden death What did we learn so far from important ICD- and CRT trials? Helmut U. Klein M.D. University of Rochester Medical Center Heart Research Follow up Program Arrhythmic substrate
Preventing Sudden Death Current & Future Role of ICD Therapy
Preventing Sudden Death Current & Future Role of ICD Therapy Derek V Exner, MD, MPH, FRCPC, FACC, FAHA, FHRS Professor, Libin Cardiovascular Institute of Alberta Canada Research Chair, Cardiovascular Clinical
Selective Cardiac Myosin Activators in Heart Failure
Selective Cardiac Myosin Activators in Heart Failure John McMurray Eugene Braunwald Scholar in Cardiovascular Diseases, Brigham and Women s Hospital, Boston & Visiting Professor, Harvard Medical School
Chapter 13 The Cardiovascular System: Cardiac Function
Chapter 13 The Cardiovascular System: Cardiac Function Overview of the Cardiovascular System The Path of Blood Flow through the Heart and Vasculature Anatomy of the Heart Electrical Activity of the Heart
Neuromodulation Device Therapy for Treatment of Hypertensive Heart Disease
Circulation Journal Official Journal of the Japanese Circulation Society http://www.j-circ.or.jp REVIEW Neuromodulation Device Therapy for Treatment of Hypertensive Heart Disease Thomas M. Todoran, MD;
Ray Matthews MD Professor of Clinical Medicine Chief of Cardiology University of Southern California
High Risk PCI Making Possible the Impossible Ray Matthews MD Professor of Clinical Medicine Chief of Cardiology University of Southern California Disclosures Abiomed Research Support Consulting Agreement