Πρόληψη του ΑΚΘ σε ασθενείς με μη-ισχαιμική μυοκαρδιοπάθεια:
|
|
- Cuthbert Copeland
- 6 years ago
- Views:
Transcription
1 Πρόληψη του ΑΚΘ σε ασθενείς με μη-ισχαιμική μυοκαρδιοπάθεια: Νεώτερα δεδομένα στη διαστρωμάτωση κινδύνου Εμμ. Μ. Κανουπάκης MD, PhD, FESC Πανεπιστημιακό Νοσοκομείο Ηρακλείου
2 NIDCM Presence of LV dilatation and LV systolic dysfunction Absence of abnormal loading conditions or CAD prevalence: 36-40/ individuals incidence: 5-8 cases/100000/year 5-year mortality from 70% in the early 1980s to approximately 20% nowadays Maron B et al, Circulation 2006;113:
3 Final common pathway of Infections viral, often producing myocarditis bacterial, fungal, rickettsial, mycobacterial parasitic (Chagas disease) Toxins alcohol, chemotherapeutic agents, metals Autoimmune and systemic disorders collagen vascular disorders Neuromuscular disorders dystrophies Mitochondrial, metabolic, endocrine and nutritional disorders Familial (~25%) incomplete and age-dependent penetrance Maron B et al, Circulation 2006;113:
4 SCD & NIDCM Why is NIDCM arrhythmogenic? How to prevent SCD in NIDCM? How to stratify the risk?
5 Pathology in NIDCM Diffuse presence of: reactive (interstitial) & reparative (replacement) fibrosis creating patchy areas. 60% in autopsy Myofiber disarray, with variable degrees of myocyte hypertrophy and atrophy. de Leeuw N et al, Traspl Int 2001;14:299
6 EP substrate in NIDCM Abnormal fractionated electrograms due to lines of activation block from fibrosis Wu et al, J Am Coll Cardiol 1998;32:187 96
7 EP substrate in NIDCM Generation of reentrant wavefronts de Bakker et al, JACC 1996;27:1071
8 VA mechanisms in NIDCM Soejima K et al, JACC 2004;43:
9 Ventricular arrhythmias in NIDCM Frequent ventricular ectopy: up to 87% Non-sustained ventricular tachycardia: 49-60% Sustained monomorphic VT: 3-4% per year Sudden Cardiac Death 10 15% of all SCDs are due to DCM SCD accounts for at least 30% of all deaths in DCM Eckhardt et al, ESC textbook 2009
10 SCD & NIDCM Why is NIDCM arrhythmogenic? How to prevent SCD in NIDCM? How to stratify the risk?
11 Evidence-based medicine Randomized controlled trials Consensus guidelines Clinical practice
12 CAT trial 104 pts recent-onset (<9mo) NIDCM, LVEF<30%, NYHA II & III ICD vs. medical therapy alone Only 3.8% of pts on β-blocker therapy The survival was excellent in both groups The trial was stopped for futility All-cause mortality was not different in either short-term or long-term follow-up Prognosis in NIDCM differs significantly from that of ICM Circulation 2002;105:
13 AMIOVERT 103 pts NIDCM and NSVT, LVEF <35% and NYHA I III ICD vs. amiodarone Prematurely stopped Inability to demonstrate that ICDs are better than amiodarone in reducing mortality Amiodarone was more cost effective and had a better arrhythmia-free survival rate at 3 years than ICDs Should amiodarone be the initial choice in patients with NIDCM, especially in those with NSVT? J Am Coll Cardiol 2003;41:
14 DEFINITE 458 pts NIDCM, EF<35% & NSVT and/or PVCs Optimal medical therapy ± ICD Only 5% on amiodarone Arrhythmic death was significantly reduced in the ICD group All-cause mortality benefit was not demonstrated Routine implantation of an ICD not recommended for all patients with NIDCM N Engl J Med 2004;350:
15 SCD-HeFT 1211 pts NYHA II or III LVEF <35% Amiodarone did not improve survival ICD therapy reduced mortality compared with placebo but not statistically significant Limited benefit of ICD therapy in NIDCM primary prevention N Engl J Med 2005;352:
16 RCT on ICD primary prevention in NIDCM ICD may reduce the risk of SD but total mortality is not significantly modified
17 ACCF/AHA/HRS Guidelines 2012 Class I, level of evidence B ICD is recommended for primary prevention, to reduce total mortality by reducing SCD in patients with: Non-ischaemic dilated cardiomyopathy LVEF 35 % NYHA class II III Optimal Medical Therapy (duration not defined) Contraindications: Life expectancy <1 year, important comorbidities Epstein et al. JACC 2013;61:e6 75
18 ACCF/HRS/AHA/ASE/HFSA/SCAI/SCCT/SCMR Appropriate use criteria 2013 Russo et al. JACC 2013;61:
19 Recent onset NIDCM & improvement 2/3 of pts with NIDCM and SCD-HeFT criteria at presentation did not maintain ICD indications 3 to 9 months later with optimal medical therapy. Am J Cardiol 2012;109: In a multicenter cohort of recent onset NIDCM the risk of SCD was low at 1% per year J Cardiac Fail 2012;18: Patients with new-onset systolic HF have both a good chance of LVEF recovery and low 6-month mortality. Am Heart J 2012;164: These data support delaying ICD implantation
20 How many primary prevention pts benefit from ICD? Only 5 7% of RCT participants with DCM received an appropriate shock per year. NNT: 25 to prevent 1 death at 2 years
21 LVEF limitations Odds ratio: 2.58 Sensitivity: 71.1% Specificity: 50.5% In order to achieve adequate risk stratification for clinical decision making with a high level of discrimination, odds ratios>15-20 are likely necessary. Goldberger J et al, JACC in press
22 EF sensitivity Maastricht Circulatory Arrest Registry The absolute number of SCD victims (who had EF measured before their arrest) was highest in the normal EF category Gorgels et al, Eur Heart J 2003; 24: Stecker et al, JACC 2006;47:1161-6
23 SCD & NIDCM Why is NIDCM arrhythmogenic? How to prevent SCD in NIDCM? How to stratify the risk?
24 From evidence-based to personalized medicine
25 Towards personalized medicine tailoring of medical treatment to the individual characteristics of each patient. doesn t mean the creation of drugs or medical devices that are unique to a patient BUT rather the ability to classify individuals into subpopulations that differ in their susceptibility to a particular disease or their response to a specific treatment.
26 Personalized medicine in NIDCM The combination of LVEF with other markers identifies high- and low-risk patients in a better manner. Especially, those at low risk for ventricular tachyarrhythmias despite low EFs.
27 Risk stratification tools extent of myocardial damage and scar formation LVEF slowed conduction QRS duration, SAECG heterogeneities in ventricular repolarization QT interval, QT dispersion, T-wave alternans imbalance in autonomic tone HRV, heart rate turbulence, baroreceptor sensitivity ventricular ectopy Holter, EP study Goldberger J et al, JACC 2008;52:
28 Risk markers...not promising Fragmented QRS prognostic power not confirmed in a recent prospective trial QT dispersion methodological problems in measurement HRV, BRS, HR turbulence not statistically significant predictors
29 NSVT in NIDCM After medical stabilization, NSVT did not increase the risk of major VA in patients with DCM and LVEF 0.35 Zecchin et al, PACE 2008; 31:
30 Reappraisal of the role of EPS Induction of VT/VF during EPS, in contrast to LVEF, was the only single independent prognostic factor for future ICD activation. Gatzoulis et al, Circ Arrhythm Electrophysiol. 2013;6:
31 T-wave alternans TWA is directly linked to cellular arrhythmia mechanisms arising from sympathetic nerve activity and abnormalities in calcium handling
32 T-wave alternans High negative predictive value BUT No randomized trial to confirm that TWA identify DCM pts at low risk of SD among those with LVEF 35%.
33 The killer is fibrosis detected by serum markers and imaging techniques
34 Serum markers of fibrosis in NIDCM J Am Coll Cardiol 2010;55: Am Heart J 2012;164:530-7
35 Serum markers of fibrosis in NIDCM Serum markers of collagen turnover could predict arrhythmic events in ICD recipients Kanoupakis et al, J Am Coll Cardiol 2010;55:2753 9
36 Analysis of delayed enhancement images
37 LGE-CMR differentiates cardiomyopathies Stirrat et al, Canadian Journal of Cardiology 2013;29:
38 MR assessment of scar in NIDCM Scar distribution can identify the substrate for inducible VT and may identify high-risk patients with NIDCM currently missed by EF criteria. Nazarian et al, Circulation 2005;112:
39 Incidence of midwall fibrosis in NIDCM In 101 pts affected by NIDCM midwall fibrosis was present in 35% of patients Assomull R et al, JACC 2006;48:
40 Midwall fibrosis & prognosis in NIDCM Pts with fibrosis had a significantly worse outcome of the primary end point, allcause death or cardiac hospitalization and a significantly greater incidence of the secondary end point of SCD/VT. Assomull R et al, JACC 2006;48:
41 Midwall fibrosis & prognosis in NIDCM The association between the extent of fibrosis and outcome was better than for established prognostic parameters such as LVESV, LVEDV and LVEF. Assomull R et al, JACC 2006;48:
42 Fibrosis & Events Midwall fibrosis provided independent prognostic information and reclassified patients as high or low risk Gulati et al, JAMA 2013;309:
43 LGE-CMR studies with arrhythmic endpoints High negative predictive value BUT No randomized trial to confirm that LGE-CMR identify DCM pts at low risk of SD among those with LVEF 35%.
44 Familial NIDCM: 25% of cases Heart Failure Society of American Practice Guidelines Useful to consider the more common disease genes and mutations which are associated with a well-known phenotype. LMNA mutations high arrhythmic risk Dystrophin mutations - high risk of end-stage HF LMNA genetic testing for all DCM patients Hershberger et al. J Card Fail 2009;15:83 97
45 ACCF/HRS/AHA/ASE/HFSA/SCAI/SCCT/SCMR Appropriate use criteria 2013 Russo et al. JACC 2013;61:
46 A decision-making algorithm
47 The dilemma The conflict between guideline-based medicine and personalized medicine Withhold a therapy that is recommended or supported by the guidelines but that may not be beneficial for an individual patient. Future expectation If a subpopulation may not benefit from the therapy, it is important to identify the subpopulation and verify this finding in an appropriate clinical trial.
48
Εμφύτευση απινιδωτών για πρωτογενή πρόληψη σε ασθενείς που δεν περιλαμβάνονται στις κλινικές μελέτες
Εμφύτευση απινιδωτών για πρωτογενή πρόληψη σε ασθενείς που δεν περιλαμβάνονται στις κλινικές μελέτες Δημήτριος M. Κωνσταντίνου Ειδικός Καρδιολόγος, MD, MSc, PhD, CCDS Πανεπιστημιακός Υπότροφος Dr. Konstantinou
More informationVentricular Tachycardia Ablation. Saverio Iacopino, MD, FACC, FESC
Ventricular Tachycardia Ablation Saverio Iacopino, MD, FACC, FESC ü Ventricular arrhythmias, both symptomatic and asymptomatic, are common, but syncope and SCD are infrequent initial manifestations of
More informationICD. 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
More informationRisk 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
More informationPrevention of Sudden Death in ARVC
ESC Munich, August 29, 2012 Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC): Prevention of Sudden Death in ARVC Thomas Wichter, MD, FESC Professor of Medicine - Cardiology Marienhospital Osnabrück
More informationThe 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
More informationSilvia G Priori MD PhD
The approach to the cardiac arrest survivor Silvia G Priori MD PhD Molecular Cardiology, IRCCS Fondazione Salvatore Maugeri Pavia, Italy AND Leon Charney Division of Cardiology, Cardiovascular Genetics
More information20 ng/ml 200 ng/ml 1000 ng/ml chronic kidney disease CKD Brugada 5 Brugada Brugada 1
Symposium 39 45 1 1 2005 2008 108000 59000 55 1 3 0.045 1 1 90 95 5 10 60 30 Brugada 5 Brugada 80 15 Brugada 1 80 20 2 12 X 2 1 1 brain natriuretic peptide BNP 20 ng/ml 200 ng/ml 1000 ng/ml chronic kidney
More information2017 AHA/ACC/HRS Ventricular Arrhythmias and Sudden Cardiac Death Guideline. Top Ten Messages. Eleftherios M Kallergis, MD, PhD, FESC
2017 AHA/ACC/HRS Ventricular Arrhythmias and Sudden Cardiac Death Guideline Top Ten Messages Eleftherios M Kallergis, MD, PhD, FESC Cadiology Department - Heraklion University Hospital No actual or potential
More informationDo 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
More informationDialysis-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
More informationRisk prediction in inherited conditions Laminopathies
Risk prediction in inherited conditions Laminopathies Karim Wahbi Cochin hospital, Paris karim.wahbi@aphp.fr Risk prediction in laminopathies Current approach for risk stratification A new score to predict
More informationSudden 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
More informationPVCs: Do they cause Cardiomyopathy? Raed Abu Sham a, M.D.
PVCs: Do they cause Cardiomyopathy? Raed Abu Sham a, M.D. Cardiologist and Electrophysiologist No conflict of interest related to this presentation Objectives 1. PVCs are benign. What is the Evidence?
More informationROLE OF THE SIGNAL ECG IN RISK STRATIFICATION OF SCD. An overview
ROLE OF THE SIGNAL ECG IN RISK STRATIFICATION OF SCD. An overview Nabil El-Sherif, MD SUNY - Downstate Medical Center & New York harbor VA Healthcare System Brooklyn, NY, USA Signal Averaged ECG: A Selective
More informationΕκθορηίζεις απινιδωηή και θνηηόηηηα: μέθοδοι μείωζης ηων θεραπειών απινίδωζης
Εκθορηίζεις απινιδωηή και θνηηόηηηα: μέθοδοι μείωζης ηων θεραπειών απινίδωζης Εμμ. Μ. Κανοσπάκης Καρδιολογική Κλινική Πανεπιζηημίοσ Κρήηης Lessons from large trials Conditioning Rhythm and Electrical Therapy
More informationSUDDEN CARDIAC DEATH(SCD): Definition
SUDDEN CARDIAC DEATH EPIDEMIOLOGY, PATHOPHYSIOLOGY, PREVENTION & THERAPY Hasan Garan, M.D. Columbia University Medical Center SUDDEN CARDIAC DEATH(SCD): Definition DEATH DUE TO A CARDIAC CAUSE IN A CLINICALLY
More informationSUDDEN CARDIAC DEATH(SCD): Definition
SUDDEN CARDIAC DEATH EPIDEMIOLOGY, PATHOPHYSIOLOGY, PREVENTION & THERAPY Hasan Garan, M.D. Columbia University Medical Center SUDDEN CARDIAC DEATH(SCD): Definition DEATH DUE TO A CARDIAC CAUSE IN A CLINICALLY
More informationPreventing 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
More informationArrhythmias and Heart Failure Dr Chris Lang Consultant Cardiologist and Electrophysiologist Royal Infirmary of Edinburgh
Arrhythmias and Heart Failure Dr Chris Lang Consultant Cardiologist and Electrophysiologist Royal Infirmary of Edinburgh Arrhythmias and Heart Failure Ventricular Supraventricular VT/VF Primary prevention
More informationSudden cardiac death: Primary and secondary prevention
Sudden cardiac death: Primary and secondary prevention By Kai Chi Chan Penultimate Year Medical Student St George s University of London at UNic Sheba Medical Centre Definition Sudden cardiac arrest (SCA)
More informationNoninvasive Predictors of Sudden Cardiac Death
2011 년순환기관련학회춘계통합학술대회 Noninvasive Predictors of Sudden Cardiac Death 영남대학교의과대학순환기내과학교실신동구 Diseases associated with SCD Previous SCD event Prior episode of ventricular tachyarrhythmia Previous myocardial
More informationPrimary 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
More informationInherited Arrhythmia Syndromes
Inherited Arrhythmia Syndromes When to perform Genetic testing? Arthur AM Wilde February 4, 2017 Which pts should undergo genetic testing? SCD victims with a likely diagnosis Pts diagnosed with an inherited
More informationArrhythmias Focused Review. Who Needs An ICD?
Who Needs An ICD? Cesar Alberte, MD, Douglas P. Zipes, MD, Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, IN Sudden cardiac arrest is one of the most common causes
More informationWho does not need a primary preventive ICD?
Who does not need a primary preventive ICD? Hildegard Tanner, Bern Universitätsklinik für Kardiologie Disclosure of potential conflicts of interest Travel grants for educational purposes from: Biosense
More informationHeart 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
More informationHF 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
More informationICD Therapy. Disclaimers
ICD Therapy Rodney Horton, MD Texas Cardiac Arrhythmia Institute Texas Cardiovascular, PA Austin, TX Speaker s Bureau St. Jude Medical Medtronic Boston Scientific Disclaimers Clinical Advisory Panel St.
More informationXVth Balkan Congress of Radiology Danubius Hotel Helia, October 2017, Budapest, Hungary
XVth Balkan Congress of Radiology Danubius Hotel Helia, 12-14 October 2017, Budapest, Hungary Ružica Maksimović MRI in Myocarditis Faculty of Medicine, University of Belgrade, Centre for Radiology and
More informationΕνδείξεισ εμφύτευςησ απινιδωτή ςτην «γκρίζα ζώνη» Γεώργιοσ Ανδρικόπουλοσ, MD, PhD, Αν. Δ/ντήσ Καρδιολογικήσ Κλινικήσ ΓΝΑ «Ερρίκοσ Ντυνάν»
Ενδείξεισ εμφύτευςησ απινιδωτή ςτην «γκρίζα ζώνη» Γεώργιοσ Ανδρικόπουλοσ, MD, PhD, Αν. Δ/ντήσ Καρδιολογικήσ Κλινικήσ ΓΝΑ «Ερρίκοσ Ντυνάν» Major Implantable Cardioverter-Defibrillator Trials for Prevention
More informationSummary, conclusions and future perspectives
Summary, conclusions and future perspectives Summary The general introduction (Chapter 1) of this thesis describes aspects of sudden cardiac death (SCD), ventricular arrhythmias, substrates for ventricular
More informationVentricular tachycardia and ischemia. Martin Jan Schalij Department of Cardiology Leiden University Medical Center
Ventricular tachycardia and ischemia Martin Jan Schalij Department of Cardiology Leiden University Medical Center Disclosure: Research grants from: Boston Scientific Medtronic Biotronik Sudden Cardiac
More informationThe implantable cardioverter defibrillator is not enough: Ventricular Tachycardia Catheter Ablation in Patients with Structural Heart Disease
The implantable cardioverter defibrillator is not enough: Ventricular Tachycardia Catheter Ablation in Patients with Structural Heart Disease Paolo Della Bella, MD Arrhythmia Department and Clinical Electrophysiology
More informationHYPERTROPHIC CARDIOMYOPATHY RISK STRATIFICATION WHAT IS NEW?
HYPERTROPHIC CARDIOMYOPATHY RISK STRATIFICATION WHAT IS NEW? Division of Inherited Cardiac Diseases Heart Center for the Young and Athletes A Dpt of Cardiology University of Athens LANCET 2013 ESC HCM
More informationJean François Leclercq Department of Rythmology Private Hospital of Parly 2 - Le Chesnay F
SECONDARY PREVENTION of Sudden Death: in which patients? Jean François Leclercq Department of Rythmology Private Hospital of Parly 2 - Le Chesnay F Why an AID is effective? Because it stoppes a VT very
More informationJournal of the American College of Cardiology Vol. 41, No. 12, by the American College of Cardiology Foundation ISSN /03/$30.
Journal of the American College of Cardiology Vol. 41, No. 12, 2003 2003 by the American College of Cardiology Foundation ISSN 0735-1097/03/$30.00 Published by Elsevier Inc. doi:10.1016/s0735-1097(03)00467-4
More informationTachycardia Devices Indications and Basic Trouble Shooting
Tachycardia Devices Indications and Basic Trouble Shooting Peter A. Brady, MD., FRCP Cardiology Review Course London, March 6 th, 2014 2011 MFMER 3134946-1 Tachycardia Devices ICD Indications Primary and
More informationSudden death as co-morbidity in patients following vascular intervention
Sudden death as co-morbidity in patients following vascular intervention Impact of ICD therapy Seah Nisam Director, Medical Science, Guidant Corporation Advanced Angioplasty Meeting (BCIS) London, 16 Jan,
More informationName of Presenter: Marwan Refaat, MD
NAAMA s 24 th International Medical Convention Medicine in the Next Decade: Challenges and Opportunities Beirut, Lebanon June 26 July 2, 2010 I have no actual or potential conflict of interest in relation
More informationSyncope in Heart Failure Patients How to judge and treat? Jean-Claude Deharo, MD, FESC Marseilles, France
Syncope in Heart Failure Patients How to judge and treat? Jean-Claude Deharo, MD, FESC Marseilles, France Syncope in advanced heart failure: high risk of sudden death N = 491 patients with HF (NYHA III-IV)
More informationInteresting EP Cases Catheter ablation to treat congestive heart failure (CHF)
Interesting EP Cases Catheter ablation to treat congestive heart failure (CHF) Yiming WU, MD, PhD. Alaska heart and vascular institute. ywu@alaskaheart.com 907-561-3211 19 yo man transferred for out side
More informationAntiarrhythmic Drugs and Ablation in Patients with ICD and Shocks
Antiarrhythmic Drugs and Ablation in Patients with ICD and Shocks Alireza Ghorbani Sharif, MD Interventional Electrophysiologist Tehran Arrhythmia Clinic January 2016 Recurrent ICD shocks are associated
More informationTachycardias II. Štěpán Havránek
Tachycardias II Štěpán Havránek Summary 1) Supraventricular (supraventricular rhythms) Atrial fibrillation and flutter Atrial ectopic tachycardia / extrabeats AV nodal reentrant a AV reentrant tachycardia
More informationICD THERAPIES: are they harmful or just high risk markers?
ICD THERAPIES: are they harmful or just high risk markers? Konstantinos P. Letsas, MD, PhD, FESC LAB OF CARDIAC ELECTROPHYSIOLOGY EVANGELISMOS GENERAL HOSPITAL ATHENS ICD therapies are common In a meta-analysis
More informationThe Therapeutic Role of the Implantable Cardioverter Defibrillator in Arrhythmogenic Right Ventricular Dysplasia
The Therapeutic Role of the Implantable Cardioverter Defibrillator in Arrhythmogenic Right Ventricular Dysplasia By Sandeep Joshi, MD and Jonathan S. Steinberg, MD Arrhythmia Service, Division of Cardiology
More informationΔιαχείρηση Ασυμπτωματικού ασθενούς με ΗΚΓ τύπου Brugada
Διαχείρηση Ασυμπτωματικού ασθενούς με ΗΚΓ τύπου Brugada Άννα Κωστοπούλου Επιμελήτρια Α Ωνάσειο Καρδιοχειρουργικό Κέντρο Τμήμα Ηλεκτροφυσιολογίας και Βηματοδότησης BrS: Diagnosis 5:10000 First described
More informationSudden Cardiac Death in Heart Failure: What do we need to know in 2018? Juan M. Aranda, Jr. MD FACC
Sudden Cardiac Death in Heart Failure: What do we need to know in 2018? Juan M. Aranda, Jr. MD FACC Professor of Medicine Director of Heart Failure and Cardiac Transplantation University of Florida Disclosures
More informationManagement of Syncope in Heart Failure. University of Iowa
Management of Syncope in Heart Failure Brian Olshansky University of Iowa 1 Syncope Transient loss of consciousness, with rapid, usually complete, recovery, with or without prodrome A common, non-specific,
More informationIMPLANTABLE 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
More informationMEDICAL POLICY SUBJECT: MICROVOLT T-WAVE ALTERNANS
MEDICAL POLICY PAGE: 1 OF: 6 If the member's subscriber contract excludes coverage for a specific service it is not covered under that contract. In such cases, medical policy criteria are not applied.
More informationThe International Classification of Diseases, Tenth Revision,
AHA/ACCF/HRS Scientific Statement American Heart Association/American College of Cardiology Foundation/Heart Rhythm Society Scientific Statement on Noninvasive Risk Stratification Techniques for Identifying
More informationDeclaration of conflict of interest. None
Declaration of conflict of interest None Implantable cardioverter-defibrillator in patients with Chagas cardiomyopathy. Can we extrapolate results from the big trials? Dr. Santiago Nava Townsend National
More informationRole of CMR in heart failure and cardiomyopathy
Role of CMR in heart failure and cardiomyopathy Hajime Sakuma Department of Radiology, Mie University Late gadolinium enhancement (LGE) LGE MRI can demonstrate site of necrosis, fibrosis or deposition
More informationNATIONAL 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
More informationNew scientific documents from EHRA Management of patients with defibrillator shocks
New scientific documents from EHRA Management of patients with defibrillator shocks Frieder Braunschweig MD PhD FESC Karolinska University Hospital Stockholm, Sweden Evolution of ICD therapy Worldwide
More informationWhen to ablate patients with premature ventricular complexes?
When to ablate patients with premature ventricular complexes? Nikolaos Fragakis Assistant Professor, FESC 3rd University Cardiology Department Hippokration Hospital, Thessaloniki 58 year-old female Case
More informationHeart Failure Treatments
Heart Failure Treatments Past & Present www.philippelefevre.com Background Background Chronic heart failure Drugs Mechanical Electrical Background Chronic heart failure Drugs Mechanical Electrical Sudden
More informationArrhythmias (II) Ventricular Arrhythmias. Disclosures
Arrhythmias (II) Ventricular Arrhythmias Amy Leigh Miller, MD, PhD Cardiovascular Electrophysiology, Brigham & Women s Hospital Disclosures None Rhythms and Mortality Implantable loop recorder post-mi
More informationRisk Factors for Sudden cardiac Death
Risk Factors for Sudden cardiac Death A. Arenal Arrhythmias in competitive sports Disclosure Conflict of interest Advisory board: Medtronic, Boston Scientific Research grants: Medtronic, Boston Scientific,
More informationDefibrillation threshold testing should no longer be performed: contra
Defibrillation threshold testing should no longer be performed: contra Andreas Goette St. Vincenz-Hospital Paderborn Dept. of Cardiology and Intensive Care Medicine Germany No conflict of interest to disclose
More informationThe patient with (without) an ICD and heart failure: Management of electrical storm
ISHNE Heart Failure Virtual Symposium April 2008 The patient with (without) an ICD and heart failure: Management of electrical storm Westfälische Wilhelms-Universität Münster Günter Breithardt, MD, FESC,
More informationImplantable Cardioverter Defibrillator Therapy in MADIT II Patients with Signs and Symptoms of Heart Failure
Implantable Cardioverter Defibrillator Therapy in MADIT II Patients with Signs and Symptoms of Heart Failure Wojciech Zareba Postinfarction patients with left ventricular dysfunction are at increased risk
More informationImportance of CRT team for optimization of the results: a European point of view
Importance of CRT team for optimization of the results: a European point of view Matteo Bertini, MD, PhD Arcispedale S. Anna Azienda Ospedaliero-Universitaria Cona-Ferrara No conflict of interest to declare
More informationEXPERT CONSENSUS DOCUMENT
EXPERT CONSENSUS DOCUMENT American Heart Association/American College of Cardiology Foundation/Heart Rhythm Society Scientific Statement on Noninvasive Risk Stratification Techniques for Identifying Patients
More informationAll 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)
More informationLeft ventricular non-compaction: the New Cardiomyopathy on the Block
Left ventricular non-compaction: the New Cardiomyopathy on the Block Aamir Jeewa MB BCh, FAAP, FRCPC Section Head, Cardiomyopathy & Heart Function Program The Hospital for Sick Children Assistant Professor
More informationDevices 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
More informationLifeVest. Sven Reek, Aarau. Conflict of interest: none
LifeVest Sven Reek, Aarau Conflict of interest: none WCD (LifeVest, ZOLL, Pittsburg,PA) Technical aspects Wearable garment with 4 dry ECG electrodes (detection) 3 defibrillation pads External defibrillator
More informationΔΠΔΜΒΑΣΙΚΗ ΘΔΡΑΠΔΙΑ ΚΟΙΛΙΑΚΩΝ ΑΡΡΤΘΜΙΩΝ
ΔΠΔΜΒΑΣΙΚΗ ΘΔΡΑΠΔΙΑ ΚΟΙΛΙΑΚΩΝ ΑΡΡΤΘΜΙΩΝ ΣΔΛΙΟ ΠΑΡΑΚΔΤΑÏΓΗ ΓΙΔΤΘΤΝΣΗ ΔΤ Α Καρδιολογική Κλινική ΑΠΘ, Νοζοκομείο ΑΧΕΠΑ, Θεζζαλονίκη NO CONFLICT OF INTEREST INTRODUCTION Sustained VT is an important cause
More informationSyncope in patients with inherited arrhythmogenic syndromes. Is it enough to justify ICD implantation?
Innovations in Interventional Cardiology and Electrophysiology Thessaloniki 2014 Syncope in patients with inherited arrhythmogenic syndromes. Is it enough to justify ICD implantation? K. Letsas, MD, FESC
More informationPattarapong Makarawate MD, FHRS Assistant Professor. Division Of Cardiology Faculty of Medicine, Khon Kaen University
Pattarapong Makarawate MD, FHRS Assistant Professor. Division Of Cardiology Faculty of Medicine, Khon Kaen University 1. Important and impact of ICD in primary prevention 2. Risk stratification for ICD
More informationHeart Rhythm Disorders. How do you quantify risk?
Heart Rhythm Disorders How do you quantify risk? Heart Rhythm Disorders Scale of the Problem 1/2 population will have an episode of transient loss of consciousness (T-LOC) at some stage in their life.
More information1. 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,
More informationVentricular 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
More informationCardiac 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
More informationwhile the absence of LGE-CMR may reduce the need for ICD implantation in patients with NIDM who are at low risk for future VF/VT or SCD.
Midwall replacement fibrosis with late gadolinium enhancement LGE-CMR imaging as an independent predictor of mortality and utility of Cardiovascular Magnetic Resonance Image One-third of all patients with
More informationCardiac 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
More informationRole of Ablation of AF and PVCs in the Management of Heart Failure
Role of Ablation of AF and PVCs in the Management of Heart Failure Cara Pellegrini, MD, FHRS Acting Chief, Cardiology, SF VA Associate Professor of Medicine, UCSF Disclosures I have nothing to disclose
More informationArrhythmogenic Cardiomyopathy cases. Δέσποινα Παρχαρίδου Καρδιολόγος Επιστημονικός Συνεργάτης Α Καρδιολογική κλινική ΑΧΕΠΑ
Arrhythmogenic Cardiomyopathy cases Δέσποινα Παρχαρίδου Καρδιολόγος Επιστημονικός Συνεργάτης Α Καρδιολογική κλινική ΑΧΕΠΑ Definition ARVD (Arrhythmogenic Right Ventricular Dysplasia) Progressive loss of
More informationAdvanced MR Imaging in Myocarditis
Naeem Merchant MD FRCP Professor of Medicine Department of Radiology Department of Cardiac Sciences Cumming School of Medicine University of Calgary Advanced MR Imaging in Myocarditis The Lake Louise Criteria
More informationSudden Cardiac Death and Asians Disclosures
Sudden Cardiac Death and Asians Disclosures 7 February 2009 Asian Heart and Vascular Symposium None Zian H. Tseng, M.D., M.A.S. Assistant Professor of Medicine Cardiac Electrophysiology Section University
More informationUsefulness of Delayed Enhancement by Magnetic Resonance Imaging in Hypertrophic Cardiomyopathy as a Marker of Disease and Its Severity
Usefulness of Delayed Enhancement by Magnetic Resonance Imaging in Hypertrophic Cardiomyopathy as a Marker of Disease and Its Severity G.D.Aquaro, MD Fondazione G.Monasterio Regione Toscana/CNR Pisa, Italy
More informationThe patient with electric storm
The complex patient in the cardiac care unit: The patient with electric storm Helmut U. Klein University of Rochester Medical Center Heart Research Follow-up Program and Isar Heart Center Muenchen Presenter
More informationCT for Myocardial Characterization of Cardiomyopathy. Byoung Wook Choi, Yonsei University Severance Hospital, Seoul, Korea
CT for Myocardial Characterization of Cardiomyopathy Byoung Wook Choi, Yonsei University Severance Hospital, Seoul, Korea Cardiomyopathy Elliott P et al. Eur Heart J 2008;29:270-276 The European Society
More informationWhat Every Physician Should Know:
What Every Physician Should Know: The Canadian Heart Rhythm Society estimates that, in Canada, sudden cardiac death (SCD) is responsible for about 40,000 deaths annually; more than AIDS, breast cancer
More informationPearls of the ESC/ERS Guidelines 2015 Channelopathies
Pearls of the ESC/ERS Guidelines 2015 Channelopathies Carina Blomstrom Lundqvist Dept Cardiology, Uppsala, Sweden Content 2015 ESC Guidelines for the Management of Patients with Ventricular Arrhythmias
More informationT-Wave Alternans. Policy # Original Effective Date: 06/05/2002 Current Effective Date: 09/17/2014
Applies to all products administered or underwritten by Blue Cross and Blue Shield of Louisiana and its subsidiary, HMO Louisiana, Inc.(collectively referred to as the Company ), unless otherwise provided
More information03/17/16, 03/16/17, 03/15/18 CATEGORY: Technology Assessment. Proprietary Information of Excellus Health Plan, Inc.
MEDICAL POLICY SUBJECT: MICROVOLT T-WAVE ALTERNANS, PAGE: 1 OF: 6 If a product excludes coverage for a service, it is not covered, and medical policy criteria do not apply. If a commercial product, including
More information4/14/15. The Electrocardiogram. In jeopardy more than a century after its introduction by Willem Einthoven? Time for a revival. by Hein J.
The Electrocardiogram. In jeopardy more than a century after its introduction by Willem Einthoven? Time for a revival. by Hein J. Wellens MD 1 Einthoven, 1905 The ECG! Everywhere available! Easy and rapid
More informationRecurrent Implantable Defibrillator Discharges (ICD) Discharges ICD Storm
Recurrent Implantable Defibrillator Discharges (ICD) Discharges ICD Storm Guy Amit, MD, MPH Soroka University Medical Center Ben-Gurion University of the Negev Beer-Sheva, Israel Disclosures Consultant:
More informationSynopsis of Management on Ventricular arrhythmias. M. Soni MD Interventional Cardiologist
Synopsis of Management on Ventricular arrhythmias M. Soni MD Interventional Cardiologist No financial disclosure Premature Ventricular Contraction (PVC) Ventricular Bigeminy Ventricular Trigeminy Multifocal
More informationESC 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
More informationWhat s new in Hypertrophic Cardiomyopathy?
What s new in Hypertrophic Cardiomyopathy? Dr Andris Ellims HCM Clinic @ The Alfred Hypertrophic Cardiomyopathy = otherwise unexplained LV hypertrophy* 1 in 500 prevalence most common inherited cardiovascular
More informationContinuing Cardiology Education
Continuing Cardiology Education REVIEW ARTICLE Risk stratification for the primary prevention of arrhythmic sudden cardiac death in post-infarction patients Part II: Cardiac magnetic resonance and electrophysiological
More informationCorporate Medical Policy
Corporate Medical Policy File Name: Origination: Last CAP Review: Next CAP Review: Last Review: signal_averaged_ecg 7/1992 10/2017 10/2018 10/2017 Description of Procedure or Service Signal-averaged electrocardiography
More informationUpdate on use of cardiac MRI in ARVC/D. Stefan L. Zimmerman, MD Johns Hopkins University Department of Radiology
Update on use of cardiac MRI in ARVC/D Stefan L. Zimmerman, MD Johns Hopkins University Department of Radiology Outline Background Diagnosis Characteristic imaging findings Genetics of ARVC Genotype phenotype
More informationDELAYED ENHANCEMENT IMAGING IN CHILDREN
NASCI 38 TH ANNUAL MEENG, SEATLE October 3-5, 21 1. DELAYED ENHANCEMENT IN CHILDREN Shi-Joon Yoo, MD Lars Grosse-Wortmann, MD University of Toronto Canada -1. 1. 1. Magnitude image Magnitude images -1.
More informationDIAGNOSIS AND MANAGEMENT OF ARRHYTHMOGENIC CARDIOMYOPATHY. David SIU MD ( 蕭頌華醫生 ) Division of Cardiology The University of Hong Kong
APHRS Summit 2018 in conjunction with HKCC Heart Rhythm Refresher Course DIAGNOSIS AND MANAGEMENT OF ARRHYTHMOGENIC CARDIOMYOPATHY David SIU MD ( 蕭頌華醫生 ) Division of Cardiology The University of Hong Kong
More informationC. Lutman, L. Vitali Serdoz, G. Barbati, E. Cadamuro, S. Magnani, M. Zecchin, M. Merlo, G. Sinagra
C. Lutman, L. Vitali Serdoz, G. Barbati, E. Cadamuro, S. Magnani, M. Zecchin, M. Merlo, G. Sinagra Cardiovascular Department, Ospedali Riuniti and University, Trieste, Italy PURPOSE Sex differences exist
More information