Focus on the role of Catheter Ablation: Simple cases Intermediate level Difficult cases (and patients) Impossible (almost )
|
|
- Helena Simon
- 6 years ago
- Views:
Transcription
1 22nd SHA Scientific Session February 2011, Riyadh, KSA Management of Ventricular Arrhythmias: an Overview Corrado Carbucicchio Ventricular Intensive Care Unit Cardiac Arrhythmias Research Centre Centro Cardiologico Monzino - IRCCS University of Milan Milan, Italy
2 Focus on the role of Catheter Ablation: Simple cases Intermediate level Difficult cases (and patients) Impossible (almost )
3 Simple Cases : - Idiopathic arrhythmias, no structural t Heart Disease
4
5
6
7
8
9
10 Intermediate level : Arrhythmogenicsubstrate t t in patients t with cardiomyopathy (mainly CAD), tolerated arrhythmias, relatively yp preserved cardiac function
11 CA for VT Almendral J and Josephson M: Circulation 2007; 116:
12 A. S
13 A. S
14 A. S
15 A. S
16 Difficult cases / patients : More complex substrate, t high degree of pleomorphism, advanced cardiomyopathy, non tolerated arrhythmias (typically pts. with an ICD and Electrical Storm or frequent recurrences of VT.) Transcutaneous epicardial mapping
17
18 Death from any cause according to RFCA acute result Cardiac Death according to RFCA acute result Class B (RFCA partial success) Class A (RFCA success) Class A (RFCA success) l Ev vent-free Survival Class B (RFCA partial success) Class C (RFCA failure) l Ev vent-free Survival Class C (RFCA failure) Log-Rank test p = Log-Rank test p = Follow up (months) Follow up (months) Electrical Storm recurrence according to RFCA acute result Ventricular Tachycardia recurrence according to RFCA acute result Class A (RFCA success) Log-Rank test p < Class B (RFCA partial success) Event-free e Survival Log-Rank test p < Survival Event-free Class A (RFCA success) Class B (RFCA partial success) Class C (RFCA failure) Class C (RFCA failure) Follow up (months) Follow up (months)
19
20 Poole JE et al. NEJM 2008; 359(10):
21 Mapping Strategy High Density electro anatomical mapping Identification of Conduction isthmi (channels channels) and Late / fragmented EGMs Validation by pacemapping or activation mapping during self terminating arrhythmias VT induction (pacing from the best site of mapping) VT mapping and VT termination ti n by RF delivery Lesion reinforcement / strategy of linear ablation Validation! and multisite PVS to test induction
22 G. V CARTO MAP
23 G. V CARTO MAP
24 C. M P A S O Mapping
25 C. M CARTO MAP
26 Almost impossible cases (no conventional approach feasible / effective) : Electrical l Storm + Hemodynamic impairment i / Cardiogenic shock Alternative approaches
27
28 Cardiopulmonary Support
29 CPS: How it works
30 CPS activation: mean BP 76 mmhg
31 CA C.A. 72yrs yrs. Systolic disfunction and LV dilatation secondary to valvular heart disease and coronary artery disease Prior infero-apical MI 1991 Mitral and Aortic valve replacement (MSorin 25 A Sorin23) 2004 Upgrade to CRT Sept 2008 recurrent episodes of non tolerated VT Medical Therapy: Mexiletine, Amiodarone, Flecainide id Referred to our Centre because of Electrical storm refractory to any pharmacological treatment (general anaesthesia and respiratory assistance)
32 TRANS-APICAL ENDOCARDIAL APPROACH
33 TRANS-APICAL ENDOCARDIAL APPROACH
34
35 CONCLUSIONS A wide spectrum of ventricular arrhythmia is a potential ti target t for Catheter t Ablation Arrhythmia presentation and patient s profile signifcantly yimpact on the role of CA and determine the mapping strategy of choice Catheter Ablation is part of a multidisciplinary approach in patients with severe cardiac disease and unstable hemodynamic conditions
36
37 Our Experience at CCM Milano Outcome in patients without ICD ( ) (FU 18 ± 8 mo) 53(/228) pts 8 pts ICD implanted after CA (induction of non-tolerated VTs) 45 pts still without ICD (only tolerated VT induced and ablated) 5 pts (62%) with VT recurrence 7 pts (15%) with VT recurrence 1 Aborted Sudden Death
38 Patients requiring RFCA as a form of primary or secondary treatment for VT ( ) 264 VT pts: ICD at presentation 46/82 pts (56%) with EF >40% 90/101 pts (90%) with EF 30 to 40% 81/81 pts (100%) with EF <30%
39 Long-term outcome after RFCA according to LVEF (FU 21±12 12 months) 264 VT pts undergoing RFCA 82 pts with 101 pts with EF 81 pts with EF >40% 30 to 40% EF <30% 6 pts 11 pts 22 pts (7% recurrence rate) (11% recurrence rate) (27% recurrence rate)
40 Long-term outcome after RFCA according to VT characteristics (FU 21±12 12 months) 264 patients undergoing RFCA 158 pts (60%) 106 pts (40%) with hemodynamically with hemodynamically tolerated VT non-tolerated VT 8% recurrence rate 19% recurrence rate (13 pts) (20 pts)
41 Outcome of patients without ICD 47 RFCA pts 6 pts ICD implanted after RFCA (induction of non-tolerated VTs) 41 pts still without ICD (only tolerated VT induced and ablated) 2 pts (5%) with VT recurrence successfully re-ablated No Sudden Death
42
43
44
45 Cardiopulmonary Support (Courtesy of Medtronic) Multiple side-holed, arterial al (15F) and venous (17F) cannulas are shown
46 Cardiopulmonary Support (Courtesy of Medtronic) Centrifugal cone-type pump (Bio-Medicus Medtronic; flow rate range: 1-5 l/min)
47 CPS: How it works Ventricular unloading - reduction of left ventricular dimensions and wall stress (minor myocardial oxygen demand) -withdrawal of venous return from the right atrium decreasing pulmonary capillary wedge pressure Increased mean arterial pressure mainly achieved by liquid volume delivery Blood oxygenation
48
49
50 Sinus rhythm Centro Cardiologico Fond. Monzino MI, Italy
51 VT 1 mapping Centro Cardiologico Fond. Monzino MI, Italy
52 VT 2 mapping Centro Cardiologico Fond. Monzino MI, Italy
53 VT 3 mapping Centro Cardiologico Fond. Monzino MI, Italy
54 RF ablation line Centro Cardiologico Fond. Monzino MI, Italy
55
56
57 Carto TV 2010: RESULTS 74 pts. (mean age 60yrs, 28 86) (64 M) (34 CAD, 29 IDCM, 6 ARVD, 4 myocarditis, i 1 neoplasm) + SVT, refractory to AAD; 32 ES; 63 pts. dependent from iv. AAD treatment; 69 ICD In 71 pts. VT induced (1 4 morphologies); in 48/ 71 pts. all VTs terminated by RF 71 pts.: Class A: 56 pts. (79%); Class B: 10 pts. (14%); Class C: 5 pz. (7%) 4 pts. undergoing epicardial mapping; Redo: 5 pts.
The 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 informationIndications for catheter ablation in 2010: Ventricular Tachycardia
Indications for catheter ablation in 2010: Ventricular Tachycardia Paolo Della Bella, MD Arrhythmia Department and Clinical Electrophysiology Laboratories Ospedale San Raffaele, IRCCS, Milan, Italy Europace
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 informationTreatment of VT of Purkinje fiber origin: ablation targets and outcome
Treatment of VT of Purkinje fiber origin: ablation targets and outcome Ch. Piorkowski University Leipzig - Heart Center - Dept. of Electrophysiology Leipzig, Germany Presenter Disclosure Information Gerhard
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 informationVentricular tachycardia ablation
Ventricular tachycardia ablation Paolo Della Bella, Corrado Carbucicchio, Nicola Trevisi Arrhythmia Department, Institute of Cardiology, University of Milan, Centro Cardiologico Monzino, Milan, Italy Key
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 informationCatheter Ablation of Recurrent Ventricular Tachycardia Should Be Done Before Antiarrhythmic Therapy with Amiodarone is Tried CONTRA
Catheter Ablation of Recurrent Ventricular Tachycardia Should Be Done Before Antiarrhythmic Therapy with Amiodarone is Tried CONTRA Erik Wissner, MD, F.A.C.C. Director - Magnetic Navigation Laboratory
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 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 informationCatheter ablation of monomorphic ventricular tachycardia. Department of Cardiology, IKEM, Prague, Czech Republic
Catheter ablation of monomorphic ventricular tachycardia Department of Cardiology, IKEM, Prague, Czech Republic DECLARATION OF CONFLICT OF INTEREST None Ventricular tachycardia ablation in IKEM, Prague
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 informationNovel 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
More informationthat number is extremely high. It s 16 episodes, or in other words, it s 14, one-four, ICD shocks per patient per day.
Doctor Karlsner, Doctor Schumosky, ladies and gentlemen. It s my real pleasure to participate in this session on controversial issues in the management of ventricular tachycardia and I m sure that will
More informationMap-Guided Ablation of Non-ischemic VT. Takashi Nitta Cardiovascular Surgery, Nippon Medical School Tokyo, JAPAN
Map-Guided Ablation of Non-ischemic VT Takashi Nitta Cardiovascular Surgery, Nippon Medical School Tokyo, JAPAN nothing Declaration of Interest Catheter Ablation of Non-ischemic VT Sarcoidosis, 13, 6%
More informationProphylactic ablation
Ventricular tachycardia in ischaemic heart disease. Update on electrical therapy 29 august 2010 Prophylactic ablation Pasquale Notarstefano Cardiovacular Department S. Donato Hospital, Arezzo (IT) Prophylactic
More informationNon-Invasive Ablation of Ventricular Tachycardia
Non-Invasive Ablation of Ventricular Tachycardia Dr Shaemala Anpalakhan Newcastle upon Tyne Hospitals NHS Foundation Trust Freeman Road, Newcastle Upon Tyne, NE7 7DN Contact: shaemala@doctors.org.uk Introduction
More informationDos and Don t in Cardiac Arrhythmia. Case 1 -ECG. Case 1. Management. Emergency Admissions. Reduction of TE risk -CHADS 2 score. Hospital Admissions
Emergency Admissions Dos and Don t in Cardiac Arrhythmia Tom Wong, MD, FESC Consultant Cardiologist, Honorary Senior Lecturer Royal Brompton & Harefield Hospitals National Heart and Lung Institute, Imperial
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 informationNAAMA s 24 th International Medical Convention Medicine in the Next Decade: Challenges and Opportunities Beirut, Lebanon June 26 July 2, 2010
NAAMA s 24 th International Medical Convention Medicine in the Next Decade: Challenges and Opportunities Beirut, Lebanon June 26 July 2, 2010 I have a financial interest/arrangement or affiliation with
More information8th Emirates Cardiac Society Congress in collaboration with ACC Middle East Conference Dubai: October Acute Coronary Syndromes
8th Emirates Cardiac Society Congress in collaboration with ACC Middle East Conference 2017 OSPEDALE Dubai: 19-21 October 2017 Acute Coronary Syndromes Antonio Colombo Centro Cuore Columbus and S. Raffaele
More informationΠρώτης γραμμή θεραπεία η κατάλυση κοιλιακής ταχυκαρδίας στην ισχαιμική μυοκαρδιοπάθεια
Πρώτης γραμμή θεραπεία η κατάλυση κοιλιακής ταχυκαρδίας στην ισχαιμική μυοκαρδιοπάθεια Δ. Τσιαχρής Διευθυντής Εργαστηρίου Ηλεκτροφυσιολογίας - Βηματοδότησης, Ιατρικό Κέντρο Αθηνών, Αθήνα Ventricular tachycardia
More informationRecurrent refractory ventricular tachycardia in a patient with LVAD
Monster Cases Recurrent refractory ventricular tachycardia in a patient with LVAD Maurizio Lunati MD Director SC Cardiologia 3 Elettrofisiologia Chairman De Gasperis Cardio Center Department ASST G.O.M.
More informationCardiovascular Nursing Practice: A Comprehensive Resource Manual and Study Guide for Clinical Nurses 2 nd Edition
Cardiovascular Nursing Practice: A Comprehensive Resource Manual and Study Guide for Clinical Nurses 2 nd Edition Table of Contents Volume 1 Chapter 1: Cardiovascular Anatomy and Physiology Basic Cardiac
More informationAblation of Ventricular Tachycardia in Non-Ischemic Cardiomyopathy
Ablation of Ventricular Tachycardia in Non-Ischemic Cardiomyopathy Fermin C Garcia, MD University of Pennsylvania Cardiac Electrophysiology Philadelphia, PA Nothing to disclose No conflict of interest
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 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 informationThe HISTORIC-AF TRIAL
European Prospective Multicenter Study of Hybrid Thoracoscopic and Transcatheter Ablation of Persistent Atrial Fibrillation: The HISTORIC-AF TRIAL Claudio Muneretto 1, Gianluigi Bisleri 1, Gianluca Polvani
More informationMapping and Ablation of VT in The Operating Room
Mapping and Ablation of VT in The Operating Room Sanjay Dixit, M.D. Associate Professor, University of Pennsylvania School of Medicine Director, Cardiac Electrophysiology Laboratory, Philadelphia V.A.M.C.
More information- Special VT Cases - Idiopathic Dilated Cardiomyopathy. D. Bänsch
- Special VT Cases - Idiopathic Dilated Cardiomyopathy D. Bänsch Introduction VT Ablation in CAD Strickberger SA, et al. J Am Coll Cardiol 2000 (35: 414-21) Sra J. et al. Pacing Clin Electrophysiol 2001
More informationWhen to implant an ICD in systemic right ventricle?
When to implant an ICD in systemic right ventricle? Département de rythmologie et de stimulation cardiaque Nicolas Combes n.combes@clinique-pasteur.com Pôle de cardiologie pédiatrique et congénitale Risk
More informationINTRODUCTION. left ventricular non-compaction is a sporadic or familial cardiomyopathy characterized by
A Rare Case of Arrhythmogenic Right Ventricular Cardiomyopathy Co-existing with Isolated Left Ventricular Non-compaction NS Yelgeç, AT Alper, Aİ Tekkeşin, C Türkkan INTRODUCTION Arrhythmogenic right ventricular
More informationEpicardial VT Ablation The Cleveland Clinic Experience
Epicardial VT Ablation The Cleveland Clinic Experience Walid Saliba, MD, FHRS Director, EP Lab Cardiac Electrophysiology Heart and Vascular Institute Epicardial Access in the EP Lab Why Epicardial Special
More informationLong-Term Outcome and Risks of Catheter Ablation for Atrial Fibrillation
Long-Term Outcome and Risks of Catheter Ablation for Atrial Fibrillation Carlo Pappone, MD, PhD, FACC EP Director, Villa Maria Hospital Group How many times AF can increase mortality DO MORTALITY REALLY
More informationMapping and Ablation of Challenging Outflow Tract VTs: Pulmonary Artery, LVOT, Epicardial
Mapping and Ablation of Challenging Outflow Tract VTs: Pulmonary Artery, LVOT, Epicardial Samuel J. Asirvatham, MD Mayo Clinic Rochester California Heart Rhythm Symposium San Francisco, CA September 8,
More informationAdvances in Ablation Therapy for Ventricular Tachycardia
Advances in Ablation Therapy for Ventricular Tachycardia Nitish Badhwar, MD, FACC, FHRS Director, Cardiac Electrophysiology Training Program University of California, San Francisco For those of you who
More informationEHRA EUROPACE How to perform epicardial ventricular tachycardia mapping and ablation
EHRA EUROPACE 2011 How to perform epicardial ventricular tachycardia mapping and ablation Jacob Atié Director Arrhythmias Department Federal University of Rio de janeiro jacobatie1@gmail.com Presenter
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 informationTreatment of Atrial Fibrillation in Heart Failure
Stockholm, September 1st 2010 Treatment of Atrial Fibrillation in Heart Failure Rhythm control: Which drugs? Stefan H. Hohnloser J.W. Goethe University Frankfurt, Germany Presenter disclosure information:
More informationTwo Years Living with the EHRA/HRS Consensus Document of VT Ablation: Need for an Update?
Two Years Living with the EHRA/HRS Consensus Document of VT Ablation: Need for an Update? David Wilber MD Loyola University of Chicago Disclosures: Biosense / Webster: Consultant, Investigator; Boston
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 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 informationAssist Devices in STEMI- Intra-aortic Balloon Pump
Assist Devices in STEMI- Intra-aortic Balloon Pump Ioannis Iakovou, MD, PhD Onassis Cardiac Surgery Center Athens, Greece Cardiogenic shock 5-10% of pts after a heart attack 60000-70000 pts in Europe/year
More informationCatheter ablation of atrial macro re-entrant Tachycardia - How to use 3D entrainment mapping -
Catheter ablation of atrial macro re-entrant Tachycardia - How to use 3D entrainment mapping - M. Esato, Y. Chun, G. Hindricks Kyoto Ijinkai Takeda Hosptial, Department of Arrhythmia, Japan Kyoto Koseikai
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 informationAblative Therapy for Ventricular Tachycardia
Ablative Therapy for Ventricular Tachycardia Nitish Badhwar, MD, FACC, FHRS 2 nd Annual UC Davis Heart and Vascular Center Cardiovascular Nurse / Technologist Symposium May 5, 2012 Disclosures Research
More informationIHCP bulletin INDIANA HEALTH COVERAGE PROGRAMS BT JANUARY 24, 2012
IHCP bulletin INDIANA HEALTH COVERAGE PROGRAMS BT201203 JANUARY 24, 2012 The IHCP to reimburse implantable cardioverter defibrillators separately from outpatient implantation Effective March 1, 2012, the
More informationPercutaneous Mechanical Circulatory Support for Cardiogenic Shock. 24 th Annual San Diego Heart Failure Symposium Ryan R Reeves, MD FSCAI
Percutaneous Mechanical Circulatory Support for Cardiogenic Shock 24 th Annual San Diego Heart Failure Symposium Ryan R Reeves, MD FSCAI The Need for Circulatory Support Basic Pathophysiologic Problems:
More informationRay 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
More informationShould hybrid ablation be the standard of care instead of transcatheter ablation techniques?
Should hybrid ablation be the standard of care instead of transcatheter ablation techniques? Christian Shults, MD Assistant Professor, Georgetown University School of Medicine Cardiac Surgeon, Medstar
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 informationCatheter Ablation of Atrial Fibrillation in Patients with Prosthetic Mitral Valve
Catheter Ablation of Atrial Fibrillation in Patients with Prosthetic Mitral Valve Luigi Di Biase, MD, PhD, FHRS Senior Researcher Texas Cardiac Arrhythmia Institute at St. David s Medical Center, Austin,
More informationErik Wissner, MD, F.A.C.C. Asklepios Klinik St. Georg Hamburg, Germany on behalf of the VTACH Study group
Impact of Inducibility of VT during Ablation and Acute Success of Catheter Ablation on Survival Free from VT/VF and ICD Shocks: Lessons from the VTACH Study Erik Wissner, MD, F.A.C.C. Asklepios Klinik
More informationManagement of Acute Shock and Right Ventricular Failure
Management of Acute Shock and Right Ventricular Failure Nader Moazami, MD Department of Thoracic and Cardiovascular Surgery and Biomedical Engineering, Cleveland Clinic NONE Disclosures CARDIOGENIC SHOCK
More informationWhat s new in my specialty?
What s new in my specialty? Jon Melman, MD Heart Rhythm Specialists McKay-Dee Hospital some would say some would say my specialty 1 some would say my specialty First pacemaker 1958 some would say my specialty
More informationCase Report Catheter ablation of ventricular tachycardia related to a septo-apical left ventricular aneurysm
Int J Clin Exp Med 2015;8(10):19576-19580 www.ijcem.com /ISSN:1940-5901/IJCEM0014701 Case Report Catheter ablation of ventricular tachycardia related to a septo-apical left ventricular aneurysm Radu Rosu
More informationABLATION OF CHRONIC AF
ABLATION OF CHRONIC AF A PISAPIA ST JOSEPH HOSPITAL MARSEILLE MEET 2008 Atrial Fibrillation The most common significant heart rhythm disturbance Incidence increases with age and the development of structural
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 informationVentricular 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?
More informationEHRA 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
More informationThe EP Perspective: Should We Do Hybrid Ablation, and Who Should We Do It On?
The EP Perspective: Should We Do Hybrid Ablation, and Who Should We Do It On? L. Pison, MD PhD FESC AATS Surgical Treatment of Arrhythmias and Rhythm Disorders November 17-18, 2017 Miami Beach, FL, USA
More informationCRT-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
More informationHF with Systolic or Diastolic LV Dysfunction
HF with Systolic or Diastolic LV Dysfunction Pasquale Santangeli MD Assistant Professor of Medicine Hospital of the University of Pennsylvania Disclosures Honoraria and consultant for Biosense Webster
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 informationTachycardia-induced heart failure - Does it exist?
Tachycardia-induced heart failure - Does it exist? PD Dr Etienne Delacrétaz Clinique Cecil et Hôpital de Fribourg SSC Cardiology meeting 2015 Zürich Rapid atrial fibrillation is a common cause of heart
More informationINNOVATIONS IN DEVICE THERAPY:
INNOVATIONS IN DEVICE THERAPY: Subcutaneous ICDs, Leadless Pacemakers, CRT Indications David J Wilber MD Loyola University Medical Center Disclosures: ACC Foundation: Consultant; Biosense / Webster: 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 informationICD 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
More informationBasics of Atrial Fibrillation. By Mini Thannikal NP-BC Mount Sinai St Luke s Hospital New York, NY
Basics of Atrial Fibrillation By Mini Thannikal NP-BC Mount Sinai St Luke s Hospital New York, NY Atrial Fibrillation(AF) is a supraventricular tachyarrhythmia characterized by uncoordinated atrial activation
More informationCardiogenic Shock. Carlos Cafri,, MD
Cardiogenic Shock Carlos Cafri,, MD SHOCK= Inadequate Tissue Mechanisms: Perfusion Inadequate oxygen delivery Release of inflammatory mediators Further microvascular changes, compromised blood flow and
More informationAPPROACH TO TACHYARRYTHMIAS
APPROACH TO TACHYARRYTHMIAS PROF.DR.MD.ZAKIR HOSSAIN PROFESSOR AND HEAD DEPARTMENT OF MEDICINE SZMCH TACHYARRYTHMIA Cardiac arrythmia is a disturbance of electrical rhythm of heart. Cardac arrythmia with
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 informationUrgent VT Ablation in a Patient with Presumed ARVC
Urgent VT Ablation in a Patient with Presumed ARVC Mr Alex Cambridge, Chief Cardiac Physiologist, St. Barts Hospital, London, UK The patient, a 52 year-old male, attended the ICD clinic without an appointment
More information7. Echocardiography Appropriate Use Criteria (by Indication)
Criteria for Echocardiography 1133 7. Echocardiography Criteria (by ) Table 1. TTE for General Evaluation of Cardiac Structure and Function Suspected Cardiac Etiology General With TTE 1. Symptoms or conditions
More informationCirculatory Support: From IABP to LVAD
Circulatory Support: From IABP to LVAD Howard A Cohen, MD, FACC, FSCAI Director Division of Cardiovascular Intervention Co Director Cardiovascular Interventional ti Laboratories Lenox Hill Heart & Vascular
More informationTachy. Induction tachycardia lead ECG during Tachy /25/2009. Sinus Rhythm Single His
12-lead ECG during Tachy 10.30.31 Sinus Rhythm Single His 11.20.02 Induction tachycardia 11.23.23 Tachy 11.25.23 1 I This finding excludes: (a) AVNRT (either typical or atypical) Tachy: Alternating cycle
More informationΗ χρήση των νέων καθετήρων με αισθητήρα πίεσης Κλινικά δεδομένα και παραδείγματα
Η χρήση των νέων καθετήρων με αισθητήρα πίεσης Κλινικά δεδομένα και παραδείγματα Νικόλαος Φραγκάκης Επίκουρος Καθηγητής Καρδιολογίας ΑΠΘ Γ Κ/Δ Κλινική Ιπποκράτειο Νοσοκομείο Θεσσαλονίκης Why Contact Force?
More informationInterventional solutions for atrial fibrillation in patients with heart failure
Interventional solutions for atrial fibrillation in patients with heart failure Advances in Cardiovascular Arrhythmias Great Innovations in Cardiology Matteo Anselmino, MD PhD Division of Cardiology Department
More informationMedical Therapy after LVAD
Medical Therapy after LVAD Maria Frigerio 2nd Section of Cardiology, Heart Failure & Cardiac Transplant Unit DeGasperis CardioCenter, Niguarda Hospital, Milan, Italy Heart failure therapy in LVAD pts A
More informationCardiac Electrical Therapies. By Omar AL-Rawajfah, PhD, RN
Cardiac Electrical Therapies By Omar AL-Rawajfah, PhD, RN Outlines What are cardiac electrical therapies Ablation Defibrillation Cardioversion What are the nursing considerations for each type of therapy
More informationRationale 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
More informationESSA HEART AND VASCULAR INSTITUTE APR/MAY/JUNE 2009 CLINICAL LETTER
CLINICAL LETTER Exciting things are happening at the ESSA Heart and Vascular Institute and the Pocono Medical Center! We are all proud of the stellar team of professionals who are working very hard to
More informationNEIL CISPER TECHNICAL FIELD ENGINEER ICD/CRTD BASICS
NEIL CISPER TECHNICAL FIELD ENGINEER ICD/CRTD BASICS OBJECTIVES Discuss history of ICDs Review the indications for ICD and CRT therapy Describe basic lead and device technology Discuss different therapies
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 informationTRANSCATHETER AORTIC VALVE IMPLANTATION: PSCC EXPERIENCE DR HUSSEIN ALAMRI PSCC RIYADH
TRANSCATHETER AORTIC VALVE IMPLANTATION: PSCC EXPERIENCE DR HUSSEIN ALAMRI PSCC RIYADH Available systems: Edwards (TA and TF) and Core valve. INTRODUCTION 3 4% 0f > 65 y. 30 40% of elderly denied surgery,.
More informationFirst 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
More informationVentricular Tachycardia in Structurally Normal Hearts (Idiopathic VT) Patient Information
Melbourne Heart Rhythm Ventricular Tachycardia in Structurally Normal Hearts (Idiopathic VT) Patient Information What is Ventricular Tachycardia? Ventricular tachycardia (VT) is an abnormal rapid heart
More informationImaging congestive heart failure: role of coronary computed tomography angiography (CCTA)
Imaging congestive heart failure: role of coronary computed tomography angiography (CCTA) Gianluca Pontone, MD, PhD, FESC, FSCCT Director of MR Unit Deputy Director of Cardiovascul CT Unit Clinical Cardiology
More informationMEDICAL POLICY Cardioverter Defibrillators
POLICY........ PG-0224 EFFECTIVE......06/01/09 LAST REVIEW... 01/27/17 MEDICAL POLICY Cardioverter Defibrillators GUIDELINES This policy does not certify benefits or authorization of benefits, which is
More informationIntraaortic Balloon Counterpulsation- Supportive Data for a Role in Cardiogenic Shock ( Be Still My Friend )
Intraaortic Balloon Counterpulsation- Supportive Data for a Role in Cardiogenic Shock ( Be Still My Friend ) Stephen G. Ellis, MD Section Head, Interventional Cardiology Professor of Medicine Cleveland
More informationInvasive and Medical Treatments for Atrial Fibrillation. Thomas J Dresing, MD Section of Electrophysiology and Pacing Cleveland Clinic
Invasive and Medical Treatments for Thomas J Dresing, MD Section of Electrophysiology and Pacing Cleveland Clinic Disclosures Fellow s advisory panel for St Jude Medical Speaking honoraria from: Boston
More informationRhythm Disorders 2017 TazKai LLC and NRSNG.com
Rhythm Disorders 1. Outline the conduction system of the heart. 2. What do the different portions of the EKG represent? 3. Define the following terms: a. Automaticity b. Conductivity c. Excitability d.
More informationTehran Arrhythmia Center
Tehran Arrhythmia Center The Worst Scenario A 4 year old kid High heart rates first noted by parents at 20 months of age. Family physician detected rates as high as 220 bpm at that age. He was visited,
More informationCardiac Arrhythmias in Acute Coronary Syndrome. Roj Rojjarekampai, MD Thammasart Hospital 26/5/59
Cardiac Arrhythmias in Acute Coronary Syndrome Roj Rojjarekampai, MD Thammasart Hospital 26/5/59 OUTLINE Management of tachy and brady-arrhytmia related ACS : AF : VA [ sustained VT /VF] : conduction disturbance
More informationUse of Biventricular Pacing in Arrhythmogenic Right Ventricular Cardiomyopathy with Disarticulated Right Ventricle
Use of Biventricular Pacing in Arrhythmogenic Right Ventricular Cardiomyopathy with Disarticulated Right Ventricle Clare Stodart (Cardiac Physiologist) University Hospital Southampton NHS Foundation Trust
More informationCARDIOMYOPATHY IN CT. Hans- Christoph Becker Professor of Radiology
CARDIOMYOPATHY IN CT Hans- Christoph Becker Professor of Radiology 1 Cardiomyopathy Heart muscle disease Deterioration of the heart function, heart failure Dyspnea, peripheral edema Risk of arrhythmia,
More informationIndications of Coronary Angiography Dr. Shaheer K. George, M.D Faculty of Medicine, Mansoura University 2014
Indications of Coronary Angiography Dr. Shaheer K. George, M.D Faculty of Medicine, Mansoura University 2014 Indications for cardiac catheterization Before a decision to perform an invasive procedure such
More informationAblation vs. Amiodarone for Treatment of Atrial Fibrillation in Patients with Congestive Heart Failure and an Implanted ICD/CRTD (AATAC-AF in Heart Failure) Luigi Di Biase, MD, PhD, FACC, FHRS Section
More informationWhen Should I Order a Stress Test or an Echocardiogram
When Should I Order a Stress Test or an Echocardiogram Updates in Cardiology 2015 March 7, 2015 Donald L. Lappé, MD, FAHA, FACC Chairman, Cardiovascular Department Medical Director, Intermountain Cardiovascular
More informationVentricular Tachycardia Substrate. For the ablationist. Stanley Tung, MD FRCPC Arrhythmia Service/St Paul Hospital University of British Columbia
Ventricular Tachycardia Substrate For the ablationist Stanley Tung, MD FRCPC Arrhythmia Service/St Paul Hospital University of British Columbia Two Attitudes of Ventricular Tachycardia Ablation 1 2C:\Documents
More information