עדכונים באלקטרופיזיולוגיה Electrophysiology Unit Soroka University Medical Center Faculty of Health Sciences Ben-Gurion University of the Negev

Transcription

1 עדכונים באלקטרופיזיולוגיה 2014 Electrophysiology Unit Soroka University Medical Center Faculty of Health Sciences Ben-Gurion University of the Negev 1

2 מבנה הצגת היחידה פעילות ביחידה סקירה על הטיפול באלקטרופיזיולוגיה חידושים בטיפול בהשתלות מכשירים חידושים בטיפול באלקטרופיזיולוגיה 2

3 Electrophysiology Today EVALUATION AND MANAGEMENT OF SYNCOPE BRADYCARDIA AND PACEMAKERS PRIMARY PREVENTION OF SCD (ISCHEMIC, NON ISCHEMIC, CHANNELOPATHIES) SECONDARY PREVENTION OF SCD (VT, VF) CONGESTIVE HEART FAILURE SVT, ATRIAL FLUTTER, ARIAL FIBRILLATION 3 3

4 Major Activities Arrhythmia Care Arrhythmia Clinic Invasive Electrophysiology and Ablations Total Number of Clinic Visits: (4000) Total Number of Ablations and EPS (100) Device Implantations Pacemakers ICD CRT Device Follow-up Clinic Total Number of Devices (330) PM ICD CRTD 4

5 5 Electrophysiology Lab

6 Electrophysiology Lab Team Work 6 6

7 Electro-Anatomical Mapping: Atrial Tchycardia 7 7

8 Electro-Anatomical Mapping: Atrial Flutter 8 8

9 Special Procedures that require cardiac surgery Back up-. Cardiac EP and Ablations Electrophysiology Clinic מעבדת הולטר Device Implantations (PM, ICD, CRT) Advanced Imaging (Cardiac CT, MRI) Anasthesia Support Device Follow-up Clinic 9

10 Gold Standard: Symptom-Rhythm Correlation The gold standard for the diagnosis of syncope is when a correlation between the symptoms and a documented arrhythmia is recorded Moya et al Eur Heart J. doi: /eurheartj/ehp298 10

11 EaSyAS Study: ILR reduces time to diagnosis 11 Farwell et al Eur Heart J 27:

12 Sinus arrest documented by ILR 12 12

13 Self terminated VF documented by ILR 13 13

14 Upcoming Generation Reveal LINQ It automatically detects and records abnormal heart rhythms for up to 3 years 14

15 Cardiac Resynchronization Therapy 15

16 Cardiac Resynchronization Therapy Every 10ms of QRS increase was associated with 18% increase in CV death 16 Desai AD et al. Am J Med 2006; 119:

17 Cardiac Resynchronization Therapy Right Atrial Lead Left Ventricular Lead Right Ventricular Lead 17 17

18 Timing of CRTD Implantation 18 18

19 Criteria For CRT Implantation LVEF < 35% Wide QRS > 120 ms (The wider the better) Preferably LBBB CHF CLASS II-IV 19

20 CRT: Mortality or Hospitalizations MIRACLE 2002 CARE-HF

21 CRT For Mild Heart Failure 21 21

22 CRT For Mild Heart Failure 22 22

23 CRT For Mild Heart Failure: Death or HF 23 23

24 Cardiac Desynchronization In Narrow QRS 24

25 Primary Prevention ICD MADIT MADIT II LVEF < 35% Prior MI NSVT INDUCIBLE VT ON EPS LVEF < 30% Prior MI 25 Moss AJ et al. MADIT. N Engl J Med ;335: Moss AJ et al. MADIT II. N Engl J Med ;346:

26 26 Home Monitoring

27 27 Special Alerts

28 28 Home Monitoring Case # 1

29 29 Home Monitoring Case # 2

30 Home Monitoring Reduce Mortality The trial was conducted at 36 different clinics and hospitals in Europe, Australia, and Israel and included a total of 664 patients. All patients had either implantable cardioverter-defibrillators (ICDs) or cardiac resynchronization therapy defibrillators (CRT-Ds) with telemonitoring functionality, but only one group used that functionality Improvements in patients health are likely due to the early detection of the onset or progression of ventricular and atrial tachyarrhythmias and the early recognition of therapy settings that may need adjusting. 30

31 Atrial Fibrillation 31

32 45 pts with drug-ref PAF (6h/d) Initiation of AF was mapped by recording the earliest electrical activity preceding the onset 94% of foci were in PVs During a follow-up period of 8±6 months after ablation, 62% had no AF recurrence N Engl J Med 1998;339:

33 Initiation of AF From Pulmonary Vein Focus 33 Reprinted with permission from Haissaguerre M, et al. N Engl J Med. 1998;339(10):

34 Pulmonary Vein Isolation (PVI) is the Cornerstone of AF Ablation 2007 HRS Consensus Statement Ablation strategies which target the PVs and/or PV antrum are the cornerstone for most AF ablation procedures. Left Superior Pulmonary Vein Left Inferior Pulmonary Vein Superior Vena Cava Right Superior Pulmonary Vein Right Inferior Pulmonary Vein Complete electrical isolation should be the goal for targeted PVs and entrance and/or exit block should be demonstrated Isolate each PV independently Inferior Vena Cava 34 Cappato et al., Circ Arrhythm Electrophysiol 2010;3;

35 Trans-septal Approach October 2014

36 Recording Pulmonary Vein Signals 36

37 37

38 Left Upper PV 38

39 Summary of randomized control trials comparing catheter ablation versus antiarrhythmic therapy. Tung R et al. Circulation. 2012;126: Copyright American Heart Association, Inc. All rights reserved.

40 Ganesan A N et al. J Am Heart Assoc 2013;2:e004549

41 Ganesan A N et al. J Am Heart Assoc 2013;2:e004549

42 Ganesan A N et al. J Am Heart Assoc 2013;2:e004549

43 Patients for Procedure Paroxysmal (short-term persistent <3-6 months in AF) AF Symptomatic Failed At least One Drug Preferably Normal Heart but will take LV Dysfunction No Contra Indications to Coumadin 43

44 One Shot Ablation 22 October

45 CryoBalloon 22 October

46 The Evolution of the Procedural Treatment of AF CryoCath s Arctic Front obtains CE Mark for use in Europe for the treatment of AF Ablation Frontiers obtains the European CE Mark for its duty cycled phased RF portfolio of catheters for the treatment of AF Thermocool is approved for the treatment of AF in the US

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48 22 October

49 Thank You! טלפון מרפאה: פקס: מוטי חיים סלולארי יובל קונסטנטינו סלולארי