From Bench to Practice: Cardiac Resynchronisation Therapy
|
|
- Ernest O’Brien’
- 6 years ago
- Views:
Transcription
1 From Bench to Practice: Cardiac Resynchronisation Therapy Molecular Changes in the Dyssynchronous Heart and Cardiac Resynchronisation Therapy Gordon F. Tomaselli, M.D. Professor of Medicine and Molecular Medicine Michel Mirowski, M.D. Professor of Cardiology Johns Hopkins University September 27, 212 The authors have no financial conflicts of interest to disclose concerning this presentation Research Grant Support NIH NHLBI
2 Outline Cellular & tissue electrophysiology and Ca 2+ handling alterations in HF Remodeling in CRT cellular electrophysiology and Ca 2+ handling regional gene expression profiling cellular metabolism
3 HF & CRT Scope of the Problem 5.8 x 1 6 patients with HF in the US ( < ) 67, new diagnoses (adults > 35 yrs) >1.1 x 1 6 hospitalizations (NHDS, NHLBI) >$39 billion estimated annual cost >6, deaths ( > ), ~5% SCD (NCHS) b-ar agonists increase contractility and mortality CRT improves symptoms, ventricular performance and myocardial efficiency AHA Heart Disease and Stroke Statistics 21 Update. Circulation 121:e46, 21
4 Membrane voltage (mv) Cellular electrophysiological features of heart failure 3-4 Weeks of rapid (24bpm) RV pacing LVEDP 3-45 mmhg 5 endocardial midmyocardial epicardial CONTROL HF D APD Class III AAD action APD msec Cycle Length (sec)
5 repolarizing depolarizing Current clone mrna protein I Na I Ca,L I Na/Ca SCN5A DHP receptor NCX voltage time I K1 I to,1 Kir2.x Kv4.x /KChIP2 I to,2 I Kr I Ks I Kp HERG/MiRP-1 KvLQT1/minK
6 A.U. CV (cm/sec) CV (cm/sec) HF - conduction slowing Normal Epicardium HF 45 Cx43 N-cad NL S1 S NL HF HF Endocardium Normal HF p <.1 45 S1 S1 S NL HF Epi Endo p < NL HF NL HF Akar et al. Circ Res 95:717, 24 Hesketh et al. Circ Res 16:1153, 21
7 Fiber stress LV Pressure (mmhg) Strain Cardiac dyssynchrony influences regional & global function Normal Heart Dyssynchronous Failing Heart 8 NSR Dyssynchrony 4 Anterior Lateral 2 Area = Regional Work LV Volume (ml) Fiber strain Fiber strain
8 Week Mechanical treatment of HF: What molecular/cellular changes are induced? Animal model of CRT Left Bundle Ablation (QRS > 12 msec) 3 RA pacing (2 bpm) 3 weeks 6 RA pacing (2 bpm) 3 weeks BiV pacing (2 bpm) 3 weeks Dyssynchronous Heart Failure () Resynchronization Heart Failure (CRT) Tissue isolation from epi/endocardium of lateral wall and septum Protein and enzyme analysis
9 Strain (%) CRT restores synchronous contraction. Control Septum Lateral II NSR 1 mv DEF (3 wk vs 6 wk) -4.4 ± 2.7% CRT 2.8 ± 1.8%. RAP CRT 1 ms BiV apoptosis regional heterogeneity of expression: CaMKII, MAPK p38 Time (s) Aiba et al. Circulation 119:122-3, 29; Chakir et al. Circulation 117: , sec
10 Cellular Structural Remodeling WGA (t-tubes) RyR (jsr) 5 μm overlay deconvolution 3-D horizontal vertical Sachse et al. Circ Res 11:588,212
11 Control 5 μm LAT LAT LAT CRT LAT Sachse et al. Circ Res 11:588,212
12 APD (ms) CRT remodeling cellular AP effects are regional LBBB + RA pacing (2 ppm) 6 wks 3 wks 6 wks LBBB + RA pacing (2ppm) Bi-V pacing (2 ppm) CRT No ablation and pacing Control 14 Anterior 14 Lateral Anterior Control Lateral 5 mv 5 ms # 6 4 Control (12) 2 (17) CRT (8) CL (s) Control (13) DH F (28) CRT (11) CL (s) CRT Aiba et al. Circulation 119:122-3, 29
13 Kir2.1 protein (AU) Kv4.3 Protein (AU) KvLQT1 protein (AU) pa/pf pa/pf pa/pf 1 pa/pf 1 pa/pf.1 na Control CRT 1 ms mv # Kir2.1 CSQ Control CRT Control CRT A L A L A K currents in CRT I K1, I to, I K L Control CRT 5 ms Kv4.3 CSQ Control -2 A L A L A CRT L mv IK tail +5-5 Control (n=13) (n=14) CRT (n=12) 4. s Control CRT 2. s mv KvLQT1 CSQ Control CRT A L A L A L Aiba et al. Circulation 119:122-3, 29 #
14 I Na-L (2-22 ms) pa/pf CaMKII p-thr287 A 2 % 2% Inward Na + current (I Na ) 1 ms NF CRT Control CRT CaMKII total 8 x (AU) NF CRT NF CRT baseline Ranolazine CRT c/w 3 x 1 3 (AU) NF CRT NF CRT p <.5 I K1, I K, I to Aiba et al. unpublished
15 tau (ms) I Ca,L (pc/pf) Normalized expression Normalized expression 2 pa/pf Normalized expression Inward Ca 2+ current (I Ca ) Control 1 ms 1 ms CRT 1 ms Ca V 1.2 (Ca v α1c) Control CRT Ca v β (14) -6 (9) Control CRT (11) (15) Control CRT (7) (11) Ca v β Control CRT Control CRT Aiba et al. Circulation 119:122-3, 29
16 F45/495 tau (ms) F45/495 CaT in CRT Control CRT 5 ms # #.1 1 Control CRT Control CRT Aiba et al. Circulation 119:122-3, 29
17 A L L %EAD EADs - CRT # Control CRT APD 2 EAD (-) APD 2 EAD(-) EAD(+) p <.1 APD 9 EAD (+) APD 9 EAD(-) EAD(+) p = ms APD 2 APD 2 /APD 9 EAD(-) EAD(+) p <.1 APD 9 1 ms Aiba et al. Circulation 119:122-3, 29
18 Delta SS (%) Sarcomere length Sarcomere Shortening (%) ECC CRT enhances b-adrenergic response Sarcomere Shortening Baseline ISO 1-7 M 16 Baseline ISO 1-7 M sec DF/F Control Ant Lat Ant Lat Ant Lat Control CRT b1 vs b2 b1: NE 1-7 M + Prazosin 1-6 M b2: ISO 51-7 M + CGP 31-7 M Chakir et al. Circulation 119:1231-4, 29 CRT CTL CRT GRK-2 :, No D CRT FSK AC stimulation :, No D CRT Gai inhibition: CRT RGS2,3 : CRT
19 CRT NF CRT regional gene expression NF + CRT 6 5 p<.1 p=.9 p< n=6 n=5 n=5 NF CRT Barth et al. Circ Genetics 2:371-8, 29
20 Mitochondrial protein changes with CRT Agnetti, G. et al. Circ Cardiovasc Genet 21;3:78-87
21 Integration with mitochondrial bioenergetics (complex I) HF and CRT (complex II) RCR Efficiency of oxidative-phosphorylation complex V Agnetti, G. et al. Circ Cardiovasc Genet 21;3:78-87
22 Molecular changes in & CRT Summary Active membrane and network properties of the heart are remodeled in K currents, I Na-L, altered Ca 2+ handling Remodeled Cx43 with reduced CV Heart failure is associated with genetically driven regional remodeling of structure and function CRT has the capacity to in part reverse cellular structural, electrical and metabolic remodeling
23 Acknowledgements Cardiology Fadi Akar Andreas Barth Federica Farinelli Debbie DiSilvestre YanLi Tian Takeshi Aiba Hana Cho Geoff Hesketh Pei Dong Tori Halperin Khalid Chakir Guilio Agnetti Ting Liu University of Utah Frank Sachse Dave Kass Jenny van Eyk Brian O Rourke John Bridge DNA nebula Spitzer Space Telescope
Declaration of conflict of interest
Declaration of conflict of interest Electrical activation pattern in Left Bundle Branch Block Patients Angelo Auricchio, MD FESC Director, Cardiac Electrophysiology Programme, Fondazione Cardiocentro Ticino,
More informationWhat Can We Learn From Integrative Modeling of the Heart?
What Can We Learn From Integrative Modeling of the Heart? Raimond L. Winslow The Institute for Computational Medicine & Department of Biomedical Engineering The Johns Hopkins University 1 The Human Heart
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 informationDéclaration de Relations Professionnelles -Disclosure Statement of Financial Interest SPEAKER NAME. Nothing to disclose
Déclaration de Relations Professionnelles -Disclosure Statement of Financial Interest SPEAKER NAME Nothing to disclose Resynchronisation en pédiatrie Paediatric resynchronisation J. Janoušek Kardiocentrum
More informationESC Paris, August 2011
Controversial Issues in CRT: Is The Optimisation of AV & VV Delays Useful? ESC Paris, August 2011 D Gras, MD, Nantes, France DECLARATION OF CONFLICT OF INTEREST Consultancy Minor Medtronic Saint Jude Medical
More informationCardiac Resynchronisation Therapy for all Patients Requiring Ventricular Pacing
Cardiac Resynchronisation Therapy for all Patients Requiring Ventricular Pacing Philippe Mabo University Hospital, Rennes, France ESC Congress 2010, Stockholm 29 Aug 2010 Which Patients? Candidate for
More informationInteractions of biventricular pacing with alterations in heart failure
2008 NBCR Summer Institute La Jolla, August 11 th, 2008 Interactions of biventricular pacing with alterations in heart failure Cardiac Resynchronization Therapy Heart failure: 250,000 deaths/year in US
More informationImpact of QRS duration and morphology on CRT effectiveness
Impact of QRS duration and morphology on CRT effectiveness Dr Tim Betts MD MBChB FRCP Consultant Cardiologist & Electrophysiologist Oxford Heart Centre, John Radcliffe Hospital Oxford University Hospitals
More informationDeclaration of conflict of interest. I have nothing to disclose.
Declaration of conflict of interest I have nothing to disclose. Left Bundle branch block in HF: DO GENETICS MATTER? Silvia Giuliana Priori Cardiovascular Genetics, Langone Medical Center, New York University
More informationCardiac Resynchronization Therapy for Heart Failure
Cardiac Resynchronization Therapy for Heart Failure Ventricular Dyssynchrony vs Resynchronization Ventricular Dysynchrony Ventricular Dysynchrony 1 Electrical: Inter- or Intraventricular conduction delays
More informationEffect of Ventricular Pacing on Myocardial Function. Inha University Hospital Sung-Hee Shin
Effect of Ventricular Pacing on Myocardial Function Inha University Hospital Sung-Hee Shin Contents 1. The effect of right ventricular apical pacing 2. Strategies for physiologically optimal ventricular
More informationCardiac 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
More informationPathophysiology and Current Evidence for Detection of Dyssynchrony
Editorial Cardiol Res. 2017;8(5):179-183 Pathophysiology and Current Evidence for Detection of Dyssynchrony Michael Spartalis a, d, Eleni Tzatzaki a, Eleftherios Spartalis b, Christos Damaskos b, Antonios
More informationA Square Peg in a Round Hole: CRT IN PAEDIATRICS AND CONGENITAL HEART DISEASE
A Square Peg in a Round Hole: CRT IN PAEDIATRICS AND CONGENITAL HEART DISEASE Adele Greyling Dora Nginza Hospital, Port Elizabeth SA Heart November 2017 What are the guidelines based on? MADIT-II Size:
More informationJ Wave Syndromes. Osama Diab Lecturer of Cardiology Ain Shams University
J Wave Syndromes Osama Diab Lecturer of Cardiology Ain Shams University J Wave Syndromes Group of electric disorders characterized by > 1 mm elevation of the J point or prominent J wave with or without
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 informationJ-wave syndromes: update on ventricular fibrillation mechanisms
J-wave syndromes: update on ventricular fibrillation mechanisms Michael Nabauer University of Munich, Germany 28.8.2011 I have no conflicts of interest ECG labelling by Einthoven Circ 1998 Osborn wave
More informationHeart. Heart 2-Tunica media: middle layer (media ='middle') muscle fibers (smooth or cardiac).
t. innermost lumenal General Circulatory system heart and blood vessels walls have 3 layers (inside to outside) 1-Tunica interna: aka tunica intima layer--lumenal layer epithelium--endothelium simple squamous
More informationHow do I convert my CRT Non Responder into Responder?
How do I convert my CRT Non Responder into Responder? Michael R Gold, MD, PhD Medical University of South Carolina Charleston, SC Disclosures: Clinical Trials and Consulting Boston Scientific, Medtronic
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 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 informationMechanisms Underlying Conduction Slowing and Arrhythmogenesis in Nonischemic Dilated Cardiomyopathy
Mechanisms Underlying Conduction Slowing and Arrhythmogenesis in Nonischemic Dilated Cardiomyopathy Fadi G. Akar, David D. Spragg, Richard S. Tunin, David A. Kass, Gordon F. Tomaselli Abstract Heart Failure
More informationDevice 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,
More informationHighlights of the Congress - Basic Science -
Highlights of the Congress - Basic Science - Myocyte function and ion homeostasis Frank R. Heinzel, Graz Predisposition Trigger Cardiomyocyte Excitability/ Arrhythmias Na + ECC channels pumps Ca 2+ receptors
More informationCardiac Resynchronization Therapy. Michelle Khoo, MD
Cardiac Resynchronization Therapy Michelle Khoo, MD 10.7.08 HuiKuri HV NEJM 2001 Sudden Death (SD) in Subset Populations HuiKuri HV NEJM 2001 Sudden Death (SD) in Subset Populations SD in Competitive Athletes
More informationAdvances in Safety Pharmacology: Utilizing ipsc-derived cardiomyocytes in early stage safety pharmacology investigations. Blake Anson, PhD.
Advances in Safety Pharmacology: Utilizing ipsc-derived cardiomyocytes in early stage safety pharmacology investigations Blake Anson, PhD. Presentation Outline I. Safety Pharmacology and in-vitro models
More informationCardiac Gene Therapy: Beyond the Mouse. David M Kaye Heart Failure Research Group Baker IDI, Melbourne, AUSTRALIA
Cardiac Gene Therapy: Beyond the Mouse David M Kaye Heart Failure Research Group Baker IDI, Melbourne, AUSTRALIA Presenter Disclosure Information FINANCIAL DISCLOSURE: Equity: Osprey Medical Grants/Research
More informationJournal of Chemical and Pharmaceutical Sciences Print ISSN: Abnormal Calcium Channels: Role on Generation of ST Segment Depression, T-wave
Abnormal Calcium Channels: Role on Generation of ST Segment Depression, T-wave Alternant and T- wave Inversion A Computational Study Gulothungan G*, Malathi R Department of Electronics and Instrumentation
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 informationDevice Based Therapy for the Failing Heart: ICD and Cardiac Resynchronization Rx
Device Based Therapy for the Failing Heart: ICD and Cardiac Resynchronization Rx Charles Gottlieb, MD Director of Electrophysiology Abington Memorial Hospital Heart Failure Mortality Mechanism of death
More informationIonchannels and channelopaties in the heart. Viktória Szőts
Ionchannels and channelopaties in the heart Viktória Szőts Action of membrane transport protein ATP-powered pump Ion chanels Transporters 10 1-10 3 ions/s 10 7-10 8 ions/s 10 2-10 4 ions/s Cardiac K +
More informationHow 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
More informationChapter 12: Cardiovascular Physiology System Overview
Chapter 12: Cardiovascular Physiology System Overview Components of the cardiovascular system: Heart Vascular system Blood Figure 12-1 Plasma includes water, ions, proteins, nutrients, hormones, wastes,
More informationThis 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,
More informationImplantable 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
More informationMADIT 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
More informationHow to Use Echocardiography for. Cardiac Resynchronization Therapy WHY TRY TO IMPROVE PATIENT SELECTION FOR CRT? PROSPECT: CRT Response at 6 Months
2/6/12 How to Use Echocardiography for Cardiac Resynchronization Therapy John Gorcsan, MD University of Pittsburgh, Pittsburgh, PA Disclosures: Research Grant Support: Biotronik, GE, Medtronic, St. Jude,
More informationMechanisms Underlying Conduction Slowing and Arrhythmogenesis in Nonischemic Dilated Cardiomyopathy
Mechanisms Underlying Conduction Slowing and Arrhythmogenesis in Nonischemic Dilated Cardiomyopathy Fadi G. Akar, David D. Spragg, Richard S. Tunin, David A. Kass, Gordon F. Tomaselli Downloaded from http://circres.ahajournals.org/
More informationPhase 2 Early Afterdepolarization as a Trigger of Polymorphic Ventricular Tachycardia in Acquired Long-QT Syndrome
Phase 2 Early Afterdepolarization as a Trigger of Polymorphic Ventricular Tachycardia in Acquired Long-QT Syndrome Direct Evidence From Intracellular Recordings in the Intact Left Ventricular Wall Gan-Xin
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 informationBasics of Structure/Function of Sodium and Potassium Channels Barry London, MD PhD
Basics of Structure/Function of Sodium and Potassium Channels Barry London, MD PhD University of Pittsburgh Medical Center Pittsburgh, PA International Symposium of Inherited Arrhythmia Disorders and Hypertrophic
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 informationHow Do I Balance Bradycardia with Rate Control in Atrial Fibrillation?
How Do I Balance Bradycardia with Rate Control in Atrial Fibrillation? Thang Nguyen MD FRCPC Assistant Professor Section of Cardiology Department of Internal Medicine University of Manitoba Objectives
More informationHis 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
More informationGender and cardiac resynchronization therapy. Chairs: David Heaven & Belinda Green. Gender and Cardiac Resynchronisation Therapy
Electrophysiology Gender and cardiac resynchronization therapy Dean Boddington Chairs: David Heaven & Belinda Green Gender and Cardiac Resynchronisation Therapy Dean Boddington Tauranga Hospital 1 Disclosure/Warning
More informationCardiac physiology. b. myocardium -- cardiac muscle and fibrous skeleton of heart
I. Heart anatomy -- general gross. A. Size/orientation - base/apex B. Coverings D. Chambers 1. parietal pericardium 2. visceral pericardium 3. Layers of heart wall a. epicardium Cardiac physiology b. myocardium
More informationElectrical Conduction
Sinoatrial (SA) node Electrical Conduction Sets the pace of the heartbeat at 70 bpm AV node (50 bpm) and Purkinje fibers (25 40 bpm) can act as pacemakers under some conditions Internodal pathway from
More informationClinical and Electrocardiographic Characteristics of Patients with Brugada Syndrome: Report of Five Cases of Documented Ventricular Fibrillation
J Arrhythmia Vol 25 No 1 2009 Original Article Clinical and Electrocardiographic Characteristics of Patients with Brugada Syndrome: Report of Five Cases of Documented Ventricular Fibrillation Seiji Takashio
More informationAssessment of pro-arrhythmic effects using Pluricyte Cardiomyocytes. on the ACEA xcelligence RTCA CardioECR
Assessment of pro-arrhythmic effects using Pluricyte Cardiomyocytes on the ACEA xcelligence RTCA CardioECR Application Note Version 2.1 / March 2018 Contents 1. Introduction 1 2. Assessment of pro-arrhythmic
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 informationDR QAZI IMTIAZ RASOOL OBJECTIVES
PRACTICAL ELECTROCARDIOGRAPHY DR QAZI IMTIAZ RASOOL OBJECTIVES Recording of electrical events in heart Established electrode pattern results in specific tracing pattern Health of heart i. e. Anatomical
More informationGene annotation for heart rhythm. 1. Control of heart rate 2. Action Potential 3. Ion channels and transporters 4. Arrhythmia 5.
Gene annotation for heart rhythm 1. Control of heart rate 2. Action Potential 3. Ion channels and transporters 4. Arrhythmia 5. EC coupling Control of heart rate Autonomic regulation of heart function
More informationComputational Modeling of Cardiac Resynchronization Therapy. Britta Baynes UC San Diego- Cardiac Mechanics Research Group
Computational Modeling of Cardiac Resynchronization Therapy Britta Baynes UC San Diego- Cardiac Mechanics Research Group Background Cardiac Resynchronization Therapy (CRT) is a widely used and proven treatment
More informationCardiac Resynchronization Therapy Selection therapy Echocardiography
Cardiac Resynchronization Therapy Selection therapy Echocardiography Prof. Patrizio LANCELLOTTI CHU Sart Tilman, Liège April, 2010 Candidates for CRT : class IA NYHA Functional Class III or IV (Subjective)
More information좌심실수축기능평가 Cardiac Function
Basic Echo Review Course 좌심실수축기능평가 Cardiac Function Seonghoon Choi Cardiology Hallym university LV systolic function Systolic function 좌심실수축기능 - 심근의수축으로심실에서혈액을대동맥으로박출하는기능 실제임상에서 LV function 의의미 1Diagnosis
More informationUpgrade to Resynchronization Therapy. Saeed Oraii MD, Cardiologist Interventional Electrophysiologist Tehran Arrhythmia Clinic May 2016
Upgrade to Resynchronization Therapy Saeed Oraii MD, Cardiologist Interventional Electrophysiologist Tehran Arrhythmia Clinic May 2016 Event Free Survival (%) CRT Cardiac resynchronization therapy (CRT)
More informationTdP Mechanisms and CiPA
TdP Mechanisms and CiPA Craig T. January, MD, PhD Division of Cardiovascular Medicine University of Wisconsin-Madison Cardiac Safety Research Consortium Hilton Washington DC December 6, 2016 Disclosures
More informationBrugada Syndrome: An Update
Brugada Syndrome: An Update Osama Diab Associate professor of Cardiology Ain Shams university, Cairo, Egypt Updates Mechanism and Genetics Risk stratification Treatment 1 Brugada syndrome causes 4 12%
More informationThe action potential and the underlying ionic currents. Norbert Jost, PhD
The action potential and the underlying ionic currents Norbert Jost, PhD The propagation of the stimulation in the heart Sinus node Left atria His Bundle Conduction velocity in m/s Time to arrive from
More informationModeling of Anatomy, Electrophysiology and Tension Development in the Human Heart
European Functional Cardiac Modeling Meeting Modeling of Anatomy, Electrophysiology and Tension Development in the Human Heart Dr.-Ing. Gunnar Seemann Overview Electrophysiology Tension development Anatomy
More informationCARDIOVASCULAR SYSTEM
CARDIOVASCULAR SYSTEM Overview Heart and Vessels 2 Major Divisions Pulmonary Circuit Systemic Circuit Closed and Continuous Loop Location Aorta Superior vena cava Right lung Pulmonary trunk Base of heart
More informationEffects of I Kr and I Ks Heterogeneity on Action Potential Duration and Its Rate Dependence
Effects of I Kr and I Ks Heterogeneity on Action Potential Duration and Its Rate Dependence A Simulation Study Prakash C. Viswanathan, BE; Robin M. Shaw, PhD; Yoram Rudy, PhD Background A growing body
More informationEffects of reference compounds on impedance signals from stem cellderived human cardiomyocytes
Effects of reference compounds on impedance signals from stem cellderived human cardiomyocytes Herbert M. Himmel, Safety Pharmacology, Bayer Pharma AG, Wuppertal, Germany SPS Webinar Cardiac Safety Testing
More informationElectrocardiography Normal 5. Faisal I. Mohammed, MD, PhD
Electrocardiography Normal 5 Faisal I. Mohammed, MD, PhD 1 Objectives 2 1. Describe the different waves in a normal electrocardiogram. 2. Recall the normal P-R and Q-T interval time of the QRS wave. 3.
More informationNonpharmacologic Treatment of Ventricular Heart Failure
Nonpharmacologic Treatment of Ventricular Heart Failure Hong Ryang Kil, MD, PhD Department of Pediatrics, College of Medicine, Chungnam National University 2001 AHA Guideline for CHF - Symptomatic LV dysfunction
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 informationAsk Mish. EKG INTERPRETATION part i
EKG INTERPRETATION part i What is EKG? EKG or ECG= electrocardiogram(~graphy) means the recording of the heart electrical activity from Greek kardio= heart, graphein= to write cardiac cell physiology Cardiac
More informationArthur 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
More informationIt has been shown from meta-analysis of randomized clinical trials that patients with a pre-crt QRS duration (QRSD) >150 ms benefit
Cardiac Resynchronization Therapy may be detrimental in patients with a Very Wide QRSD > 180 ms (VWQRSD) and Right Bundle Branch Block Morphology: Analysis From the Medicare ICD Registry Varun Sundaram
More informationMolecular Physiology of Ion Channels That Control Cardiac Repolarization
Chapter 2 / Ion Channels Underlying Repolarization 13 2 Molecular Physiology of Ion Channels That Control Cardiac Repolarization Jeanne M. Nerbonne, PhD and Robert S. Kass, PhD CONTENTS INTRODUCTION INWARD
More informationBENEFIT 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
More informationLarge RCT s of CRT 2002 to present
Have We Expanded Our Use of CRT for Heart Failure Patients? Sana M. Al-Khatib, MD, MHS Associate Professor of Medicine Electrophysiology Section- Division of Cardiology Duke University Potential Conflicts
More informationHeart Failure Compendium
Heart Failure Compendium Circulation Research Compendium on Heart Failure Research Advances in Heart Failure: A Compendium Epidemiology of Heart Failure Genetic Cardiomyopathies Causing Heart Failure Non-coding
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 information/$ -see front matter 2011 Heart Rhythm Society. All rights reserved. doi: /j.hrthm
Electrophysiologic substrate and intraventricular left ventricular dyssynchrony in nonischemic heart failure patients undergoing cardiac resynchronization therapy Subham Ghosh, PhD,* Jennifer N.A. Silva,
More informationActivation électromécanique dans la tétralogie de Fallot opérée. Dr Xavier Iriart Unité de cardiologie congénitale CHU de Bordeaux
Activation électromécanique dans la tétralogie de Fallot opérée Dr Xavier Iriart Unité de cardiologie congénitale CHU de Bordeaux Geva T et al. JCMR 2011 Geva T et al. JCMR 2011 1.Surgical lesions and
More informationStrain Imaging: Myocardial Mechanics Simplified and Applied
9/28/217 Strain Imaging: Myocardial Mechanics Simplified and Applied John Gorcsan III, MD Professor of Medicine Director of Clinical Research Division of Cardiology VECTORS OF CONTRACTION Shortening Thickening
More informationIntroduction. Circulation
Introduction Circulation 1- Systemic (general) circulation 2- Pulmonary circulation carries oxygenated blood to all parts of the body carries deoxygenated blood to the lungs From Lt. ventricle aorta From
More informationMedical Cyber-Physical Systems
Medical Cyber-Physical Systems Electrophysiology basics Lecture 10 Principles of Modeling for Cyber-Physical Systems Instructor: Madhur Behl Many thanks to: Zhihao Jiang, Houssam Abbas, and Rahul Mangharam,
More informationCardiac Telemetry Self Study: Part One Cardiovascular Review 2017 THINGS TO REMEMBER
Please review the above anatomy of the heart. THINGS TO REMEMBER There are 3 electrolytes that affect cardiac function o Sodium, Potassium, and Calcium When any of these electrolytes are out of the normal
More informationLV FUNCTION ASSESSMENT: WHAT IS BEYOND EJECTION FRACTION
LV FUNCTION ASSESSMENT: WHAT IS BEYOND EJECTION FRACTION Jamilah S AlRahimi Assistant Professor, KSU-HS Consultant Noninvasive Cardiology KFCC, MNGHA-WR Introduction LV function assessment in Heart Failure:
More informationTitle. CitationJournal of electrocardiology, 46(6): Issue Date Doc URL. Type. File Information
Title Unique preferential conduction within the isolated s with non-ischemic dilated cardiomyopathy Author(s)Watanabe, Masaya; Yokoshiki, Hisashi; Mitsuyama, Hir CitationJournal of electrocardiology, 46(6):
More informationAmiodarone and Catheter Ablation as Cardiac Resynchronization Therapy for Children with Dilated Cardiomyopathy and Wolff-Parkinson-White Syndrome
Case Report Print ISSN 1738-5520 On-line ISSN 1738-5555 Korean Circulation Journal Amiodarone and Catheter Ablation as Cardiac Resynchronization Therapy for Children with Dilated Cardiomyopathy and Wolff-Parkinson-White
More informationQUIZ/TEST REVIEW NOTES SECTION 1 CARDIAC MYOCYTE PHYSIOLOGY [CARDIOLOGY]
QUIZ/TEST REVIEW NOTES SECTION 1 CARDIAC MYOCYTE PHYSIOLOGY [CARDIOLOGY] Learning Objectives: Describe the ionic basis of action potentials in cardiac contractile and autorhythmic cells Explain the relationship
More informationIonchannels and channelopaties in the heart
Ionchannels and channelopaties in the heart Csatorna müködés Több betegség Drugok kapcsolodása csat.hoz Sejtekbe ioncsat.expresszios módszerek, bemutatása Viktória Szőts Action of membrane transport protein
More informationBlocking the Late Sodium Current
Non-classical Targets in Antiarrhythmic Therapy Blocking the Late Sodium Current Luiz Belardinelli, MD SVP, Cardiovascular Therapeutics Gilead Sciences, CA, USA Madrid June 28, 2011 Disclosures: Full time
More informationBi-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
More informationReappraisal of Luo-Rudy Dynamic Cell Model
Review Reappraisal of Luo-Rudy Dynamic Cell Model Acta Cardiol Sin 2010;26:69 80 Reappraisal of Luo-Rudy Dynamic Cell Model Yi-Hsin Chan, 1 Chia-Tung Wu, 1 Yung-Hsin Yeh 1 and Chi-Tai Kuo 1,2 The cardiac
More informationCover Page. The handle holds various files of this Leiden University dissertation.
Cover Page The handle http://hdl.handle.net/1887/19036 holds various files of this Leiden University dissertation. Author: Bommel, Rutger Jan van Title: Cardiac resynchronization therapy : determinants
More informationIndications for and Prediction of Successful Responses of CRT for Patients with Heart Failure
Indications for and Prediction of Successful Responses of CRT for Patients with Heart Failure Edmund Keung, MD Clinical Chief, Cardiology Section San Francisco VAMC October 25, 2008 Presentation Outline
More informationA tale of two dogs: analyzing two models of canine ventricular electrophysiology
Am J Physiol Heart Circ Physiol 292: H43 H55, 2007. First published September 22, 2006; doi:10.1152/ajpheart.00955.2006. CALL FOR PAPERS Computational Analyses in Ion Channelopathies A tale of two dogs:
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 informationElectrocardiogram ECG. Hilal Al Saffar FRCP FACC College of medicine,baghdad University
Electrocardiogram ECG Hilal Al Saffar FRCP FACC College of medicine,baghdad University Tuesday 29 October 2013 ECG introduction Wednesday 30 October 2013 Abnormal ECG ( ischemia, chamber hypertrophy, heart
More informationDiastolic Function Assessment Practical Ways to Incorporate into Every Echo
Diastolic Function Assessment Practical Ways to Incorporate into Every Echo Jae K. Oh, MD Echo Hawaii 2018 2018 MFMER 3712003-1 Learning Objectives My presentation will help you to Appreciate the importance
More informationEBR Systems, Inc. 686 W. Maude Ave., Suite 102 Sunnyvale, CA USA
Over 200,000 patients worldwide are estimated to receive a CRT device each year. However, limitations prevent some patients from benefiting. CHALLENGING PROCEDURE 5% implanted patients fail to have coronary
More informationJohn D. Fisher, MD. Montefiore Medical Center Professor of Medicine, Albert Einstein College of Medicine, NY
John D. Fisher, MD Montefiore Medical Center Professor of Medicine, Albert Einstein College of Medicine, NY Multisite pacing in CRT does it help? John D. Fisher, MD Professor of Medicine Montefiore Medical
More informationΕνδείξεις αμφικοιλιακής βηματοδότησης. Ποιοι ασθενείς με καρδιακή ανεπάρκεια πρέπει να λάβουν αμφικοιλιακό απινιδωτή;
Ενδείξεις αμφικοιλιακής βηματοδότησης. Ποιοι ασθενείς με καρδιακή ανεπάρκεια πρέπει να λάβουν αμφικοιλιακό απινιδωτή; Άννα Κωστοπούλου Επιμελήτρια Α Ωνάσειο Καρδιοχειρουργικό Κέντρο Τμήμα Ηλεκτροφυσιολογίας
More information8/8/2011. 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
More informationWhy do we need ECHO for CRT device optimization?
Why do we need ECHO for CRT device optimization? Prof.dr.sc. J. Separovic Hanzevacki Department of Cardiovascular Diseases, University Hospital Centre Zagreb School of medicine, University of Zagreb Zagreb,
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 information