Implantable cardioverter-defibrillators and cardiac resynchronization therapy
|
|
|
- Carol Johnston
- 6 years ago
- Views:
Transcription
1 Implantable cardioverter-defibrillators and cardiac resynchronization therapy Johannes Holzmeister, MD University Hospital Zurich, Zurich, Switzerland Frontiers of heart failure controversies, ESC - Paris 2011 Conflict of interest: consulting fees from St Jude Medical and Biotronik; research grants and speaker honoraria from Biotronik, St Jude Medical, Medtronic, and Boston Scientific; and is a co-principal investigator in EchoCRT. No Stocks/Options from a medical device company. Stocks/Options from Cardiorentis (Biotech)
2 Implantable Defibrillators Mieczysław (Michel) Mirowski
3 ICD Landmark Trials Acronym, Pub Year Hazard ratio LVEF, other features MADIT-I 1996 AVID 1997 CABG-Patch 1997 CASH 2000 CIDS 2000 MADIT-II 2002 DEFINITE 2004 DINAMIT 2004 SCD-HeFT N = 196 N = N = N = N = 1, N = N = 1, N = N = or less, NSVT, EP positive Aborted cardiac arrest 0.35 or less, abnormal SAECG and scheduled for CABG Aborted cardiac arrest Aborted cardiac arrest or syncope 0.30 or less, prior MI 0.35 or less, NICM and PVCs or NSVT 0.35 or less, MI within 6 to 40 days and impaired cardiac autonomic function 0.35 or less, LVD due to prior MI and NICM ICD better
4 ESC Guidelines for Heart Failure (2008) Johannes Holzmeister & Christophe Leclercq, The Lancet, Volume 378, Issue 9792, August 2011
5 First Implantable Cardioverter Defibrillator (ICD) Components of the one of the earliest ICDs: Incl. battery and capacitors the weight was 895 g
6 The ICD Lead is the weak spot of ICD Systems
7 Active Treatment with Cardiac Resynchronisation Therapy (CRT) Pre CRT Post-CRT
8 CRT and Heart Failure LV Function OMT OMT + CRT(D) Reverse Remodeling 0.30 CRT Clinical-Non Progressor Non responder Time
9 CRT: State of the art and expanding indications Patients with less severe heart failure (asymptomatic LVD and mild HF) Patients with chronic RV pacing due to conduction disease and heart failure Patients with less severe LVD (e.g., LVEF 36% to 50%) or normal LVEF and a chronic pacing indication Patients with a narrow QRS and ventricular dysynchrony measured by echocardiography Changing the definition of ventricular dysynchrony (QRS duration ECHO)
10 CRT: State of the art and expanding indications Patients with less severe heart failure (asymptomatic LVD and mild HF) Patients with chronic RV pacing due to conduction disease and heart failure Patients with less severe LVD (e.g., LVEF 36% to 50%) or normal LVEF and a chronic pacing indication Patients with a narrow QRS and ventricular dysynchrony measured by echocardiography Changing the definition of ventricular dysynchrony (QRS duration ECHO)
11 2010: RAFT Minimum 18 months, n= : Contak CD 6 months, n =263 Primary Obj: composite (mortality, HF hospitalization, and VT/VF) 2004: MICD II 6 months, n=186 Primary Obj: Peak V : REVERSE 12 months, n= months, n=262 Primary Obj: HF Clinical Composite Score 2009: MADIT CRT Average 29 months, n=1820 Primary Obj: composite (mortality or HF event) Primary Obj: composite (total mortality and HF hospitalization)
12 REVERSE at 24 Months Powered Secondary End Point: LVESVi 110 LVESVi (ml/m2 ) CRT OFF CRT ON P< Months Since Randomization P-value compares 24-month changes
13 REVERSE: Time to First HF Hospitalization or Death from Any Cause Percentage Hospitalized for HF or Died 30% 25% 20% 15% 10% 5% 0% P=0.003 HR=0.38 CRT OFF CRT ON Months Since Randomization Number at Risk CRT OFF CRT ON % 11.7% Patients censored at their 24-month follow-up. Some were before 24 months (730 days), hence the low number at risk. Some were after 24 months, hence the curves rising past 24 months.
14 MADIT-CRT Moss, A. et al., N Engl J Med 361:1329, October 1, 2009
15 MADIT-CRT Moss, A. et al., N Engl J Med 361:1329, October 1, 2009
16 Moss, A. et al., N Engl J Med 361:1329, October 1, 2009
17 RAFT - Resynchronization/Defibrillation for Ambulatory Heart Failure Trial Tang et al., NEJM November 14, 2010
18 Anthony S.L. Tang, AHA, Scientific Session, late breaking clinical trials session I, November 14, 2010, Chicago.
19 Is QRS duration a good marker of ventricular dyssynchrony?
20 CRT in NYHA Class I-II Heart Failure >4000 patients evaluated in randomized controlled trials completed as of November 2010 Strong evidence for reverse remodeling LV volumes and dimensions LV ejection fraction Mitral regurgitation Improvement in functional status and outcomes, as measured by clinical composite endpoints combined endpoint of heart failure morbidity and all-cause mortality
21 Is QRS duration a good marker of ventricular dyssynchrony? In the CARE-HF trial patients with a QRS duration between msec had to fulfill 2 out of 3 echocardiographic dyssynchrony criteria to be included. In the subgroup analysis of the Companion trial, patients with a QRS < 160 msec did not benefit from CRT. In the subgroup analysis of the MADIT-CRT and RAFT trial, patients with a QRS < 150 msec did not benefit from CRT.
22 2010 Focused Update of ESC Guidelines on device therapy in heart failure European Heart Journal (2010) 31,
23 2010 Focused Update of ESC Guidelines on device therapy in heart failure European Heart Journal (2010) 31,
24 Who Benefits From CRT? The Latest Patients with less severe heart failure (asymptomatic LVD and mild HF) Patients with chronic RV pacing due to conduction disease and heart failure Patients with less severe LVD (e.g., LVEF 36% to 50%) or normal LVEF and a chronic pacing indication Patients with a narrow QRS and ventricular dysynchrony measured by echocardiography Changing the definition of ventricular dysynchrony (QRS duration ECHO)
25 Georg Fröhlich, Jan Steffel, David Hürlimann, Frank Enseleit, Thomas F. Lüscher, Frank Ruschitzka, William T. Abraham and Johannes Holzmeister, Eur Heart J Jun;31(12):
26
27 2010 Focused Update of ESC Guidelines on device therapy in heart failure European Heart Journal (2010) 31,
28 2010 Focused Update of ESC Guidelines on device therapy in heart failure European Heart Journal (2010) 31,
29 Who Benefits From CRT? The Latest Patients with less severe heart failure (asymptomatic LVD and mild HF) Patients with chronic RV pacing due to conduction disease and heart failure Patients with less severe LVD (e.g., LVEF 36% to 50%) or normal LVEF and a chronic pacing indication Patients with a narrow QRS and ventricular dysynchrony measured by echocardiography Changing the definition of ventricular dysynchrony (QRS duration ECHO)
30 CRT and Heart Failure LV Function OMT OMT + CRT(D) Reverse Remodeling 0.30 CRT Clinical-Non Progressor Non responder Time
31 CRT and Heart Failure LV Function OMT OMT + CRT(D) 0.30 CRT Reverse Remodeling Clinical-Non Progressor Non responder Time
32
33 Who Benefits From CRT? The Latest Patients with less severe heart failure (asymptomatic LVD and mild HF) Patients with chronic RV pacing due to conduction disease and heart failure Patients with less severe LVD (e.g., LVEF 36% to 50%) or normal LVEF and a chronic pacing indication Patients with a narrow QRS and ventricular dysynchrony measured by echocardiography Changing the definition of ventricular dysynchrony (QRS duration ECHO)
34 Rationale for Studying CRT in Narrow QRS Patients Recent small studies 1,2,3 have indicated that HF patients with a narrow QRS duration and echocardiographic evidence of ventricular dysynchrony may benefit from CRT Lack of definitive evidence and other contradictory studies 4 provide the rationale for a long-term, randomized, controlled trial of CRT in these patients 1 Khan et al, Eur J Heart Fail 2007; 9: Bleeker et al, J Cardiovasc Electrophysiol 2004; 15: Bleeker et al, Am J Cardiol 2005; 95: Beshai JF et al, N Engl J Med 2007; 357:
35 Rationale for Studying CRT in Narrow QRS Patients Hundreds of thousands of needy heart failure patients could benefit if the indication for CRT was expanded to those with a narrow QRS Study investigates the controversy between electrical and mechanical dysynchrony
36 Potential for CRT in Narrow QRS Patients More than 70% of HF patients present with narrow QRS HF patient population in NYHA III/IV 1,2,3 Total Narrow QRS 70% 30% 30% 50% 50% 35% 50% of patients with narrow QRS have ventricular dyssynchrony Wide QRS (CRT patients according to guidelines) with ventricular dyssynchrony Narrow QRS without ventricular dyssynchrony 1 Schoeller et al, Am J Cardiol 1993; 71: Aaronson et al, Circulation 1997; 95: Farwell et al, Eur Heart J 2000; 21:
37 Johannes Holzmeister & Christophe Leclercq, The Lancet, Volume 378, Issue 9792, August 2011
38 Mechanical Dyssynchrony
39 Speckle Tracking Radial Strain LBBB Dyssynchrony
40 Apical 4-Chamber View Opposing Wall Delay Method by TDI AVO 140 ms AVC Septal Lateral IVC
41 Mechanical Dyssynchrony (% Patient Population) Dyssynchrony in relation to QRS width in Heart Failure Patients (EF < 35%) 100% Intraventricular dyssynchrony Global dyssynchrony 50% 30% Mean QRS CARE-HF, Companion QRS width (msec)
42 Presence of pre-defined dyssynchrony measures in patients with a narrow QRS complex 1,2 1, Rutger J. van Bommel, V. Delgado, Matteo Bertini, C. Jan Willem Borleffs, Nina Ajmone Marsan, Johannes Holzmeister, Frank Ruschitzka, Martin J. Schalij, Jeroen J. Bax and John Gorcsan III, Eur Heart J Dec;31(24):
43 Echocardiography Guided Cardiac Resynchronization Therapy Prospective, international, multicenter, double-blinded, randomized study which all patients followed for 24 months 1,258 patients NYHA III/IV, OPT, NSR, LVEF 35%, LVEDD 55 mm QRS<130ms, Echo Dysynchrony R 1:1 CRT= ON CRT= OFF Primary endpoint: Effectiveness: Combination of all-cause death or HF-Hospitalization Safety: Complication-free rate at 6 months Sponsor: Biotronik
44 Mechanical Dyssynchrony (% Patient Population) Dyssynchrony in relation to QRS width in Heart Failure Patients (EF < 35%) 100% Intraventricular dyssynchrony Global dyssynchrony 50% 30% EchoCRT Patients Mean QRS CARE-HF, Companion QRS width (msec)
45 Mechanical Dyssynchrony (% Patient Population) Dependece of Future CRT Indication on Echo Dyssynchrony 100% ECHO necessary for CRT indication 50% 30% Patient population EF < 35% Mean QRS CARE-HF, Companion QRS width (msec)
46 ESC Guidelines for ICDs and CRTs for Heart Failure 2008, 2010 NYHA I NYHA II NYHA III NYHA IV Basic therapy also if asymptomatic ACE-Inhibitors ARB if ACE-I Intolerant or add to ACE-I if B-B intolerant Post MI ß-Blocker ICD (EF < 35% on OMT) Aldosterone Antagonisten ICD for Survivers of SCA or with sustained VT CRT or CRT-ICD patients with dyssynchrony on OMT
The Role of ICD Therapy in Cardiac Resynchronization
The Role of ICD Therapy in Cardiac Resynchronization The Korean Society of Circulation 15 April 2005 Angel R. León, MD Carlyle Fraser Heart Center Division of Cardiology Emory University School of Medicine
Do All Patients With An ICD Indication Need A BiV Pacing Device?
Do All Patients With An ICD Indication Need A BiV Pacing Device? Muhammad A. Hammouda, MD Electrophysiology Laboratory Department of Critical Care Medicine Cairo University Etiology and Pathophysiology
Bi-Ventricular pacing after the most recent studies
Seminars of the Hellenic Working Groups February 18th-20 20,, 2010, Thessaloniki, Greece Bi-Ventricular pacing after the most recent studies Maurizio Lunati MD Director EP Lab & Unit Cardiology Dpt. Niguarda
Arthur J. Moss, MD Professor of Medicine/Cardiology University of Rochester Medical Center Rochester, NY. DISCLOSURE INFORMATION Arthur J.
Saving Lives and Preventing Heart Failure: The MADIT Family of Trials Arthur J. Moss, MD Professor of Medicine/Cardiology University of Rochester Medical Center Rochester, NY Update in Electrocardiography
Large 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
Cardiac Resynchronization ICD Therapy: What is New?
Cardiac Resynchronization ICD Therapy: What is New? Emile Daoud, MD Section Chief, Cardiac Electrophysiology Professor of Medicine The Ohio State University Normal Activation, Narrow QRS Synchrony Abnormal
Cardiac Devices CRT,ICD: Who is and is not a Candidate? Who Decides
Cardiac Devices CRT,ICD: Who is and is not a Candidate? Who Decides Colette Seifer MB(Hons) FRCP(UK) Associate Professor, University of Manitoba, Cardiologist, Cardiac Sciences Program, St Boniface Hospital
MADIT Studies: CRT in the Non-LBBB Patient and Other Findings. Arthur J. Moss, MD
MADIT Studies: CRT in the Non-LBBB Patient and Other Findings Arthur J. Moss, MD University of Rochester Medical Cntr. Rochester, NY 13 th Annual New Frontiers in Heart Failure Rx NYC, NY January 26, 2013
THE ROLE OF ICD THERAPY FOR PRIMARY PREVENTION Leonard Ganz, M.D. Pittsburgh, PA
THE ROLE OF ICD THERAPY FOR PRIMARY PREVENTION Leonard Ganz, M.D. Pittsburgh, PA Speakers Bureau: Zoll / Lifecore, Sanofi Aventis, Cardionet Consultant: Boston Scientific, St. Jude Medical, Biotronik,
IMPLANTABLE DEVICE THERAPY FOR HEART FAILURE
IMPLANTABLE DEVICE THERAPY FOR HEART FAILURE Nora Goldschlager, M.D. MACP, FACC, FAHA, FHRS Cardiology San Francisco General Hospital UCSF Disclosures: None LEADING CAUSES OF DEATH IN US Sudden cardiac
Cardiac Resynchronization Therapy Guidelines and Missing Groups
Cardiac Resynchronization Therapy Guidelines and Missing Groups Frank Pelosi, Jr., MD, FACC, FHRS Director, Cardiac Electrophysiology Fellowship Associate Professor of Medicine University of Michigan Health
How 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
Dialysis-Dependent Cardiomyopathy Patients Demonstrate Poor Survival Despite Reverse Remodeling With Cardiac Resynchronization Therapy
Dialysis-Dependent Cardiomyopathy Patients Demonstrate Poor Survival Despite Reverse Remodeling With Cardiac Resynchronization Therapy Evan Adelstein, MD, FHRS John Gorcsan III, MD Samir Saba, MD, FHRS
Heart failure and sudden death
Heart failure and sudden death What did we learn so far from important ICD- and CRT trials? Helmut U. Klein M.D. University of Rochester Medical Center Heart Research Follow up Program Arrhythmic substrate
Primary prevention of SCD with the ICD in Nonischemic Cardiomyopathy
Primary prevention of SCD with the ICD in Nonischemic Cardiomyopathy Michael R Gold, MD, PhD Medical University of South Carolina Charleston, SC USA Disclosures: Consulting and Clinical Trials Medtronic
ICD. Guidelines and Critical Review of Trials. Win K. Shen, MD Professor of Medicine Mayo Clinic College of Medicine Mayo Clinic Arizona Torino 2011
ICD Guidelines and Critical Review of Trials Win K. Shen, MD Professor of Medicine Mayo Clinic College of Medicine Mayo Clinic Arizona Torino 2011 Disclosure Relevant Financial Relationship(s) None Off
Left Ventricular Ejection Fraction >35%
Controversies in Cardiac Resynchronisation Therapy Left Ventricular Ejection Fraction >35% Professor John GF Cleland University of Hull Kingston-upon-Hull United Kingdom Conflict of Interest: I have received
HF and CRT: CRT-P versus CRT-D
HF and CRT: CRT-P versus CRT-D Andrew E. Epstein, MD Professor of Medicine, Cardiovascular Division University of Pennsylvania Chief, Cardiology Section Philadelphia VA Medical Center Philadelphia, PA
Cardiac resynchronization therapy for heart failure: state of the art
Cardiac resynchronization therapy for heart failure: state of the art Béla Merkely MD, PhD, DSc, FESC, FACC Vice president of the European Society of Cardiology Honorary president of the Hungarian Society
This is What I do to Improve CRT Response for CRT Non-Responders
This is What I do to Improve CRT Response for CRT Non-Responders Michael R Gold, MD, PhD Medical University of South Carolina Charleston, SC Disclosures: Steering Committees (unpaid) and Clinical Trials,
Preventing Sudden Death Current & Future Role of ICD Therapy
Preventing Sudden Death Current & Future Role of ICD Therapy Derek V Exner, MD, MPH, FRCPC, FACC, FAHA, FHRS Professor, Libin Cardiovascular Institute of Alberta Canada Research Chair, Cardiovascular Clinical
Comparison of clinical trials evaluating cardiac resynchronization therapy in mild to moderate heart failure
HOT TOPIC Cardiology Journal 2010, Vol. 17, No. 6, pp. 543 548 Copyright 2010 Via Medica ISSN 1897 5593 Comparison of clinical trials evaluating cardiac resynchronization therapy in mild to moderate heart
Device based CRT optimization: is there a future? Lessons learned from published trials
Device based CRT optimization: is there a future? Lessons learned from published trials C. Leclercq Department of Cardiology Centre Cardio-Pneumologique Rennes, France Presenter Disclosure Information
Implantation of a CRT-Pacemaker Rather than CRT-Defibrillator is Usually Preferred
Implantation of a CRT-Pacemaker Rather than CRT-Defibrillator is Usually Preferred Professor John GF Cleland University of Hull Kingston-upon-Hull United Kingdom Conflict of Interest: Funding or Speakers
Risk Stratification of Sudden Cardiac Death
Risk Stratification of Sudden Cardiac Death Michael R Gold, MD, PhD Medical University of South Carolina Charleston, SC USA Disclosures: None Sudden Cardiac Death A Major Public Health Problem > 1/2 of
Cover 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
Site of Latest Mechanical Activation, LV Lead Position and Response to Cardiac Resynchronization Therapy
Site of Latest Mechanical Activation, LV Lead Position and Response to Cardiac Resynchronization Therapy J.M.J. Boogers Department of Cardiology Leiden University Medical Center Leiden, The Netherlands
ICD 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.
How 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,
CRT-P or CRT-D From North Alberta to Nairobi
CRT-P or CRT-D From North Alberta to Nairobi Dr Mzee Ngunga Aga Khan University Hospital Nairobi KCS Congress: Impact through collaboration CONTACT: Tel. +254 735 833 803 Email: kcardiacs@gmail.com Web:
Device 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
Heart Failure Overview. Dr Chris K Y Wong
Heart Failure Overview Dr Chris K Y Wong Heart Failure: A Growing, Global Health Issue Heart Failure 23 Million Afflicted Global Impact Worldwide ~23 million peopleworldwide afflicted with CHF 1 Exceeds
Who 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
BENEFIT OF CRT IN MILDLY SYMPTOMATIC HEART FAILURE RECENT DATA FROM MADIT-CRT AND RAFT
BENEFIT OF CRT IN MILDLY SYMPTOMATIC HEART FAILURE RECENT DATA FROM MADIT-CRT AND RAFT Ilan Goldenberg MD Professor of Cardiology Sheba Medical Center and Tel Aviv University, Israel University of Rochester
Heart Failure Overview. Dr Chris K Y Wong
Heart Failure Overview Dr Chris K Y Wong Heart Failure: A Growing, Global Health Issue Heart Failure 23 Million Afflicted Global Impact Worldwide ~23 million peopleworldwide afflicted with CHF 1 Exceeds
The SEPTAL CRT study (NCT: )
Comparison of right ventricular septal pacing and right ventricular apical pacing in patients receiving cardiac resynchronization therapy defibrillators The SEPTAL CRT study (NCT: 00833352) Christophe
BSH Annual Autumn Meeting 2017
BSH Annual Autumn Meeting 2017 Presentation title: The Development of CRT Speaker: John GF Cleland Conflicts of interest: I have received research support and honoraria from Biotronik, Boston Scientific,
WHAT DO ELECTROPHYSIOLOGISTS WANT TO KNOW FROM ECHOCARDIOGRAPHERS BEFORE, DURING&AFTER CARDIAC RESYNCHRONIZATION THERAPY?
WHAT DO ELECTROPHYSIOLOGISTS WANT TO KNOW FROM ECHOCARDIOGRAPHERS BEFORE, DURING&AFTER CARDIAC RESYNCHRONIZATION THERAPY? Mary Ong Go, MD, FPCP, FPCC, FACC OUTLINE What is CRT Who needs CRT What does the
ESC Guidelines. ESC Guidelines Update For internal training purpose. European Heart Journal, doi: /eurheart/ehn309
ESC Guidelines Update 2008 ESC Guidelines Heart failure update 2008 For internal training purpose. 0 Agenda Introduction Classes of recommendations Level of evidence Treatment algorithm Changes to ESC
Sudden 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,
Effect 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
The road to successful CRT implantation: The role of echo
The road to successful CRT implantation: The role of echo Tae-Ho Park Dong-A University Hospital, Busan, Korea Terminology Cardiac Resynchronization Therapy (CRT) = Biventricular pacing (BiV) = Left ventricular
Response of Right Ventricular Size to Treatment with Cardiac Resynchronization Therapy and the Risk of Ventricular Tachyarrhythmias in MADIT-CRT
Response of Right Ventricular Size to Treatment with Cardiac Resynchronization Therapy and the Risk of Ventricular Tachyarrhythmias in MADIT-CRT Heart Rhythm Society (May 11, 2012) Colin L. Doyle, BA,*
ESC Stockholm Arrhythmias & pacing
ESC Stockholm 2010 Take Home Messages for Practitioners Arrhythmias & pacing Prof. Panos E. Vardas Professor of Cardiology Heraklion University Hospital Crete, Greece Disclosures Small teaching fees from
Why 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,
Cardiac resynchronization therapy for mild-to-moderate heart failure
For reprint orders, please contact reprints@expert-reviews.com Cardiac resynchronization therapy for mild-to-moderate heart failure Expert Rev. Med. Devices 8(3), 313 317 (2011) Haran Burri Electrophysiology
Importance 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
Indications 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
Devices and Other Non- Pharmacologic Therapy in CHF. Angel R. Leon, MD FACC Division of Cardiology Emory University School of Medicine
Devices and Other Non- Pharmacologic Therapy in CHF Angel R. Leon, MD FACC Division of Cardiology Emory University School of Medicine Disclosure None University of Miami vs. OSU Renegade Miami football
8/8/2011. CARDIAC RESYCHRONIZATION THERAPY for Heart Failure. Case Presentation. Case Presentation
CARDIAC RESYCHRONIZATION THERAPY for Heart Failure James Taylor, DO, FACOS Cardiothoracic and Vascular surgery San Angelo Community Medical Center San Angelo, TX Case Presentation 64 year old female with
Dipartimento di Scienze Cardiovascolari Università Campus Bio-Medico di Roma Dott. Vito Calabrese
Dipartimento di Scienze Cardiovascolari Università Campus Bio-Medico di Roma Dott. Vito Calabrese Because the primary objective was cure symptomatic bradicardya due to syncope Because this is the common
Is QRS width predictive of the clinical and echocardiographic response to chronic CRT in mildly symptomatic HF patients?
Is QRS width predictive of the clinical and echocardiographic response to chronic CRT in mildly symptomatic HF patients? Data from REVERSE C Thébault 1, M Gold 2, C Linde 3, WT Abraham 4, C Leclercq 1,
Resynchronization/Defibrillation
Resynchronization/Defibrillation for Ambulatory Heart Failure Trial Cardiac Resynchronization Therapy for Mild to Moderate Heart Failure George Wells University of Ottawa Heart Institute Department of
Cardiac 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
Implantable Cardioverter- Defibrillators (ICDs) for the Prevention of SCD: Appropriate Use in Disclosures
Implantable Cardioverter- Defibrillators (ICDs) for the Prevention of SCD: Appropriate Use in 2015 Andrew E. Epstein, MD Professor of Medicine, Cardiovascular Division University of Pennsylvania Chief,
Ενδείξεις 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
Implantable 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
CRT: whom does it benefit?
CRT: whom does it benefit? Francisco Leyva BSH Revalidation and Training 2018 Queen Elizabeth Hospital NICE guidelines for CRT LVEF 35% NYHA class I II III IV QRS
Cecilia Linde Karolinska University Hospital Stockholm
The mildly symptomatic patient with low EF, moderate/severe mitral regurgitation and QRS 140 ms Cecilia Linde Karolinska University Hospital Stockholm Presenter Disclosure Information Cecilia Linde, MD,
CRT-D or CRT-P: HOW TO CHOOSE THE RIGHT PATIENT?
CRT-D or CRT-P: HOW TO CHOOSE THE RIGHT PATIENT? Alessandro Lipari, MD Chair and Department of Cardiology University of Study and Spedali Civili Brescia -Italy The birth of CRT in Europe, 20 years ago
Gender 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
Cover 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
Cardiac resynchronisation therapy (biventricular pacing) for the treatment of heart failure
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE Health Technology Appraisal for the treatment of heart failure Final scope Appraisal objective To appraise the clinical and cost effectiveness of cardiac
Strain 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
Cardiac 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
Biventricular Pacemakers (Cardiac Resynchronization Therapy) for the Treatment of Heart Failure
Last Review Status/Date: June 2015 Page: 1 of 29 Resynchronization Therapy) for the Treatment Description Cardiac resynchronization therapy (CRT), which consists of synchronized pacing of the left and
Provocative Cases: Issues in the Expanding Use of CRT in Treating CHF Patients
Provocative Cases: Issues in the Expanding Use of CRT in Treating CHF Patients David E. Krummen, MD Associate Professor of Medicine University of California San Diego and VA San Diego Healthcare System
La stimulation biventriculaire (Traitement par Resynchronisation Cardiaque) Indications et Résultats. Daniel Gras, DIU, Paris 2007
La stimulation biventriculaire (Traitement par Resynchronisation Cardiaque) Indications et Résultats, DIU, Paris 2007 CRT: Results and indications Background Results of CRT Studies Today s classical CRT
Device Update Implantable Cardioverter Defibrillator (ICD) 박상원
2012 년춘계학술대회 Device Update Implantable Cardioverter Defibrillator (ICD) 박상원 Arrhythmia Center, KUMC www.korea-heartrhythm.com Korea University Medical Center Seoul, Korea The Development of ICD by a team
ICD Guidelines: who benefits from an ICD?
ICD Guidelines: who benefits from an ICD? Matthew Bennett Cardiac Electrophysiologist Vancouver Coastal Health, Device Lead Associate Professor, UBC Matthew.bennett@vch.ca Disclosures I have research collaborations
Cover 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
Technology appraisal guidance Published: 25 June 2014 nice.org.uk/guidance/ta314
Implantable cardioverter defibrillators and cardiac resynchronisation therapy for arrhythmias and heart failure Technology appraisal guidance Published: 25 June 2014 nice.org.uk/guidance/ta314 NICE 2017.
Cardiac 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
The Influence of Left Ventricular Ejection Fraction on the Effectiveness of Cardiac Resynchronization Therapy
Journal of the American College of Cardiology Vol. 61, No. 9, 2013 2013 by the American College of Cardiology Foundation ISSN 0735-1097/$36.00 Published by Elsevier Inc. http://dx.doi.org/10.1016/j.jacc.2012.11.051
CRT Vs RV Pacing Benefits
CRT-P & CRT-D Indications According to Guidelines are Guidelines Fully Adopted? Salama H. Omar M.D. Prof. Critical Care Medicine, Cairo University CRT Vs RV Pacing Benefits 1 Benefit of Upgrade CTR-P &
ACD Heart failure - biventricular pacing (cardiac resynchronisation)
Mr Christopher Feinmann Project Manager NICE Mid-City Place 71 High Holborn London WC1V 6NA 18 December 2006 Dear Mr Feinmann Re: NICE Appraisal Consultation Document: Cardiac resynchronisation therapy
Multisite Left Ventricular Pacing for Cardiac Resynchronization
Multisite Left Ventricular Pacing for Cardiac Resynchronization C. W. Israel, M.D. Ass. Prof. Dept. of Medicine Cardiology Evangelical Hospital Bielefeld Germany J. W. Goethe University Frankfurt C.W.Israel@em.uni-frankfurt.de
Journal of the American College of Cardiology Vol. 52, No. 23, by the American College of Cardiology Foundation ISSN /08/$34.
Journal of the American College of Cardiology Vol. 52, No. 23, 2008 2008 by the American College of Cardiology Foundation ISSN 0735-1097/08/$34.00 Published by Elsevier Inc. doi:10.1016/j.jacc.2008.08.027
EBR 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
Ενδείξεισ 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
עדכונים באלקטרופיזיולוגיה Electrophysiology Unit Soroka University Medical Center Faculty of Health Sciences Ben-Gurion University of the Negev
עדכונים באלקטרופיזיולוגיה 2014 Electrophysiology Unit Soroka University Medical Center Faculty of Health Sciences Ben-Gurion University of the Negev 1 מבנה הצגת היחידה פעילות ביחידה סקירה על הטיפול באלקטרופיזיולוגיה
Defibrillation 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
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE Implantable cardioverter defibrillators for the treatment of arrhythmias and cardiac resynchronisation therapy for the treatment of heart failure (review
Biventricular Pacemakers (Cardiac Resynchronization Therapy) for the Treatment of Heart Failure
Last Review Status/Date: September 2016 Page: 1 of 29 Resynchronization Therapy) for the Treatment Description Cardiac resynchronization therapy (CRT), which consists of synchronized pacing of the left
A BS TR AC T. n engl j med 369;15 nejm.org october 10,
The new england journal of medicine established in 1812 october 10, 2013 vol. 369 no. 15 Cardiac-Resynchronization Therapy in Heart Failure with a Narrow QRS Complex Frank Ruschitzka, M.D., William T.
Upgrade 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)
Three-dimensional Wall Motion Tracking:
Three-dimensional Wall Motion Tracking: A Novel Echocardiographic Method for the Assessment of Ventricular Volumes, Strain and Dyssynchrony Jeffrey C. Hill, BS, RDCS, FASE Jennifer L. Kane, RCS Gerard
Sudden Cardiac Death
Sudden Cardiac Death management challenges of a global problem Zayd A. Eldadah, MD, PhD Co-Director, Cardiac Electrophysiology, Washington Hospital Center Director, Cardiac Electrophysiology, Georgetown
Understanding and Development of New Therapies for Heart Failure - Lessons from Recent Clinical Trials -
Understanding and Development of New Therapies for Heart Failure - Lessons from Recent Clinical Trials - Clinical trials Evidence-based medicine, clinical practice Impact upon Understanding pathophysiology
All in the Past? Win K. Shen, MD Mayo Clinic Arizona Controversies and Advances in CV Diseases Cedars-Sinai Heart Institute, MFMER
ICD for NICM All in the Past? Win K. Shen, MD Mayo Clinic Arizona Controversies and Advances in CV Diseases Cedars-Sinai Heart Institute, 2017 2017 MFMER 3686275-1 DISCLOSURE Relevant Financial Relationship(s)
Cover 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
Chapter. Victoria Delgado, Claudia Ypenburg, Qing Zhang, Sjoerd A. Mollema, Jeffrey Wing-Hong Fung, Martin J. Schalij, Cheuk-Man Yu, Jeroen J. Bax.
16 Chapter Changes in global left ventricular function by multidirectional strain assessment in heart failure patients undergoing cardiac resynchronization therapy Victoria Delgado, Claudia Ypenburg, Qing
Nonischemic cardiomyopathy, LVEF 31-35%, no prior implant, SR for ANY of the following:
Cigna Medical Coverage Policy Subject Biventricular Pacing/Cardiac Resynchronization Therapy (CRT) Table of Contents Coverage Policy... 1 General Background... 2 Coding/Billing Information... 17 References...
Nonpharmacologic 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
Name of Policy: Bi-Ventricular Pacemakers (Cardiac Resynchronization Therapy) for the Treatment of Heart Failure
Name of Policy: Bi-Ventricular Pacemakers (Cardiac Resynchronization Therapy) for the Treatment of Heart Failure Policy #: 055 Latest Review Date: April 2014 Category: Surgery Policy Grade: A Background/Definitions:
A 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:
Michel Mirowski and colleagues ABSTRACT CARDIOLOGY. ICD Update: New Evidence and Emerging Clinical Roles in Primary Prevention of Sudden Cardiac Death
ICD Update: New Evidence and Emerging Clinical Roles in Primary Prevention of Sudden Cardiac Death Ronald D. Berger, MD, PhD, FACC ABSTRACT PURPOSE: To review recent major randomized trials of implantable
Prior Authorization Review Panel MCO Policy Submission
Prior Authorization Review Panel MCO Policy Submission A separate copy of this form must accompany each policy submitted for review. Policies submitted without this form will not be considered for review.
CRT implant using Mediguide: towards fluoroless implant?
CRT implant using Mediguide: towards fluoroless implant? Christopher Piorkowski University Dresden Heart Center - Department of Electrophysiology Presenter Disclosure Information C. Piorkowski has the
DON T FORGET TO OPTIMISE DEVICE PROGRAMMING
CRT:NON-RESPONDERS OR NON-PROGRESSORS? DON T FORGET TO OPTIMISE DEVICE PROGRAMMING Prof. ALİ OTO,MD,FESC,FACC,FHRS Chairman,Department of Cardiology Hacettepe University Faculty of Medicine,Ankara Causes