16 rencontres biomédicale LIR Michel Haissaguerre

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2ND INTERNATIONAL RESEARCH MEETING …

2ND INTERNATIONAL RESEARCH MEETING
4 JUNE 2010- HÔTEL DE MARIGNY PARIS

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  • 1.
  • 2. Targeting the Electrical Heart From identified cells to novel approaches against: Cardiac Arrhythmias Sudden Death Heart Failure Major Impact of Cardiac Electrical disorders on human Health
  • 3. Human Cardiac Arrhythmias
    • Tachycardias
    • =1 focus or circuit
    Fibrillations = multiple foci/circuits Chaos
  • 4. The most common : Atrial Fibrillation
    • 1-2% of the population: 6 Millions subjects
    • Increases with age
    • 1st US emergency: 6.65 billion $/yr
    • Main Cause of Embolic Strokes (20% of all strokes)
    • Vascular,senile & Alzheimer’s dementia X 2
    In 2050 ( Olmsted County Study) 16 M in USA 25 M in Europe Atria Ventricles
  • 5.
    • Method: Map of 100 ms preceding spontaneous initiation 1994.1998
    Mapping the genesis of chaos NEJM 1998 Results - Episodes of AF originate from Sources outside the heart - in vascular wall (pulmonary veins) Proof of Concept: local energy delivery eliminate recurrences
  • 6. Curative therapy of Paroxysmal Atrial Fibrillation 10 000 pts treated in 2000 - 200 000 patients in 2010
    • Therapy for Drug Resistant AF
    • acknowledged by AHA/EHA 2007
    Birth of a specific biotechnological industry ( X 5 next 10 years) (Sources: Philips-GE-Siemens) Thermo-exclusion of venous foci
  • 7. Research Perspectives
    • 1.<1% of pts are treated by ablation:
    • Strong Need of Drugs targeting PV cells
    • 2.Understand/image atrial structural remodeling- ageing to develop preventive drugs (Leducq-FP7)
    • 3.Characterise AF individually for specific blockers ; Targeted sites for delivery; Thermally activated drugs; Local gene therapies
  • 8. INTERNATIONAL AWARDS
    • Mirowski Excellence in Cardiology  Boston Award in Electrophysiology
    • Best European Scientist Award  Pioneer North American Award
    • Jeantet Prize of Medecine  Grand Prize of Sciences Academy
    • Nylin Swedish Royal Society of Medecine
    INNOVATIONS Platelet GPIIbIIIa and P2Y12 receptors (Antiaggregants) Coinvention of Resynchronisation Propranolol in hemangioma Catheters, devices, softwares
  • 9. Sudden death is not a ‘cardiac arrest’ but Ventricular Fibrillation in 80%
      • Mean Age 65 years , 80% at home
      • In Europe (or USA) :
      • (Newborns : 2500/ yr)
      • Largely underestimated:
      • VF = Breast + Colon
      • + Lung Cancers
      • + AIDS
    300 000 adults/yr Survival rate 2% Fatal Electrical Tornado during night- M 57
  • 10. First maps in Humans with multiple VFs: initiation by Purkinje cells (<2 % of cardiac mass) Arborized Network of Purkinje cells Lancet 2003 - Circulation 2004 et 2006 Proof of Responsibility : Focal energy eliminates recurrences F 37 yr- Arrhythmic storm
  • 11. Research Perspectives
    • Ablation can’t be the solution for everybody: Mechanisms of Purkinje firing to develop specific blockers
    • Identify pts at risk is unmet medical need: markers of Vulnerability in the broad population of cardiac pts
    • Tailored drugs aiming at preventing and/or reversing vulnerability (Ex: early repolarisation-Ito blockers NEJM )
    Unique tools for mapping
  • 12. Heart Failure
    • EUROPE: 9 MILLIONS INDIVIDUALS
    • 50%† at 5 yrs= 350 à 400 000 deaths/yr
    Unknown Role of Abnormal activation via Purkinje disease ? >50% of HF patients have electrical dysfunction Its role is largely unexplored
  • 13. Original Research Projects
    • Investigate electrical dysfunction
    • as a cause of Heart Failure
    • Earlier detection & Regenerative therapies
    • Optimize Resynchronisation Devices/strategies (signal-modelisation)
  • 14. Unique Translational Research Center on Cardiac Electrical Disorders- BORDEAUX Top level international expertise : Whole heart ElectroPhysiology Computer Sciences ( Signal-Modelisation ) Cardiac Imaging Public & Private institutions Industrial Partnership *