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Arrhythmia News 014

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  • 1. Tsu-Juey Wu (Taiwan Heart Rhythm Society) 10041 50 22 26 886-2-23821530 886-2-23821528 www.thrs.org.tw I S S N 2 2 2 3 - 0 1 3 0 Yenn-Jiang Lin Kuo-Hung Lin Shih-Tsung Cheng Cheng-Hung Li Wen-Chin Tsa Hung-Yu Chang Tze-Fan Chao Shuenn-Nan Chiu Shih-Chung Huang Jan-Yow Chen Po-Ching Chi Bien-Hsien Huang Wei-Hua Tang Shan-Huei Huang Hung-Ta Wo Jun. 2014 VOL. 014Arrhythmia News 1994 Cazeau PACE four chamber pacing dilated cardiomyopathy left bundle branch block (LBBB) (Cardiac Resynchronization Therapy, CRT) 20 CRT (algorithm) P1 P1 P3 P5 P7 - P9 EKG of the month P10 P13 P16 P17 HRS P18 2014 HRS 2011 Effectiveness of cardiac resynchronization therapy by QRS morphology in the Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy (MADIT-CRT). Circulation 2011;123:1061-72 CRT-D( defibrillation CRT) QRS 2.4 CRT-D 34% 41% (LBBB) NEJM Survival with Cardiac- Resynchronization Therapy in Mild Heart Failure, N Engl J Med 2014; 370:1694-1701 (MADIT-CRT) MADIT-CRT 1820 EF<30%, NYHA class I II 3:2 CRT-D ICD guideline ICD MADIT-CRT 2004 12 22 2009 6 22 1691 2010 9 10 (post trial phase I) 854 2013 9 (post trial phase 2) QRS LBBB LBBB LBBB CRT-D ICD 41% (hazard ratio of 0.59) 62% (hazard ratio of 0.38) subgroup
  • 2. Taiwan Heart Rhythm Society 103 6THRS VOL.0142 QRS 150 <150ms CRT-D LBBB (RBBB intraventricular conduction delay) (NYHA class III and IV) CRT-D MADIT-CRT the Resynchronization Reverses Remodeling in Systolic Left Ventricular Dysfunction (REVERSE) trial 2 CRT-D The Resynchronization–Defibrillation for Ambulatory Heart Failure Trial (RAFT) CRT-D (NYHA class I ~ III) MEDIT-CRT CRT-D LBBB (NYHA I II) (EF<30%) LBBB CRT-D CRT-D LBBB Reference 1. Goldenberg I, Kutyifa V, Klein HU, et al. Survival with Cardiac- Resynchronization Therapy in Mild Heart Failure, N Engl J Med 2014; 370:1694-1701. 2. Zareba W, Klein H, Cygankiewicz I, et al. Effectiveness of cardiac resynchronization therapy by QRS morphology in the Multicenter Therapy (MADIT-CRT). Circulation 2011;123:1061-72. 3. Tang AS, Wells GA, Talajic M, et al. Cardiac-resynchronization therapy for mild-to-moderate heart failure. N Engl J Med 2010;363:2385-95. Survival with Cardiac-Resynchronization Therapy in Mild Heart Failure, N Engl J Med 2014; 370:1694-1701 LBBB CRT-D ICD LBBB CRT-D Survival with Cardiac-Resynchronization Therapy in Mild Heart Failure, N Engl J Med 2014; 370:1694-1701 LBBB QRS EF>25% or EF<25% CRT-D ICD
  • 3. Taiwan Heart Rhythm Society 103 6VOL.014 3THRS ( ) Cardiac Resynchronization Therapy (CRT) QRS left bundle branch block(LBBB) MADIT-CRT 7 (Ischemic cardiomyopathy NYHA Fc I-II; Non-Ischemic Cardiomyopathy Fc II) CRT-de brillator (CRT-D) 1 CRT (LV reversed remodeling) 1/3 (non-responder) 2,3 non-responders 4 CRT non-responder AV interval VV interval AV interval LBBB CRT CRT (synchronized LV pacing, sLVP) 5 AdaptivCRT® sLVP CRT (Biventricular pacing, BVP) (LVP) LVP PR 200msec BVP 6 100 BPM BVP LVP 7 LVP LVP AV delay AV interval 70% RV 30-90mesc 8,9 BVP BVP AV delay P 30msec RV 50msec 9,10 AdaptivCRT® ( ) Adaptive CRT trial 522 2:1 AdaptivCRT® 6 AdaptivCRT® 11 AdaptivCRT® RV pacing 44% sLVP sLVP 50% sLVP 50% sLVP 50% 12 AdaptivCRT® 48%
  • 4. Taiwan Heart Rhythm Society 103 6THRS VOL.0144 (P=0.044) 12 46% 13 MIRACLE MIRACLE ICD InSync III Marquis PROSPECT CRT AdaptivCRT® 12% 14 CRT (phrenic nerve stimulation, PNS) PNS CRT CRT (Cardiac Vein) 70 15 PNS (QuartetTM by St. Jude Medical Attain® Performa® by Medtronic) RV 10 CRT non-responder PNS St. Jude Medical VectSelect QuartetTM CRT Medtronic Vector Express® 16 CRT non-responder St Jude Medical MultiPointTM Pacing (MPP) ( ( )) BVP LV dP/dtmax 16,17 tissue Doppler imaging (TDI) BVP 18 CRT References 1. Goldenborg I, et al. NEJM. 2014:370;1694-1701. 2. Abraham WT, et al. NEJM. 2002;346:1845-1853. 3. Abraham WT, et al. Circulation. 2004;110:2864-2868. 4. Mullens W, et al. JACC. 2009;53:765-773. 5. Van Gelder BM, et al. JACC. 2005;46:2305-2310. 6. Kurzidim K, et al. PACE. 2005;28:754-761. 7. Vollman D, et al. Circulation. 2006;113:953-959. 8. Khaykin Y, et al. Europace. 2011;13:1464-1470. 9. Bailey R, et al. JACC. 2008;1022-1101. (Abstract) 10. Jones RC, et al. JC. 2012;21:1226-1232. 11. Martin DO, et al. Heart Rhythm. 2012;9:1807-1814. 12. Birnie D, et al. Heart Rhythm. 2013;9:1368-1374. 13. Martin OD, et al. Circulation. 2013;128:A17740. (Abstract) 14. Singh JP, et al. Europace. 2013;15:1622-1628. 15. Randhawa A, et al. PACE. 2013;36:94-102. 16. Thibault B, et al. Europace. 2013;15:984-991. 17. Pappone C, et al. Heart Rhythm. 2014;11:394-401. 18. Rinaldo CA, et al. J Cardiac Fail. 2013;19:731-738. ( )
  • 5. Taiwan Heart Rhythm Society 103 6VOL.014 5THRS 11% 3% 1.6% 0.8% 0.5% CS 2.9 10.6 1. (transseptal puncture) 1 2. WiCSw® -LV system (EBR Systems Inc.; Battery model 3000; Pulse generator model 4000) Plavix 3 WiSE-CRT 2 WiCSw® -LV system
  • 6. Taiwan Heart Rhythm Society 103 6THRS VOL.0146 (A): W i C S - L V ( P i e z o e l e c t r i c transducers) LV (B): WICS-LV 1. pacemaker 2. pulse generatior 3. pulse generator (C): X (trans- aortic approach ) ( ) 3. Medtronic 20066 4Fr 3 1. Rademakers LM, et al. Heart Rhythm. 2014;11:609-613. 2. Auricchio A, et al. Europace. 2014;16:681-688. 3. Yee R, et al. Heart Rhythm. 2014 (Epub ahead of print)
  • 7. Taiwan Heart Rhythm Society 103 6VOL.014 7THRS (AF) 5 1 AF 2,3 2 4 3 5 AF 2050 1200 -1500 AF 6-8 2006~2008 (TSR) 16.5% (transient ischemic attack, TIA) AF AF 28% AF 9 CHA2DS2-VASc score AF CHA2DS2-VASc score 2 10,11 aspirin anticoagulant ESC HAS-BLED score HAS-BLED score 3 12 K (VKAs) warfarin ( INR 2-3 INR ) onset/offset AF 13 optimal INR ( ) Warfarin NOACS (NOACs) ROCKET-AF (CHADS2 score 3.5) /TIA ( 55%) Rivaroxaban ( ) warfarin (ITT on-treatment warfarin 21% ) 14 (RELY ARISTOTLE) ROCKET-AF CHADS2 score 2.1 /TIA 20% 14 warfarin 4 15 ROCKET-AF East Asia Cohort AF Rivaroxaban warfarin Rivaroxaban (HR=0.28 72% ) (HR=0.24 76% ) (HR=0.54) (HR=0.14) 16 double blind, double dummy J-ROCKET ( 15mg/QD CrCl 30-49 mL/min 10mg/QD) warfarin 17 NOACs warfarin Dabigatran 80% ( ) 18 RELY ( 75 ) (CrCl 30-50 mL/min) Dabigatran warfarin Dabigatran ( ) 11-12% FDA (HR=1.41 [95% CI, 1.28-1.55]; P < .001) 19 ATLAS2 TIMI 22 Rivaroxaban (ACS) 20 ACS Rivaroxaban Rivaroxaban AF Dabigatran AF 21,22 Rivaroxaban 24 Dabigatran 24 36 48 23 BID QD
  • 8. Taiwan Heart Rhythm Society 103 6THRS VOL.0148 23% TID 30% 24 Rivaroxaban QD 25 AF NOACs warfarin John Camn CAD Rivaroxaban 26 Reference: 1. Wolf PA, et al. Stroke. 1991;22:983-988. 2. Lin HJ, et al. Stroke. 1996;27:1760-1764. 3. Jørgensen HS, et al. Stroke. 1996;10:1765-1769. 4. Benjamin EJ, et al. Circulation. 1998;98:946-952. 5. Stewart S, et al. Am J Med. 2002;113:359-364. 6. Miyasaka Y, et al. Circulation. 2006;114:119-125. 7. Go AS, et al. JAMA. 2001;285:2370-2375. 8. United Nations. Available at: http://www.un.org/esa/population/ publications/WPA2009/WPA2009-report.pdf. Accessed July 2011. 9. Hsieh FI & Taiwan Stroke Registry Investigators. Circulation. 2010;122:1116-1123. 10. Olesen JB, et al. BMJ. 2011;342 ePublication – do. 11. Camm AJ, et al. Eur Heart J. 2010;31:2369-2429. 12. Pisters R, et al. Chest. 2010;138:1093-1100. 13. ACC/AHA/ESC Guidelines, Eur Heart J. 2006. 14. Patel MR, et al. N Engl J Med. 2011;365:883-891. 15. Shen AY, et al. J Am Coll Cardiol. 2007;50:309-315. 16. Wong KS, et al. Stroke. 2014 (Epub ahead of print) 17. Hori M, et al. Circ J. 2012;76:2104-2111. 18. Mavrakanas T, et al. Pharmacol Ther. 2011;130:46-58. 19. FDA Safety Announcement http://www.fda.gov/Drugs/DrugSafety/ ucm396470.htm. 20. Mega JL, et al. Lancet. 2009;374:29-38. 21. Chatterjee S, et al. presented at AHA 2012. 22. Artang R, et al. Am J Cardiol. 2013;112:1973-1979. 23. EHRA practical guide for use of the new oral anticoagulants. Europace. 2013;15:625-651. 24. Coleman CI, et al. Curr Med Res Opin. 2012;28:669-680. 25. Rivaroxaban ; . 26. Savelieval I, et al. Clin. Cardiol. 2014;37:32-47.
  • 9. Taiwan Heart Rhythm Society 103 6VOL.014 9THRS E K G C a s e o f t h e M o n t h 40 Brugada syndrome ( ) ICD ICD right ventricular outflow tract epicardium delay potential fragmented potential potential V1-3 ST elevation ( ) right bundle branch block (RBBB) VT VF Brugada Syndrome V1-3 RSR dynamic J wave and ST elevation RBBB V1-3 RSR V5-6 slurred S wave Yoshiyasu Aizawa Circulation 11 RBBB Brugada syndrome Brugada RBBB mask Brugada right bundle conduction typical RBBB pattern Brugada syndrome ST segment J point provocation test dynamic change V1-3 ST elevation dynamic ST change Brugada syndrome Brugada Syndrome Brugada Syndrome RBBB benign dynamic J point and ST change
  • 10. Taiwan Heart Rhythm Society 103 6THRS VOL.01410 1. Study nds common test of ICD patients to be unnecessary May 9, 2014 | By Varun Saxena http://www. ercemedicaldevices.com/story/study- nds-common-test- icd-patients-be-unnecessary/2014-05-09 (defibrillation test) Shockless Implant Evaluation 2500 5 8.3% (no-test group) 7.22 95 (no-test group) 5.4 v.s. 6.5 2. (CardioMEMS system) FDA CardioMEMS HF System for Pulmonary Pressure Monitoring in Heart Failure Patients Approved by FDA (VIDEO) by EDITORS on May 29, 2014 http://www.medgadget.com/cardiac_surgery 24 FDA ( CardioMEMS System) 24 CardioMEMS HF 3. FDA (CRT) FDA Approves Medtronic CRT Devices for Mild HF With AV Block April 10, 2014 http://www.medscape.com/viewarticle/823485 FDA (CRT-D and CRT-P) BLOCK- HF CRT-D CRT-P 35%(LVEF <35 ) QRS 130 BLOCK-HF NYHA 1-3 50 691 CRT-D CRT-P (primary endpoint) (primary endpoint) LV end-systolic volume index, LVESVI 15 LVESVI 4. (Biotronik) ProMRI 3T 1.5T BIOTRONIK’s ProMRI Technology Cleared for 3 Tesla MRI Scans and Full-Body at 1.5 Tesla by EDITORS on May 22, 2014 3:05 pm http://www.medgadget.com/2014/05/biotroniks-promri-technology- cleared-for-3-tesla-mri-scans-and-full-body-at-1-5-tesla.html BIOTRONIK ProMRI MRI 3T 1.5T 3T BIOTRONIK 2011 (ICD) CE (ICD) 1.5T BIOTRONIK
  • 11. Taiwan Heart Rhythm Society 103 6VOL.014 11THRS CRT-P CRT-D 5. (St. Jude Medical) FDA Three New Pacemakers from SJM, Including a Quadripolar, Approved in U.S. by EDITORS on Mar 24, 2014 2:29 pm http://www.medgadget.com/2014/03/three-new-pacemakers-from- sjm-including-a-quadripolar-approved-in-u-s.html (St. Jude Medical) Allure Quadra CRT-P Assurity Endurity FDA Allure Quadra Assurity Endurity Assurity Endurity Assurity Endurity Allure Quadra CRT-P Assurity Endurity 2013 03 CE 2014 6. (MRI) Medtronic snags EU approval for an MRI-safe ICD http://www.fiercemedicaldevices.com/story/medtronic-snags-eu- approval-mri-safe-icd/2014-04-09 (Metronic Inc.) MRI (ICD) (CE mark) 63% (ICD) (MRI) MRI St. Jude Medical Biotronik Evera MRI (ICD) MRI Evera MRI SmartShock 30% 7. LifeBot / / LifeBot Releases World’s Lightest Advanced Cardiac by EDITORS on May 19, 2014 3:57 pm http://www.medgadget.com/2014/05/lifebot-releases-worlds-lightest- advanced-cardiac-monitorde brillatorpacer.html
  • 12. Taiwan Heart Rhythm Society 103 6THRS VOL.01412 LifeBot 2.8 1.27 4.5 8.35 2.5 11.43 21 6.35 LifeBot 8. Biosense Webster CARTOSOUND Module (ICE) CAROSOUND Module SOUNDSTAR (ICE) (ICE) SOUNDSTAR Biosense Webster CARTO3 System CARTOSOUND Module SOUNDSTAR CARTO3 System (ICE) CARTOSOUND Module Biosense Webster 9. Boston Scientific launches the Rhythmia™ Mapping System in HRS 2014 Boston Scienti c HRS 2014 Rhythmia™ Mapping System Boston Scientific 2012 10 Rhythmia Medical Inc., 2013 Rhythmia™ Mapping System FDA CE Mark 2014 (HRS 2014) 6 4 IntellaMap Orion™ High Resolution Mapping Catheter Rhythmia™ Mapping System 2016
  • 13. Taiwan Heart Rhythm Society 103 6VOL.014 13THRS Atrial Fibrillation News Heart Rhythm. 2014 May The Impact of Atrial Fibrillation Termination Mode during Catheter Ablation Procedure on Maintenance of Sinus Rhythm. (Faustino M. et al.) (AAD) (AT) (cardioversion) persistent longstanding persistent AF (prospective) 400 persistent AF ( 62.7 7.2 ) AF 135 AT 195 70 Holter 72.6% (direct to SR) 80.0% (through AT into SR) 28.6% (by DC cardioversion) (p<0.001) (direct to SR) Hazard ratios (HRs) DC (HR=0.54, p<0.001) AT SR (HR=1.69; p=0.027) 104 AT SR SR (HR=6.25 p=0.001) AT SR 1 SR direct to SR SR Heart. 2014 May Prediction of stroke or TIA in patients without atrial brillation using CHADS2 and CHA2DS2-VASc scores. (Mitchell LB. et al, for the APPROACH investigators) AF AFL CHADS2 CHA2DS2-VASc TIA 20970 AF APPROACH (Alberta Provincial Project for Outcomes Assessment in Coronary Heart disease) 2005 2011 (ACS) TIA 4.1 453 (2.2%) (297 ) TIA(156 ) 1903 (9.0%) TIA risk score (p<0.001) CHADS2 3 CHA2DS2-VASc 4 TIA 1% CHADS2 CHA2DS2- VASc (C-statistic 0.68 0.71) CHADS2 CHA2DS2-VASc (p<0.0001) ACS AF CHADS2 CHA2DS2-VASc TIA non-valvular AF (ACS without AF ) TIA CHADS2 CHA2DS2- VASc thromboembolic risk Pacing Clin Electrophysiol. 2014 May Left Ventricular Hypertrophy and Antiarrhythmic Drugs in Atrial Fibrillation: Impact on Mortality. (Chung R. et al.) AF guideline amiodarone AF LVH persistent AF LVH amiodarone (AAD) amiodarone (observation cohort analysis) AF (cardioversion) LVH ( LV wall thickness 1.4cm) AAD (LVEF) ( Social Security Death Index ) Kaplan-Meier Cox proportional hazards models AAD 3926 1399 LV wall thickness ( 66.8 11.8 67% LVEF 46 15% septum 1.3 0.4cm 1.2 0.2cm) LVH( 1.4cm) 537 (38%) 537 LVH 67.5 11.7 76.4% LVEF 48.3 13.3% LVEF CAD (p=0.023) Amiodarone (log rank p=0.001) propensity-score matched cohort AF LVH AAD (no drug) amiodarone AAD (non-AADs) amiodarone ( 65 ) amiodarone (p=0.05) Persistent AF LVH amiodarone AAD amiodarone amiodarone AF LVH Heart Rhythm. 2014 May
  • 14. Taiwan Heart Rhythm Society 103 6THRS VOL.01414 Mortality and Cerebrovascular Events After Radiofrequency Catheter Ablation of Atrial Fibrillation. (Ghanbari H. et al Michigan group) AF 10 (Cardiovascular events CVEs) 3,058 ( 58 10 ) paroxysmal AF (1,888 ) persistent AF (1,170 ) 11,347 - (patient-year) Time-dependent rhythm status CVEs (cardiac & all-cause mortality) multivariant Cox models baseline time-dependent high arrhythmia burden independent predictor ( coefficient: 0.017/10years; 95% CI: 0.006-0.029, p=0.003) LA diameter ( coef cient: 0.044/5mm; 95% CI: 0.034-0.055, p<0.0001) persistent AF ( coef cient: 0.174; 95% CI: 0.147-0.201, p<0.0001) CVEs 71 (2.3%) 33 (1.1%) 111 (3.6%) (HR:0.41 95% CI:0.20-0.84 p=0.015) (HR:0.86; 95% CI:0.58-1.29 p=0.48) CVEs (HR:0.79; 95% CI:0.48-1.29 p=0.34) J Am Coll Cardiol. 2014 Apr. Antithrombotic treatment in patients with heart failure and associated with atrial fibrillation and vascular disease: A nationwide cohort study. (Lamberts M. et al.) 1997 2009 ( CAD PAD) AF status incident AF no AF AF time-dependent Cox regression models(HR with 95% CI) Thromboembolism(TE) (MI) 37,464 ( 74.5 10.7 36.3% ) 20.7% prevalent AF 17.2% incident AF prevalent AF VKA (Vitamin K antagonist) VKA anti-platelet TE (HR 0.91[0.73-1.12]) MI (HR 1.11[0.96-1.28]) (HR 1.31[1.09-1.57]) incident AF VKA anti-platelet VKA TE (HR 0.77[0.56-1.06]) MI(HR 1.07[0.89-1.28]) (HR 1.71[1.33-2.21]) AF TE MI VKA alone single anti-platelet agent AF VKA anti-platelet (TE or MI) Circ Res. 2014 Apr. The clinical profile and pathophysiology of atrial fibrillation: relationships among clinical features, epidemiology, and mechanisms (Andrade J. et al.) (estimated lifetime risk 22-26%) AF AF risk factors (predisposing gene variant) AF AF ectopic firing reentrant 4 (1) ion channel dysfunction (2) Ca2+ -handling abnormalities (3) structural remodeling (4) autonomic neural dysregulation structural remodeling (prior atrial infarction) Ca2+ -handling abnormalities DAD/trigger activity focal ectopic firing Neural dysregulation atrial arrhythmogenesis (Monogenic) AF ion channel dysfunction arrhythmia Af (polygenic) polygenic AF AF AF Ventricular Tachycardia / Device News Int J Cardiol. 2014 Apr. Safety of mid-septal electrode placement in implantable cardioverter defibrillator recipients - Results of the SPICE (Septal Positioning of ventricular ICD Electrodes) study (Kolb C. et al.) (RV apical pacing) ( [RV mid-septum]) ICD (mid-septal position)
  • 15. Taiwan Heart Rhythm Society 103 6VOL.014 15THRS 299 ICD (79% 65.2 12.1 83% primary prevention) ICD (mid-septum) (n = 145) ICD (RV apical location) Event-free (primary end point) (secondary end point) events (lead revision) (suboptimal RV electrode performance de brillation thresholds > 25J) event free survival 80.6% 72.3% 82.2% 72.1% P 0.726 0.969 non- inferiority High de brillation thresholds 7 (5.0%) 3 (2.2%) p 0.209 ICD (mid-septum) (RV apex) survival free of lead revision, suboptimal right ventricular electrode performance or non- randomized lead position non-inferiority Pacing Clin Electrophysiol. 2014 May Safety and Outcomes of Magnetic Resonance Imaging in Patients with Abandoned Pacemaker and De brillator Leads (John V. Higgins et al.) (abandoned cardi- ovascular implantable electronic device [CIED]) (MRI) (radiofrequency filed) (endocardial heating) CIED MRI MRI device generators MRI pacing threshold generator threshold 19 (11 8 ) 19 85 MRI 1.63 MRI ICD dual coil 35 MRI 31 MRI MRI generator pacing threshold CIED MRI MRI cardiac device Circulation. 2014 May Ef cacy of Long Detection Interval ICD Settings in Secondary Prevention Population: Data from the Advance III Trial. (Kloppe A. et al.) Advance III long detection window primary prevention secondary prevention ICD 1902 477 primary prevention 248 long detection setting (30/40 intervals) 299 (18/24 intervals) cycle length 320ms 85% 65 12 37% (VF) 38% 13% ICD 37% 47% 16% 12 25% (115.6 rate per 100/pts years vs 86.8; IRR: 0.75 95%Cl: 0.61-0.93, p=0.008) 34% (51.2 rate per 100 pts year vs 38.1; IRR 0.66; 95%Cl: 0.48-0.89, p=0.007) (89.7 vs 67.7; IRR: 0.77 95%Cl: 0.60-0.97, p=0.029) (37.1 vs 28.1; IRR: 0.64 95%Cl: 0.45-0.93, P=0.018) Advance III ICD long detection windows primary prevention secondary prevention secondary prevention secondary prevention long detection with ATP during charging Circ Arrhythm Electrophysiol. 2014 Feb. High-density mapping of ventricular scar: a comparison of ventricular tachycardia (VT) supporting channels with channels that do not support VT (Nayyar S. et al.) (channels that support VT circuit) 22 NavX system PentaRay mapping matching pacemap stimulus-to-QRS 40ms matching pacemap to the VT morphology entrainment mappinng 238 57 (97% versus 82%, p=0.036) (mean SEM, 53 5 versus 33 4mm) stimulus-to-QRS (130 12 versus 82 12ms) (103 14 versus 43 13ms) (0.87 0.23 versus 1.39 0.21m/s) fractionated, late very late potentials 21% 26% 29% mapping potentials
  • 16. Taiwan Heart Rhythm Society 103 6THRS VOL.01416 1 2014 6 7 13:30-17:35/ (Post HRS Highlight Symposium)/ 2 / 2 2014 6 8 09:00-15:20/ (Peripheral Vascular intervention: form basic to advance)/ 6F / / 3 2014 6 14 13:30-17:40/ - (CIEDs Training Program - Part III : CRT)/TICC / / 4 2014 6 14 13:30-1740/ - (CIEDs Training Program - Part III : CRT)/ 14 / / / 5 2014 7 5-6 / Asia Paci c Thrombosis Management Meeting- - / / Bayer APAC, https://www.thrombosismanagement.com/apac 6 2014 9 12-14 / (APSC 2014)/ / / 7 2014 9 27 / THRS / / 8 2014 10 4 13:30-17:30 10 5 08:50-17:00/ 2014 / 101-104 / 1 2014 6 18-21 / 2014- (Cardiostim 2014)/ - (Nice, France ) 2 2014 6 27-28 / - (2nd International Europa-Park Symposium on Cardiac Arrhythmia)/ Europa-Park Rust, (Europa-Park Rust, Germany) 3 2013 8 30 -9 3 / 2014 (ESC Congress 2014 )/ - (Barcelona , Spain) 4 2014 10 5-8 / 2014 (Heart Rhythm Congress)/ - (Birmingham, UK) 5 2014 10 15-17 / - (10th International Symposium on Catheter Ablation Techniques (ISCAT))/ - ( Paris, France) 6 2014 10 29 -11 1 / (The 7th Asia-Paci c Heart Rhythm Scienti c Session)/ - (New Delhi, India) 7 2 0 1 4 1 1 9 - 1 0 / -(Europe AF -The 7th conference)/ - (London, UK) 8 2014 12 2-5 / - (XVI International Symposium on Progress in Clinical Pacing)/ - (Rome, Italy)
  • 17. Taiwan Heart Rhythm Society 103 6VOL.014 17THRS HRS 35 (Heart Rhythm Society, HRS) 2014 Moscone Center 8 4 HRS HRS IL-17 (Rhodiola Crenulate Down-regulated Proin ammatory Cytokine IL-17 to Reduce Ventricular Arrhythmia in Failing Heart) , IL-17 Th17 IL-17 IL-17 (salidroside) H9C2 / Th1- Th2 IL-10 IL-17 IL-17 IL-17 RNA (microRNA) microRNA 20~25 microRNA miR-1 -133 -328 -499 microRNA microRNA HRS microRNA miR-106b miR- 106b ryanodine receptor type-2(RyR2) miR-106b circulating microRNA, c-miR-1, 21, 29b and -133a pulmonary vein isolation (PVI) microRNA microRNA HSR MOSCONE CENTER HRS
  • 18. Taiwan Heart Rhythm Society 103 6THRS VOL.01418 2014 HRS (Heart Rhythm Society, HRS) (2011 HRS) HRS Moscone center 30 oral poster presentation summit AF summit VT/VF summit Lead and Device management summit case (AF) (VT) (Contact Force catheter) mapping Mapping (low voltage zone area: 25% without CF vs. 13% with CF, and late potential area: 2.3% without CF vs. 5.8% with CF) 20% lesion MRI lesion non-randoized study SMART AF randomized study TOCCASTAR safety efficacy (75.9% vs. 58.1% 1 year freedom form arrhythmia) (cryoballoon) STOP-AF trial 98% acute success rate 73% freedom for AF 5 53% freedom for AF (Arctic Front AdvanceTM) Flexible surface temperature gradient 80-84% 1 year freedom from AF direct tissue observation (Compliant Laser Balloon Catheter) Low- intensity collimated ultrasound ( PV ositum ) 3D anatomy non-invasive ablation 3D 100 2010 Noninvasive stereotactic radiosurgery(CyberHeartTM) CTI ablation late breaking trial device ICD (Defibrillation testing) SIMPLE trial (A randomized trial of defibrillation testing at the time of ICD implantation) ineffective shock (3.03% vs. 2.17%) (5.83% vs. 5.21%) Leadless ICD LEADLESS trial 33 device migration/infection/ mechanical failure/pro-arrhythmia (adenosine testing) ADVICE trial (Adenosine-guided pulmonary vein isolation for the treatment of paroxysmal atrial fibrillation) dormant conduction 1 year freedom from arrhythmia (65.3% vs. 39.4%, p<0.0001) The Cryo versus RF trial (Point by point RF ablation versus the cryoballoon or a novel combined approach) 1year free from arrhythmia (76% with combine vs. 67% with cryoballoon alone, and 47% with RF alone) CTI pulmonary vein isolation PReVENT trial (Prophylactic pulmonary vein isolation during isthmus ablation for atrial utter) pulmonary vein isolation 21% SVT sudden cardiac death