The document summarizes several news items from the 2015 Heart Rhythm Scientific Session: 1) A study on leadless pacemakers found they can safely undergo MRI scans up to 1.5 Tesla. 2) A study showed percutaneous retrieval of implanted leadless pacemakers is feasible in animals after 2 years. 3) A study found cardiac resynchronization therapy using quadripolar leads improved electrical and mechanical heart function more than bipolar leads.

1. Chuen-Wang Chiou
(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
Yung-Hsin Yeh Shih-Lin Chang
Po-Cheng Chang
Tze-Fan Chao Cheng-Hung Li
Po-Tseng Lee Yu-Sheng Lin
Po-Ching Chi Hung-Yu Chang
Yung-Lung Chen Wei-Ta Chen
Wei-Hua Tang Li-Ting Ho
Shan-Huei Huang Cheng-Hung Chiang
Jun. 2015 VOL. 018Arrhythmia News
P1
P2 2015 THRS-HRS Joint Symposium
P3 2015 Heart Rhythm Scienti c Session News - Ablation
P5 2015 Heart Rhythm Scienti c Session News -
Cardiac Implantable Electric Devices
P6 2015 Heart Rhythm Scienti c Session News -
Late-breaking Trials
P7
P8 EKG of the Month
P9
P12
P15 -
P16
P17 Basic Concept of Clinical Electrophysiology Training
2012
2015
VT Forum

2. Taiwan Heart Rhythm Society 104 6THRS VOL.0182
Heart Rhythm Society
2012
THRS–HRS Joint
Symposium
THRS–HRS Joint Symposium Is
ARVC the Same in Asia and the West? Arrhythmogenic
Right Ventricular Cardiomyopathy (ARVC)
ARVC
ARVC
ARVC
ARVC
endocardial
+ epicardial approach
ARVC data base
3D
Heart rhythm society
ARVC
THRS –HRS Joint Symposium
THRS
HRS Hugh Calkins
ARVC
ARVC
ARVC
ARVC
Joint symposium
ARVC

3. Taiwan Heart Rhythm Society 104 6VOL.018 3THRS
2015 Heart Rhythm Scientific Session News
Ablation
Boston heart rhythm society
Boston
sessions
atrial brillation (AF)
1) Dr. Haissaguerre persistent AF ablation
stepwise ablation non-invasive
mapping guided driver ablation basket guided
ablation
Bordeaux group 2014
Circulation
persistent AF 75%AF
termination 83% AF free
( 65 35
) AFACART European study (multi-
centers) reproducible (
)
2) Dr. Verma STAR-AF II
persistent AF
PVI (pulmonary vein isolation) CFE (complex
fractionated electrograms) linear ablation
PVI procedural time
PVI study HRS meeting
NEJM
PVI
CFE AF termination
AF termination BMI LA size
AF history female AF
persistent AF STAR-AF II
Dr. Verma
STAR-AF III study
persistent AF
3) Adenosine test for dormant conduction ADVICE
trial ( ) PV isolation
adenosine dormant conduction (PV
reconduction) 53% 21% PV
(dormant conduction) dormant
conduction
no dormant conduction
71% 45% dormant conduction
59% (
)
adenosine test dormant conduction
PV isolation
Lancet
4) Late-breaking clinical trials
a) FreezeAF trial trial
cryoballoon ablation open irrigated radiofrequency
ablation paroxysmal AF PVI
open irrigated radiofrequency
cryoballoon X-ray dose
phrenic nerve palsy
b) SMAN-PAF trial UK
paroxysmal AF (>12 hrs)
persistent AF ( )
wide area circumferential ablation (WACA) PVI
linear ablation (LA roof line, mitral
isthmus line and cavo-tricuspid isthmus line)
linear abation
X
atrial tachyarrhythmia
c) HEARTLIGHT trial 21 centers
FDA approve visually-Guided Laser Balloon
(VGLB) irrigated RF paroxysmal AF
VGLB
irrigated RF X ray
1) Cryoballoon ablation radiofrequency (RF) ablation

4. Taiwan Heart Rhythm Society 104 6THRS VOL.0184
Dr. Kuck
paroxysmal AF FIRE and ICE Study
Dr. Hoffmann
FREEZE cohort study
cryoballoon RF ablation 2000
( paroxysmal and persistent AF)
2) DE-MRI detecting fibrosis (DECAAF-II) DECAAF
study DE-MRI fibrosis
( JAMA 2014 )
DECAAF-II study persistent AF
PVI PVI MRI
detecting fibrosis ablation
3) CABANA trial catheter
ablation antiarrhythmic drugs AF
quality of life
and cost-effect 2000
5
4) EAST trial early therapy and usual care AF
(
) early
therapy antiarrhythmic drugs
catheter ablation combined therapy
5) CASTLE-AF and RAFT-AF trials catheter
ablation standard therapy AF left
ventricular dysfunction heart failure
ventricular arrhythmia
1) Bordeaux group CT MRI
high density mapping LAVA (local abnormal
ventricular activities) ablation data 195
ICD (144 ischemic cardiomyopathy [ICM] and 51
NICM) 96% LAVA signal
62% LAVA signal 68%
VT LAVA
VT
ICD
LAVA
scar ( epicardial site)
LAVA
2014 JACC endocardial ablation
28% epicardial LAVA (Arrhythmogenic Right
Ventricular Cardiomyopathy 40%, NICM
8%) NICM wall
thickness coronary arteries and septal location
2) Di Biase, et al 2012 JACC paper
2014 HRS late breaking trial endo-epicardial
scar homogenization Berruezo, et al 2015
Circulation AE scar dechannelization Tzou, et al
2015 Circulation AE core isolation
81-86%VT
epicardial fat wall thickness intramural scar
1) BERLIN trial:
LV dysfunction (LVEF:30-50%) secondary
prevention ICD 3
appropriate shock
2) PARTITA trial: ICD ICD
shock electrical storm
3) ASPIRE trial: VT ICD
VT
4) STAR-VT trial: Sa re FlexTM irrigation catheter
substrate targeted ablation VT
5) VANISH trial:
VT ICD
( amiodarone)

5. Taiwan Heart Rhythm Society 104 6VOL.018 5THRS
2015 Heart Rhythm Scientific Session News
Cardiac Implantable Electric Devices
Can leadless pacemakers safely undergo MRI?
Kyoko Soejima, et al.
(leadless pacemakers)
Medtronic Micra Transcatheter Pacing System
2.6 cm 0.4 cm
2 g catheter
pocket
single chamber atrial brillation with slow heart rate
10
MRI
MRI Kyoko Soejima Micra pacemaker
MRI
phantom test Micra
1.5 3 Tesla MRI
0.4 C leadless generators
Kyoko Soejima
MRI sensed amplitude pacing
threshold MRI
Feasibility of percutaneous retrieval of
chronically implanted (>2 yrs) leadless
pacemaker in an in vivo ovine model
Jacob S. Koruth, et al.
Jacob S. Koruth
5 2
snare
docking button retrieval catheter
angiography
(intra-cardiac echocardiography ICE)
18 10 5.3
8 2.3 cardiac
perforation
More favorable electrical and mechanical reverse
remodeling after cardiac resynchronization
therapy with quadripolar versus conventional
bipolar lead
Seung-Jung Park, et al.
(cardiac resynchronization therapy
CRT) pacing threshold (10-20%)
(37%)
CRT Seung-Jung Park
20 (quadripolar) 51
(bipolar) CRT
paced QRS (left ventricular
ejection fraction) LV remodeling (end-systolic volume)
Left ventricular septum pacing by transvenous
approach through the interventricular septum
Masih Ma Rad, et al.
Masih Mafi Rad
(09066 LVS
Medtronic) 4 mm
1.27 mm
10
LVS
10 6
pacing threshold R wave amplitude impedance
QRS duration RV septum RV apex
dp/dt
Performance of the subcutaneous implantable
cardioverter-defibrillator in primary prevention
patients
Lucas V. A. Boersma, et al.
(subcutaneous
ICD)
(IDE study EFFORTLESS study)
ICD Lucas V. A. Boersma
primary secondary prevention
LVEF > 35% 35%
(shock ef cacy) (inappropriate shock)
Primary prevention LVEF 35%
LVEF > 35%

6. Taiwan Heart Rhythm Society 104 6THRS VOL.0186
late-breaking trials
studies
(1) Remote monitoring
– 34,259
remote monitoring 58,307 remote
monitoring device
remote monitoring
18% 30%
(2) VENTURE AF –
uninterrupted rivaroxaban warfarin
124
(3) FreezeAF study -
cryoballon open irrigated radiofrequency ablation
PV isolation
cryoballon total procedure time
X-ray dosage
phrenic nerve palsy.
(4) epicardial fat pad botulinum toxin
(CABG)
– CABG paroxysmal AF
epicardial fat pad
botulinum toxin normal saline
implantable loop recorder AF AF
burden botulinum toxin
CABG AF AF burden
(5) ICD MRI study – ICD systems MRI
(1.5T) studies, Medtronic Evera
Biotronik Iforia ICD systems,
MRI conditional ICD systems MRI
(6) Barore ex activation therapy for the treatment
of heart failure with a reduced ejection fraction
– Barore ex activation therapy sympathetic
tone
vasodilation renin secretion
baroreflex activation
therapy heart failure with reduced
ejection fraction
barore ex activation therapy
NT-proBNP left ventricular ejection
fraction
(CRT)
(7) SMAN-PAF trial – study
substrate-based AF catheter ablation
PV isolation PV isolation
linear ablation (left atrial roof, mitral isthmus
cavotricuspid isthmus)
Substrate-based AF persistent AF
paroxysmal AF 12
– dimension 45mm /sleep
apnea 65
PV isolation linear
ablation
HRS
HRS

7. Taiwan Heart Rhythm Society 104 6VOL.018 7THRS
I/O
online

8. Taiwan Heart Rhythm Society 104 6THRS VOL.0188
2
1
E K G o f t h e M o n t h
81 (aortic
stenosis)
LBBB
( 1) sinus rhythm with
premature atrial beats (PACs) lead V1 right
bundle branch block (RBBB)
leads V4-V6 QRS
RBBB left bundle branch block (LBBB)
long lead II 4 2 QRS
QRS long lead V1 ( 2)
QRS LBBB
RBBB sinus rhythm with
conducted and blocked PACs; alternating LBBB and
RBBB
Alternating bundle branch block
EKG bundle branch block QRS
LBBB RBBB RBBB left
anterior fascicular block left posterior fascicular block
alternating bundle branch block
ACC/AHA/HRS 2012
device-based therapy guideline
1
chronic bundle branch
block alternating bundle branch block
permanent pacemaker class I indication
(LVEF) 29% Tl-201
myocardial perfusion scan
LBBB
biventricular pacemaker (cardiac resynchronization
therapy, CRT)
Reference:
1. Epstein AE, DiMarco JP, Ellenbogen KA, Estes NA, 3rd, Freedman
RA, et al. (2013) 2012 ACCF/AHA/HRS focused update incorporated
into the ACCF/AHA/HRS 2008 guidelines for device-based therapy
of cardiac rhythm abnormalities: a report of the American College of
Cardiology Foundation/American Heart Association Task Force on
Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol
61: e6-75.

9. Taiwan Heart Rhythm Society 104 6VOL.018 9THRS
1. MRI
May 14, 2015 | By Varun Saxena
(MRI)
Micra
( 23
) 140
78 ( 21 94 )
30
( 5.7%)
12.6
1.5 3
275
100%
1.5
2. Dabigatran
May 22, 2015 Marlene Busko
dabigatran
500
RE-LY
phase 3 217
(40 )
(ICD) /
324 (60 )
( )
>50 / >30 50 / <30
/ dabigatran
24 2 4
2 4 6
75
dabigatran 48
72 30 10 (1.8 )
28
(5.2 ) 35
Dr. Sam Schulman (
)
dabigatran
dabigatran
(1.8% )
RE-LY ( 4% )
dabigatran

10. Taiwan Heart Rhythm Society 104 6THRS VOL.01810
3. STOP-HF: (SDF-1)
May 25, 2015
Dr. Marc Penn (
) phase II STOP-
HF trial stromal cell-derived factor 1
(SDF-1)
SDF-1
Dr. Marc Penn
SDF-1
SDF-1
SDF-1
14
Dr. Marc Penn SDF-1
phase
I trial SDF-1
SDF-1
STOP-HF II
SDF-1
93
40
(Minnesota Living with Heart Failure Questionnaire
score) 20 6 400
1 1 1 15
30 SDF-1 12
6
SDF-1
(LVESV)
(LVEF < 26 ) 30 SDF-1 12
(LVEF) 7
4 (p <0.01)
18.5
15 (p = 0.10) Dr.
Marc Penn
SDF-1
80 2
20
SDF-1
FDA
4. Tyrx
May 18, 2015 | By Emily Wasserman
(Medtronic)
36 Tyrx
Tyrx
1129 55
1% Tyrx
Tyrx
2.2%
Tyrx
7
Charles Henrikson,
54926
Tyrx
5.
May 15, 2015 | By Stacy Lawrence
5
90,000
(ICD) (CRT)
- (Merlin.net)
(PCN)

11. Taiwan Heart Rhythm Society 104 6VOL.018 11THRS
2.4
75%
10 119
370,000
9000
(CRT)
24
(Dr. Jonathan
Piccini)
Dr. Niraj Varma (Cleveland
Clinic )
6.
May 19, 2015 | Steve Stiles
(carotid barore ex activation therapy BAT Barostim
neo CVRx)
3 (NYHA FcIII)
140
BAT 45 (
24 BAT) 95 ( 47
BAT)
3 (LVEF)
35
(LVEF)
Dr. Michael R. Zile (
)
30%
(Minnesota Living
With Heart Failure Questionnaire quality-of-life score
MLWHF) 12
( 5 )
( 10 )
CRT
(
) (n=95)
End points
activation
Control
group
P
Quality-of-life score* -21.6 +3.5 <0.001
6-min-hall-walk
distance (m)
+85.5 +3.6 0.003
NT-proBNP (pg/mL) -97 +116 0.03
HF hospitalization (d) -8.9 +0.18 0.05

12. Taiwan Heart Rhythm Society 104 6THRS VOL.01812
Atrial Fibrillation News
New England Journal of Medicine. 2015 May
Approaches to catheter ablation for persistent atrial
brillation
Atul Verma, et al. (STAR AF II Investigators)
persistent AF pulmonary vein
isolation substrate modi cation AF
persistent AF
paroxysmal AF guideline PV
isolation substrate modi cation
589 1:4:4 isolation
(67 ) PV isolation complex fractionated activity
(CFAE) ablation (263 ) PV isolation mitral roof
linear ablation (259 ) 18 Holter
30 AF
18 AF
free from recurrent AF 59% 49%
46% AF
21% 26% 33% CFAE linear ablation
complications
persistent AF pulmonary vein
isolation CFAE RF linear ablation
recurrent AF
European Heart Journal. 2015 Jun. [Epub ahead
of print]
A minimal or maximal ablation strategy to achieve
pulmonary vein isolation for paroxysmal atrial
fibrillation: a prospective multi-centre randomized
controlled trial (the Minimax study)
Alex J.A. McLellan, et al.
AF pulmonary vein isolation
(PVI) intervenous ridge (IVR) AF
PVI circumferential antral PV
(minimal) IVR PV isolated
(maximal) AF
589 paroxysmal AF 1:1
minimal maximal 6 7 Holter
event monitoring
AF
Maximal group RF procedure time (46.6
14.6 vs. 41.5 13.1 min, P < 0.01) 17 8
maximal AF (freedom from AF
65% vs. 70%, P = 0.25) minimal
44% IVR PVI
minimal PVI IVR AF
(freedom from AF 57%) circumferential
PVI (freedom from AF 80% P < 0.01)
Minimal maximal freedom from AF
paroxysmal AF CPVI
IVR PVI
Lancet. 2015 Jun. [Epub ahead of print]
50 year trends in atrial fibrillation prevalence,
incidence, risk factors, and mortality in the
Framingham Heart Study: a cohort study
Renate B Schnabel, et al.
50 AF
AF
Framingham Heart Study
(age-adjusted and sex-strati ed) AF
(1958–67 1968–77 1978–87 1988–97
1998–2007)
50 (202,417 ) 1544
new-onset AF AF 50
3 20.4 96.2 /1000 -
13.7 49.4 /1000 - AF
2-3 3.7 13.4 /1000 2.5
8.6 /1000 Ptrend < 0.0001
AF
Framingham Heart Study ECG
AF
AF Multivariable-
adjusted proportional hazards models
20 75%
25%
AF

13. Taiwan Heart Rhythm Society 104 6VOL.018 13THRS
Journal of the American College of Cardiology.
2015 Jun.
Changes in renal function in patients with atrial
brillation: An analysis from the RE-LY trial
Michael Böhm, et al.
Thrombin inhibitor (Dabigatran)
Vitamine K antagonist (VKA)
thrombin inhibitor (dabigatran)
RE-LY study
dabigatran
RE-LY study 18113
16490 baseline follow-up creatinine
estimated glomerular ltration rate (GFR)
30 warfarin GFR (-3.68
0.24 ml/min) dabigatran 110 mg (-2.57
0.24 ml/min, p = 0.0009) dabigatran 150 mg (-2.46
0.23 ml/min, p = 0.0002) warfarin
GFR >25% dabigatran 110 mg (hazard ratio:
0.81, 95% CI 0.69 to 0.96) 150 mg (hazard ratio: 0.79,
95% CI: 0.68 to 0.93) warfarin INR
(INR 2-3) GFR
warfarin GFR
warfarin AF
dabigatran
Europace. 2015 Jun. [Epub ahead of print]
Prevalence of auricular thrombosis before atrial
flutter cardioversion: a 17-year transoesophageal
echocardiographic study
Alberto Cresti, et al.
Atrial utter (AFL) cardioversion
atrial fibrillation (AF)
AF 6-18% (LA)
AFL cardioversion
1999 2014 877 (81%) AF
204 (19%) AFL cardioversion AF
AFL 48
LA spontaneous echo contrast (SEC)
AFL LA 6.4% (13/204)
AF 10.5% (92/877) (P =
0.074) LA appendage 5.9% (12/204) vs.
9.9% (87/877) (P = 0.07) SEC
(3+/4+) AFL 28% (57/204) AF
35% (307/877)
AFL cardioversion
AF AFL
LA
Cardiac Implantable Electric
Devices News
Heart Rhythm. 2015 May 26. pii: S1547-5271 (15)
00593-7
Digoxin therapy and associated clinical outcomes
in the MADIT-CRT trial
MADIT-CRT (
NYHA Fc I-II QRS 130
<30%) 1820
(HR 1.07 [0.86-1.33] P=0.56)
41% (HR
1.41 [1.14-1.75] P=0.002) > 200/
(HR 1.65 [1.27-2.15] P< 0.001)
< 200/
(HR 1.20 [0.92-1.57] p=0.19)
> 200/
Eur Heart J. 2015 Jun 4. pii: ehv214. [Epub ahead
of print]
Early performance of a miniaturized leadless
cardiac pacemaker: the Micra Transcatheter Pacing
Study
(Micra Transcatheter Pacing Study)
11 23 140
(77.0 Tran ) VVI (
66% 29%)
Micra
1.9 30
60 3 pacing threshold 0.51
a 0.22 2 V R 16.1 6.5.2
mV 651 .7130

14. Taiwan Heart Rhythm Society 104 6THRS VOL.01814
transcatheterold 0.51ng
Heart Rhythm. 2015 Jun 11. pii: S1547-5271(15)
00713-4. [Epub ahead of print]
The subcutaneous implantable cardioverter-
defibrillator - first single-center experience with
other cardiac implantable electronic devices
/
216
74 41
X 125 73
12 40%
84 (area under the curve 0.59; CI
0.52-0.66 p=0.026) 90
(area under the curve 0.62; CI 0.55-0.69; p=0.004)
/
Europace. uropace.K "http://www.nc. [Epub
ahead of print]
Mid-term clinical and echocardiographic evaluation
of super responders with and without pacing: the
preliminary results of a prospective, randomized,
single-centre study
19
0 /6 /12
12 NYHA Fc
( 1.3 0.5 2.4 0.7) 6
( 569 .7 343 .7 )
( 55 3% 36 .)
( 61 10 117
7 ) ( 53
61 ) ( 40
53 ) ICD
J Am Coll Cardiol. Am Coll Cardiol./www.ncbi.
(15) 02033-1
Relationship between level of adherencehere
automatic wireless remote monitoring and survival
in pacemakerhip between level of adhere
26947
(43%) (32%)
(23%) (3%) 47%
(53%)
(47%) 53%
(hazard ratio [HR]: 2.10; p
< 0.001) (47%)
(HR: 1.58; po [HR]: )
J Am Coll Cardiol. 2015 Apr 28;65 (16): 1605-15
Safety and efficacy of the totally subcutaneous
implantable defibrillator: 2-year results from a
pooled analysis of the IDE study and EFFORTLESS
registry
(IDE [S-ICD System IDE Clinical Investigation]
EFFORTLESS [Boston Scientific Post Market S-ICD
Registry]) 6 1
IDE study EFFORTLESS registry 882
651+/-345
111 (59 ) 100 (90.1%)
109 (98.2%) 5
13.1%
11.1%

15. Taiwan Heart Rhythm Society 104 6VOL.018 15THRS
History
PE
Lab
M: Morphology
(blast cells)
I, C, G: Immunophenotype, Cytogenetics, and
Genetics
Plan

16. Taiwan Heart Rhythm Society 104 6THRS VOL.01816
1.3D
2015 7 11 ( ) 13:50-17:10
203
2.Symposium on What's New for 2015 TSOC/THS
Hypertension Guidelines
104 7 19 ( ) 14:00-17:00
42
3.APC
104 8 1 13:30-17:30
203
4.APC
104 8 15 13:30- 17:30
5FVEE 01+02
5.APC
104 8 22 13:30- 17:30
42F
6.
104 8 15
7.THRS CIEDs Training Program
104 9 6 9:00-17:30
101
( )
8. ( )
104 10 31 14:00-17:00
1.2015 (ESC Congress 2015)
2015 8 29 2015 9 2
- (London, UK)
2.2015 - World Society of Arrhythmias
2015 9 17 2015 9 20
(Beijing, China)
3.2015 (American Heart Association Scienti c
Sessions 2015)
2015 11 7 2015 11 11
- - (Orlando, FL, USA)
4. (The 8th Asia-Pacific Heart
Rhythm Scienti c Session)
2015 11 19 2015 11 22
- (Melbourne, Australia)

17. Taiwan Heart Rhythm Society 104 6VOL.018 17THRS
Basic Concept of Clinical Electrophysiology Training

18. Taiwan Heart Rhythm Society 104 6THRS VOL.01818

19. Taiwan Heart Rhythm Society 104 6VOL.018 19THRS

20. Taiwan Heart Rhythm Society 104 6THRS VOL.01820