會訊 No.18-0626-2

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

Ta iwan Hear t Rhythm Soc ie ty 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

Ta iwan Hear t Rhythm Soc ie ty 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

pers i s ten t 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) F r e e z eA F t r i a l t r i a l

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


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 t r i a l :

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)


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

Feasib i l i ty of percutaneous ret r ieva l of

chronica l ly implanted (>2 yrs) lead less

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%


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 tr ia l – s tudy

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


I/O

online


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 guideline1

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.


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


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)


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 pointsactivation

Control

groupP

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


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


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


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%


History

PE

Lab

M: Morphology

(blast cells)

I, C, G: Immunophenotype, Cytogenetics, and

Genetics

Plan


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)


Basic Concept of Clinical Electrophysiology Training

會訊 No.18-0626-2

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Transcript of 會訊 No.18-0626-2