Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.
Upcoming SlideShare
Heart- Physiology and Electrophysiology
Next

8

Share

EP Summit 2015: Electrophysiology-Heart Failure Intersection

William T. Abraham, MD, FACP, FACC, FAHA, FESC
Professor of Medicine, Physiology, and Cell Biology
Chair of Excellence in Cardiovascular Medicine
Director, Division of Cardiovascular Medicine
Deputy Director, Davis Heart & Lung Research Institute
Ohio State’s Heart and Vascular Center

Related Books

Free with a 30 day trial from Scribd

See all

Related Audiobooks

Free with a 30 day trial from Scribd

See all

EP Summit 2015: Electrophysiology-Heart Failure Intersection

  1. 1. Electrophysiology-Heart Failure Intersection William T. Abraham, MD, FACP, FACC, FAHA, FESC Professor of Medicine, Physiology, and Cell Biology Chair of Excellence in Cardiovascular Medicine Director, Division of Cardiovascular Medicine Deputy Director, Davis Heart & Lung Research Institute Ohio State’s Heart and Vascular Center The Ohio State University Heart and Vascular Center
  2. 2. 2 Faculty Disclosure Company Nature of Affiliation Product  None  None  None
  3. 3. 3 Heart Failure Specialists  Non-invasive  Interested in physiology  Focus on pump function  Prescribe pills  Smile a lot  Slouch a bit  Are the internists of cardiology
  4. 4. 4 Electrophysiologists  Invasive / Interventional  Interested in electricity  Focus on cardiac rhythm  Implant Pacemakers / Defibrillators  Wear masks (can’t tell if they’re smiling)  Stand tall  Are the neurosurgeons of cardiology
  5. 5. What do these two very different specialists have in common?  Sudden cardiac death  Atrial fibrillation  Cardiac resynchronization therapy  Device-based diagnostics
  6. 6. Heart Failure Increases the Risk of Sudden Death 5 7 8 15 0 2 4 6 8 10 12 14 16 Women Men Age-adjustedannualrate/1000 SCD-NoCHF SCD-CHF During a 39-year follow-up of subjects in the Framingham Heart Study, the presence of HF significantly increased sudden death and overall mortality in both men and women. Kannel WB, et al. Am Heart J 1998; 136: 205-212 60-115% increase in sudden death if HF present
  7. 7. 7 Sudden Death Accounts for 50% of Heart Failure Mortality MERIT-HF Study Group. LANCET 1999; 353:2001-2007 CHF Other Sudden Death NYHA Class III n = 103 NYHA Class II n = 103 NYHA Class IV n = 27 64% 12% 24% 11% 56% 33% 59% 15% 26%
  8. 8. 8 Bayés de Luna A. Am Heart J. 1989;117:151-159 Underlying Arrhythmias of Sudden Cardiac Arrest Bradycardia 17% Monomorphic VT 62% Primary VF 8% Polymorphic VT 13%
  9. 9. 9 Electrophysiology-Heart Failure Intersection SCD Prevention and Management ACE Inhibitors Angiotensin Receptor Blockers Beta-Blockers Aldosterone Antagonists Cardiac Resynchronization Therapy Implantable Cardioverter Defibrillators Antiarrhythmic Medications VT Ablation Procedures
  10. 10. 10 Twenty-five Percent of Heart Failure Patients Have Atrial Fibrillation And, 50% of Atrial Fibrillation Patients Have Heart Failure Atrial Fibrillation 2.3 Million Heart Failure 5 Million
  11. 11. 11 Which comes first, heart failure or atrial fibrillation? Anter E, et al. Circulation. 2009;119:2516-2525.
  12. 12. Effect of Atrial Fibrillation on Risk for Heart Failure Events  Retrospective analysis of data from 4 studies enrolling patients with HF with CRT-D devices (n=1,561)  Patients identified as having AF if they had ≥1 day of >5 minutes of AF and >1 hour of total AF during follow-up  AF patients further stratified into 3 groups based on AF burden (AFb) and ventricular rate during AF (VRAF) during prior 30 days  ≥1 day of high burden of paroxysmal AF (≥6 hours) or persistent AF (all 30 days with Afb >23 hours) with poor rate control (VRAF >90 beats/min)  ≥1 day of high burden of paroxysmal AF with good rate control (VRAF ≤ 90 beats/min)  No days with high burden AF Sarkar S, et al. Am Heart J 2012;164:616-24.
  13. 13. 13 Time to First HF Hospitalization in HF Patients with and without AF AF Management Sarkar S, et al. Am Heart J 2012;164:616-24. • High burden of paroxysmal AF with good rate control (HR 3.4, P < .001) • High burden of paroxysmal AF with poor rate control (HR 5.9, P < .001)
  14. 14. 14 Electrophysiology-Heart Failure Intersection AF Management Beta-Blockers Amiodarone Other Antiarrhythmic Medications Cardioversion AVN Ablation with Biventricular Pacing AF Ablation Procedures
  15. 15. Thirty Percent of Heart Failure Patients Have a Wide QRS Duration Schoeller et al, Am J Cardiol 1993; 71:720-726; Aaronson et al, Circulation 1997; 95:2660-2667; Farwell et al, Eur Heart J 2000; 21:1246-1250 Wide QRS Narrow QRS 70% 30%
  16. 16. Deleterious Effects of Ventricular Dyssynchrony (Wide QRS)  Decline in systolic performance  Decreased mechanical efficiency  Greater metabolic cost of LV contraction  Worsening mitral regurgitation  Pathological LV remodeling  Presystolic regurgitation that may occur with ventricular dyssynchrony and delayed contraction of papillary muscle root attachments
  17. 17. Cardiac Resynchronization in Heart Failure Weight of Evidence  8,500 patients evaluated in landmark randomized controlled trials  Consistent improvement in quality of life, functional status, and exercise capacity*  Strong evidence for reverse remodeling  ↓ LV volumes and dimensions   LVEF  ↓ Mitral regurgitation  Reduction in heart failure and all-cause morbidity and mortality Abraham WT, 2010 *demonstrated in NYHA Class III-IV patients only
  18. 18. 18 Electrophysiology-Heart Failure Intersection Cardiac Resynchronization Therapy Optimize the Patient Implant CRT Device Optimize the Device
  19. 19. 19 Device-based Monitoring of Heart Failure Physiologic markers of the development of acute decompensation: Pressure Changes Impedance Changes Weight Changes, HF Symptoms Hospitalization Time Stable Decompensation Autonomic Adaptation Unreliable, late, and indirect markers8,9 May be used in risk stratification, but not actionable4-7Enables proactive and personalized HF management1-3 1. Steimle AE, et al. Circulation, 1997 2. Abraham WT, et al. Lancet, 2011 3. Ritzema J, et al. Circulation, 2010 4. Abraham WT, HFSA, 2009 5. Conraads VM, et al. EHJ, 2011 6. Whellan DJ, et al. JACC, 2010 7. van Veldhuisen DJ, et al. Circulation, 2011 8. Chaudry SI, et al. NEJM 2010 9. Anker SD, et al. AHA 2010
  20. 20. 20 Electrophysiology-Heart Failure Intersection Device-Based Diagnostics Sharing Information Avoiding Hospitalizations
  21. 21. 21 Working Together at the Intersection Electrophysiology and Heart Failure
  • RussulAltaie

    Dec. 25, 2020
  • DrDurgatak

    Mar. 27, 2018
  • DmytroVolkov2

    Sep. 16, 2017
  • CarlottaCiterni

    Aug. 15, 2016
  • DrNirajYadav

    Feb. 21, 2016
  • sergiopinski

    Feb. 20, 2016
  • XinYue4

    Feb. 4, 2016
  • li_kang926

    Nov. 22, 2015

William T. Abraham, MD, FACP, FACC, FAHA, FESC Professor of Medicine, Physiology, and Cell Biology Chair of Excellence in Cardiovascular Medicine Director, Division of Cardiovascular Medicine Deputy Director, Davis Heart & Lung Research Institute Ohio State’s Heart and Vascular Center

Views

Total views

1,764

On Slideshare

0

From embeds

0

Number of embeds

14

Actions

Downloads

0

Shares

0

Comments

0

Likes

8

×