Naujienos: širdies ritmo sutrikimų diagnostika ir gydymas 2015-12-04

IKD programavimo rekomendacijos

ARRHYTHMIAS C. Linde (Stockholm, SE) Conflicts of Interest ECS CONGRESS HIGHLIGHTS ARRHYTHMIAS C. Linde (Stockholm, SE) Conflicts of Interest Speaker/advisor/Research Grants from Medtronic, Cardio-3, St Jude, Vifor

Long term results of RF-ablation compared to antiarrhythmic drugs in AF Short term effect of RF AF ablation is superior to antiarrhythmic drugs (AAD) but long term results are few. Method: In MANTRA PAF 294 pts with new px AF were randomised to RF-ablation or AAD as first line treatment and followed for 5 years by arrhythmia burden measured by 7 Day Holter recording. Results:  Freedom from any AF: è RFA group: 126/146 (86%) è AAD group: 105/148 (71%) -15% absolute risk reduction p=0.001 Pirmieji ilgalaikiai tyrimai. Bet ar MANTRA AF abl arm be vaistų? First study to show that RF ablation is superior to AAD for rhythm control over 5 years. J.C. Nielsen (Aarhus, DK), FP 5777

METHOD: AF RECURRENCE IN OBESE PTS TREATED 1. ANGIO MENTOR™ - Endovascular training Simbionix http://simbionix.com/simulators/angio-mentor/ ? labai didelė UAB "AMI sprendimai"   12-Lead ECG Placement Trainer Armstrong Medical https://www.armstrongmedical.com/index.cfm/go/product.detail/sec/2/ssec/11/cat/29/fam/2098 1035 USD nėra SimPad Cardiology simulator Laerdal http://www.laerdal.com/us/item/200-30150 3135 USD ? Resusci Anne® Simulator http://www.laerdal.com/us/doc/2670/Resusci-Anne-Simulator METHOD: AF RECURRENCE IN OBESE PTS TREATED WITH AAD+/OR ABLATION WAS COMPARED BY GAIN IN FITNESS (METS) AND BASELINE FITNESS LEVEL (CRF) OVER 4 YEARS Total arrhythmia freeedom In those who gained > 2 METS or not 85% 44% CRF Gain Group Multivariate predictors of AF recurrence Type II DM No Weight Loss Low Baseline CRF AF Freedom ≤2 MET Gain >2 MET Gain Australai… čia jeu ne svoris, o fitness P<0.001 <2-MET Gain Follow up (Days) 85% of treated AF pts who gained >2 METs were free of AF at 4yr FU Low CRF, no METS gain, DM II and no weight loss predicted recurrence A. Elliott (Adelaide, AU), FP 1847

üRates of stroke and major XANTUS: REAL-LIFE DATA ON ADVERSE EVENTS IN PATIENTS WITH NON-VALVULAR AF TREATED WITH RIVAROXABAN Aim: To assess Rivaroxaban safety in unselected pts with nonvalvular AF Method: Observational study with 1 year follow up Primary outcome: major bleeding, death and Stroke /SE Event-free rates (K–M) 6785 pts Mean CHADS score 2 80% of patients were still on rivaroxaban after 1 year CONCLUSIONS üFirst large prospective study describing use of rivaroxaban in a broad non-valvular AF patient population (patients at lower overall risk than in ROCKET AF) 96,1% (n=6522) of patients experienced no events üRates of stroke and major bleeding with rivaroxaban were low in routine clinical practice A.J. CAMM (London, UK), FP 5072

6 MONTH SAFETY AND EFFICACY LEADLESS PACING - 6 MONTH SAFETY AND EFFICACY Method:  è 300 patients got leadless pacing in observational study Serious adverse device events SADE Efficacy Results:  è Implantation success rate Freedom from SADE Pacing performance Estimated battery longevity 96 % 93 % good 15 yrs Main drawback:  è Large introducer 18Fr Risk of vascular complications Observed complication risk higher than in Danish pacemaker registry Leadless pacing is promising for pts indicated for VVIR Results open up for future possibilities of more pacing modes and combinations with SQICD Reddy V et al, NEJM 2015 on line

OBJECTIVES, STUDY POPULATION AND RESULTS CERTITUDE REGISTRY: OBJECTIVES, STUDY POPULATION AND RESULTS Aim was to study if CRT-P pts would benefit from concomittant ICD Method: analysing causes of death in CRT and CRT-D pts with regard to if they were sudden, non-sudden, cardiovascular or non-cardiovascular Patients 535 implanted with CRT-P and 1170 with CRT-D by French doctors choice and followed 4 yrs Sudden cardiac death mortality CRT-D CRT-P P-value Gray’s Test = 0.35 Cumulative incidence of Sudden Death Follow-up (day) J.Y. Le Heuzay (Paris, FR), FP 4844

Anger-Induced ICD Shocks Anger and arrhythmias in ICD patients – C. Israel, ESC London 2015 Anger-Induced ICD Shocks Lampert, Circulation 2002;106:1800-5

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