ESC SC/E /EHRA Guid idelin lines on on Cardia rdiac c Pa - PowerPoint PPT Presentation

ESC SC/E /EHRA Guid idelin lines on on Cardia rdiac c Pa Pacin cing Pa Pano nos E. E. Vard rdas Profe fesso sor o of C f Card ardio iolo logy Hera raklio lion U University y Ho Hosp spit ital Cret ete, G Greece eece

Rea Reaso sons ns fo for r Euro Europea ean n Guid uidelin elines? es? Scien cientific ic rea reaso sons Cult Cultural a and nd p polit litica ical rea reaso sons

Rea Reaso sons ns Necessit Necessitating ing Unifo niform rm Euro Europea ean n Guid uideli elines nes  Scien cientific ic rea reaso sons  Ra Rapi pid evolu oluti tion on of of curre urrent kn knowle owledge in in cert certain scien cientif ific areas areas  Resu esults of of recen ecent pu publis lished tria rials ls conc ncerni ning ng the he in indic ication ions for paci acing, mode ode sel select ection, cos cost effectiven eness, ess, follow ollow-up up  Util iliz ization ion of of prim imary ry expe perie rience from rom ne new th thera rape peutic ic moda odalit itie ies, firs irst dev evel eloped ed in in Eur urope ope (CRT) CRT).

Rea Reaso sons ns Necessit Necessitating ing Unifo niform rm Euro Europea ean n Guid uideli elines nes  Cult Cultural and nd polit litica ical rea reaso sons  The he uni unified Euro rope pean guide guidelin lines support pport fr fruitful sci scien entific colla ollabo bora ration ion which ch wi will ll benefi fit the div divers erse Eu Europ ropean requ require rements  The he Europe ropean guide idelin lines ar are an an ex excep ceptional al worldwide rldwide am ambassad assador for or the he Europe ropean scie cientif ific communi unity.

ES ESC/ C/EHRA RA Guid uidelin elines es  ESC SC guide uidelines lines co cover er tw two main main are areas as: the he first first inc inclu ludes es permanent rmanent pacing cing in in bradya adyarrhyt rrhythmi hmias, as, sy sync ncop ope and and other her sp spec ecific ific condit nditions ons, while while the he second second refe efers rs to to vent ventricu icular lar resync resynchronisat hronisatio ion as as an adjunct unct thera herapy in in patie ients with th HF HF

ES ESC/ C/EHRA RA pacing cing guid uidelines elines Appendi endices ces  The guide uidelines lines have have been een enriched enriched wit with tw two app appendi endices ces that hat refe efer not not only nly to to convent nventional onal pacemaker cemaker fo follo llow-up up bu but also lso to to technic echnical al consid considerat eratio ions ns and and requi equiremen rements for imp implant lanting ing and and fo follo llow- up of CRT CRT device evices.

ES ESC/ C/EHRA RA Guid uidelin elines es Ma Main in t topics ics  Convent ventiona ional indicat atio ions ns fo for pacin cing.  Pa Pacin cing fo for sp speci ecific ic co cond ndit itions.  Ca Card rdiac resynchr nchroniz nizat ation on therapy apy.

Co Conven nventio ional l ind indica icatio ions s fo for r pacing cing The E ESC/EHR HRA 2 A 2007 Gui Guidelines  pres esent deta tailed definitions ns  follow llow an an up up-to to-date ate approac ach to to the the ev evaluati tion of patient ents wi with th synco ncope.  ta take into to cons nsiderati tion the the resul ults of rece cent nt tria ials ls ( MOST, ST, tc) an and the the tech technologi gical ad advances, CTOPP, PASE, CTO SE, DAVID ID etc pro rovidi iding  lev evel el of ev eviden ence in in mode select ctio ion.  recomm mmend ndations ons fo for the he us use of ne new alg lgori rithms (MP MPV, V, ANTI NTITA TACH CHY)

Sinu inus no node d e disea isease Reco Recommendations f for or card cardia iac pacin pacing in in SND ND

Co Conven nventio ional l ind indica icatio ions s fo for r pacing cing ES ESC/E C/EHRA RA 2007 2007 vs vs ACC/A CC/AHA/H /HRS RS 2008 2008 Guidelin idelines  Dif Differe erences in in termi minology ology:  e.g. AC ACC/AHA/ /AHA/HR HRS QLs QLs use the the ter erm “advanced seco cond nd degree ee AV AV block ck” whi while in in the he ESC SC 2007 GL GLs we we us use the the ter terms “seco cond degree AV AV block Mo Mobitz I or II” II”  Dif Differe erences in in clas classif ificatio ion and ran rankin ing: rd degr  e.g. Fo For asym ympto tomati atic pati atients nts with th 3 rd gree ee AVB AVB paci acing is is cons nsidered ed to to be cl class IIa Ia, Lo LoE C in in ES ESC/E /EHR HRA 2007 GLs, while ile it it is is cla lassif ifie ied as I, I, Lo LoE B in in the the presence ence of SHD, D, or if if the the site te of block is is below AVN AVN an and IIa IIa, Lo LoE C if if ther there is is no no SHD in in the the ACC/ CC/ AHA/ AHA/HR HRS QLs Ls

Co Conven nventio ional l ind indica icatio ions s fo for r pacing cing The E ESC/EHR HRA 2 A 2007 Gui Guidelines  pres esent deta tailed definitions ns  follow llow an an up up-to to-date ate approac ach to to the the ev evaluati tion of patient ents wi with th synco ncope.  ta take into to cons nsiderati tion the the resul ults of rece cent nt tria ials ls ( MOST, ST, tc) an and the the tech technologi gical ad advances, CTOPP, PASE, CTO SE, DAVID ID etc pro rovidi iding  lev evel el of ev eviden ence in in mode select ctio ion.  recomm mmend ndations ons fo for the he us use of ne new alg lgori rithms (MP MPV, V, ANTI NTITA TACH CHY)

Reco Recommen endatio ions s fo for r ca card rdia iac c pacing cing in ca in caro rotid id sinus sy sinus synd ndro rome me

Reco Recommen endatio ions s fo for r ca card rdia iac c pacing cing in V in VVS (ESC/E /EHR HRA 2 2007 GLs GLs)

Reco Recommendatio ions fo for r ca card rdia iac p c pacin cing in in VVS (ACC/A CC/AHA/HRS RS 2008 2008 GLs)  Si Signif gnific icantly ly symptom ptomatic tic neu eurocar cardio-geni nic syn syncope associ asso ciat ated ed with with bra rady dycardia rdia docu cumen ented ed spon ponta taneou ously ly or or at at the he time of of tilt ilt- table table tes testi ting is is clas class IIb IIb Lo LoE B

Co Conven nventio ional l ind indica icatio ions s fo for r pacing cing The E ESC/EHR HRA 2 A 2007 Gui Guidelines  pres esent deta tailed definitions ns  follow llow an an up up-to to-date ate approac ach to to the the ev evaluati tion of patient ents wi with th synco ncope.  ta take into to cons nsiderati tion the the resul ults of rece cent nt tria ials ls ( MOST, ST, tc) an and the the tech technologi gical ad advances, CTOPP, PASE, CTO SE, DAVID ID etc pro rovidi iding  lev evel el of ev eviden ence in in mode select ctio ion.  recomm mmend ndations ons fo for the he us use of ne new alg lgori rithms (MP MPV, V, ANTI NTITA TACH CHY)

Pa Pacema cemaker mo er mode select e selectio ion n in sinus no in sinus node e disea isease se

Pa Pacing cing fo for r sp specifi ecific co cond nditio ions  New New cha chapters ers:  Sleep leep-apno apnoea syndr ndrome ome  Adenosine sine- sensit sitive ive syndr ndrome ome

Sleep leep-apn apnoea a syn yndr drom ome  Atria rial overd rdrive paci acing ng at at a rate of 15 b.p.m. highe her tha than the the mean no noct cturnal al he heart rate had a positi tive eff effect ect on sleep apno noea, reduci ucing both th obstructi uctive an and ce centr ntral apno noeic ep episodes in in pati atients nts who ho wer ere al already paced aced for co conv nventi tiona nal indicati cations. Gar arrigue S, e , et al al. N E . N Engl J M Med 2 2002  These positi tive resul ults, were re no not co conf nfirmed ed by other ther stud tudies es tha that included patients nts wi with th pur ure obstr tructive sleep ep apnoea. Sim imantirakis EN N e al l . N N Engl l J Me Med d 2005 Krahn A hn AD, D, J J Am Col oll C Cardi diol ol 2006  More re stud tudies are re ne need eded to to cla larif rify the the possible effe fect of atria rial paci acing on slee eep apno noea an and to to dete termine in in wh which ch sub ubgr group ups of patients nts thi this approach ach might ht be benefi nefici cial.

Ad Adeno enosin sine- sensit sensitive sy ive synd ndro rome me  There ha has be been no no wel ell-desi esigned ed rando andomi mized ed st study ab able le to to det etermine ermine the he ut util ilit ity of pacing ing in in pat atient ients wit with a posit ositive ive ATP ATP test est, thu hus no no definit efinitiv ive rec ecom- mend ndatio ions ns ca can be ma made.