permanent tachyc cardi ardias as permanent tachy
play

Permanent Tachyc cardi ardias as Permanent Tachy J J. . Janou Janou ek ek Klinik f. Kinderkardiologie Klinik f. Kinderkardiologie Universit t Leipzig, Herzzentrum t Leipzig, Herzzentrum Universit Mechanisms echanisms M

0 downloads 6 Views 1,69 MB Size Report
  1. Permanent Tachyc cardi ardias as Permanent Tachy J J. . Janou Janouš šek ek Klinik f. Kinderkardiologie Klinik f. Kinderkardiologie Universitä ät Leipzig, Herzzentrum t Leipzig, Herzzentrum Universit Mechanisms echanisms M � Ectopic activity Ectopic activity � » Focal Focal (e (ectopic ctopic) ) atrial atrial tachycardia tachycardia (FAT (FAT, , AE AET) T) » » Junctional ectopic (His bundle) Junctional ectopic (His bundle) tachycardia tachycardia » (JET) (JET) � Reentry Reentry � » Permanent junctional reciprocating Permanent junctional reciprocating » tachycardia (PJRT) tachycardia (PJRT)

  2. Rationale of therapeutic approach Rationale of therapeutic approach � Natural history Natural history � � Severity of symptoms Severity of symptoms � � Risk Risk of tachycardia of tachycardia- -induced induced � cardiomyopathy cardiomyopathy versus versus Benefits and risk isks s of drug therapy of drug therapy Benefits and r and catheter ablation and catheter ablation Indications for RF RF catheter ablation catheter ablation Indications for in childern: : Class Class I I in childern � Resuscitated cardiac arrest in WPW � Syncope in WPW » Min. preexc. RR <250 msec during AFib » AC ERP <250 msec � Incessant SVT with ventricular dysfunction Friedman RA et al., PACE 2002 NASPE Expert Consensus Conference

  3. Indications for RF RF catheter ablation catheter ablation Indications for in childern: : Class Class II A II A in childern � Recurrent symptomatic SVT refractory to drug therapy, age >4 yrs � Cardiac surgery prohibiting further approach to arrhythmogenic substrate (TCPC) � Incessant SVT with normal ventricular function Friedman RA et al., PACE 2002 NASPE Expert Consensus Conference Focal ( (ectopic ectopic) ) atrial tachycardia atrial tachycardia Focal

  4. AET originating from septal focus AET originating from septal focus Main features Main features � P wave of first beat identical to P wave of first beat identical to � subsequent beats subsequent beats � Warming Warming- -up and cooling up and cooling- -down down � phenomenon phenomenon � May have AV block during running May have AV block during running � tachycardia tachycardia � No induction by pacing No induction by pacing �

  5. AET / adenosine AET / adenosine Before ablation EAT – heart rate profile After ablation

  6. Tachycardia induced CMP Tachycardia induced CMP Prior to therapy 1 year after ablation Natural history and therapeutic response response Natural history and therapeutic � Tachycardia induced CMP Tachycardia induced CMP � » Higher risk with higher heart rates and Higher risk with higher heart rates and » permanent tachycardia permanent tachycardia � Spontaneous resolution Spontaneous resolution 1 1 � » <3 yrs.: 78 %, » <3 yrs.: 78 %, ≥ ≥ 3 yrs: 16 % (p<0.001) 3 yrs: 16 % (p<0.001) � Pharmacological control Pharmacological control 1 1 � » <3 yrs.: 91 %, <3 yrs.: 91 %, ≥ ≥ 3 yrs: 37 % (p<0.001) 3 yrs: 37 % (p<0.001) » � Recurrence possible! Recurrence possible! � 1 Salerno 1 Salerno JC JC et al., JACC 2004 et al., JACC 2004

  7. AET from right upper pulm. vein AET from right upper pulm. vein Sinus r. Sinus r. AET AET AET from right upper pulm. vein AET from right upper pulm. vein RAO LAO

  8. Junctional ectopic tachycardia ectopic tachycardia (JET) (JET) Junctional ECG ECG 1 s 1 s

  9. Main features Main features � Congenital, adult and postoperative form Congenital, adult and postoperative form � � Congenital form Congenital form � » Family Family history (up to 55.6 %) history (up to 55.6 %) 1 1 » » » Progression into CAVB Progression into CAVB 2,6 2,6 » Spontaneous rate acceleration Spontaneous rate acceleration 1 1 » » » High incidence of heart High incidence of heart failure (up to 60 %) failure (up to 60 %) 1 1 » Therapy: Therapy: » – Propafenone Propafenone 3 3 , Amiodarone , Amiodarone 1 1 , Amiodarone+IC , Amiodarone+IC 4 4 – – Cave: digoxin – Cave: digoxin 1 1 , proarrhythmia , proarrhythmia 4 4 – Ablation – Ablation 5 5 � Adult form Adult form � » » Later in life, better Later in life, better tolerated, lower tolerated, lower HRs HRs 1 Villain E et al. Circulation 1990, 2 Henneveld H et al. Heart 1998, 3 Paul T et al. J Am Coll Cardiol 1992, 4 Sarubbi B et al. Heart 2002, 5 Fishberger SB et al. PACE 1998, 6 Dubin AM et al. HeartRhythm 2004 Permanent junctional reciprocating junctional reciprocating Permanent tachycardia (PJRT) (PJRT) tachycardia

  10. Main features Main features � Posteroseptal pathway Posteroseptal pathway � � Retrograde conduction Retrograde conduction � only only � Decremental properties Decremental properties � � Incessant Incessant � � Tachycardia induced Tachycardia induced � CMP CMP Adapted using Mazgalev TN et al., Circulation 2001 Long RP, short PR ong RP, short PR L I V1 II V2 III V3 V4 aVR V5 aVL aVF V6 1 s 1 s

  11. Diagnostic clue Diagnostic clue 300 360 360 180 200 220 PJRT – – multicenter multicenter study study PJRT � N = 85 N = 85 � � Age at diagnosis Age at diagnosis 0 0- -20 20 yrs yrs ( (median median 3 3 mo mo) ) � � Follow Follow- -up median up median 8.2 8.2 yrs yrs � � CHF 28 % CHF 28 % � » » resolved with medical Tx resolved with medical Tx in in all all � Success of medical Tx Success of medical Tx: 94 % : 94 % � » amio amiodarone darone/ /verapamil verapamil + digoxin + digoxin » � Spontaneous resolution: 22 % Spontaneous resolution: 22 % � � Death: 2 pts with persistent LV dysfunction Death: 2 pts with persistent LV dysfunction � Vaksmann G et al., Heart 2005

  12. PJRT mapping and ablation PJRT mapping and ablation RF energy application Ventricular extrastimulus 354 ms 329 ms Retrograde block

Recommend Documents


permanent plantings outlook
PERMANENT PLANTINGS OUTLOOK May 9,

PERMANENT PLANTINGS OUTLOOK May 9, 2019 Why Permanent Crops

consultation permanent forests
Consultation: Permanent forests Public

ETS Forestry Package Consultation: Permanent forests Public Information

attracting a global community a permanent magnet
ATTRACTING A GLOBAL COMMUNITY A

ATTRACTING A GLOBAL COMMUNITY A PERMANENT MAGNET Such as the forum has been a

purchasing permanent slides at low cost
Purchasing Permanent Slides at Low

Page 1 of 14 Purchasing Permanent Slides at Low Cost Gregor Overney Page 2 of

permanent cosmetics microblading
Permanent Cosmetics & Microblading

Permanent Cosmetics & Microblading The difference between traditional

the 2 8 mill permanent improvement levy
The 2.8 Mill Permanent Improvement

The 2.8 Mill Permanent Improvement Levy Renewing Our Communitys Commitment

permanent housing
Permanent Housing Rural Communities

Permanent Housing Rural Communities Housing Development Corporation Fort

elytre
ELYTRE A PERMANENT INSTALLATION BY A

is a visual label ELYTRE A PERMANENT INSTALLATION BY A permanent

new hardness results for the permanent using linear optics
New Hardness Results for the Permanent

New Hardness Results for the Permanent Using Linear Optics Daniel Grier

permanent land protection
Permanent Land Protection In 2018, the

Permanent Land Protection In 2018, the Commission contributed $408,178 from

investor presentation 4q 2018 stereotaxis at a glance
Investor Presentation 4Q 2018

Investor Presentation 4Q 2018 Stereotaxis at a Glance Global Leader in

laser rework capabilities
Laser Rework Capabilities Utilizing

Laser Rework Capabilities Utilizing different laser wavelengths allow for

radiology presentation schedule
Radiology Presentation Schedule

Beth Israel Deaconess Medical Center Radiology Presentation Schedule Sunday,

l ablation dans les ablation dans les l arythmies
L ABLATION DANS LES ABLATION DANS

L ABLATION DANS LES ABLATION DANS LES L ARYTHMIES ARYTHMIES

adjuvant therapy of thyroid cancer
Adjuvant Therapy of Thyroid Cancer:

Adjuvant Therapy of Thyroid Cancer: rhTSH, RAI, EBRT and Targeted Therapeutics

progress in fielding a zero focus shadowgraph system for
Progress in Fielding a Zero- Focus

Progress in Fielding a Zero- Focus Shadowgraph System for Ablation

fibs and flutters the heart of the matter anita ralstin
Fibs and Flutters: The Heart of the

4/7/13 Fibs and Flutters: The Heart of the Matter Anita Ralstin, CNP By the

transformer ablation studies
Transformer Ablation Studies Simon

. . . . . . . . . . . . . . . . Transformer Ablation Studies

bringing advanced energy to endoscopy investor open event
BRINGING ADVANCED ENERGY TO ENDOSCOPY

CREO MEDICAL BRINGING ADVANCED ENERGY TO ENDOSCOPY Investor Open Event 17

the simple effective treatment of mea
The Simple, Effective Treatment of MEA

An Introduction to MEA Its about knowledge. Its about MEA For Educational Use

indicatie voor ablatie bij voorkamerfibrillatie
Indicatie voor ablatie bij

Indicatie voor ablatie bij voorkamerfibrillatie Andrea Sarkozy Cardiologie

modeling of laser ablation of lif influence of defects h
Modeling of Laser Ablation of LiF -

Modeling of Laser Ablation of LiF - Influence of Defects H. M Urbassek, Y.