Post on 15-Feb-2019
Scuola di Specializzazione in Mala/e dell’Apparato Cardiovascolare Dire8ore Prof. Massimo Volpe Facoltà di Medicina e Psicologia, Università di Roma Sapienza Anno Accademico 2013-‐2014 Dr.ssa Carmen Adduci
Proge8o Formazione Avanzata in Cardiologia nel Web 2014 Scuola di Specializzazione in Mala/e dell’Apparato Cardiovascolare
Dire8ore: Prof. Massimo Volpe
E-‐mail: massimo.volpe@uniroma1.it
Coordinatore: Dr. Giuliano Tocci E-‐mail: giuliano.tocci@uniroma1.it
Prolonged ECG monitoring strategy: -‐ Holter -‐ External loop recorder -‐ Implantable loop recorder
Provoca;ve test strategy: -‐ Caro;d sinus massage -‐ Tilt table test -‐ Electrophysiological study -‐ Exercise test
Classifica;on of bradyarrhythmias based on the pa;ent’s clinical presenta;on
Indica;on for pacing in persistent bradycardia: Sinus node disease
Permanent pacemaker implanta;on should be considered for pa;ents with persistent symptoms similar to those of PM syndrome and aFributable to first-‐degree atrioventricular block (PR > 0.3 s)
Pacing should be considered in pa;ents with second-‐degree type 1 AV block which causes symptoms or is found to be located at intra-‐ or infr-‐His levels at EPS
Pacing is indicated in pa;ents with third-‐ or second-‐degree type 2 AV block irrespec;ve of symptoms
Pacing is not indicated in pa;ents with AV block which is due to reversible causes
Indica;on for pacing in persistent bradycardia: AV block
Indica;on for pacing in intermiFent documented bradycardia
Indica;on for pacing in intermiFent documented bradycardia
ESC-‐2007
Indica;on for cardiac pacing in pa;ents with undocumented bradycardia (reflex syncope)
5) Unexplained syncope. Pacing is not indicated in pa;ents with unexplained syncope without evidence of bradycardia or conduc;on disturbance. 6) Unexplained falls. Pacing is not indicated in pa;ents with unexplained falls.
Indica;on for cardiac pacing in pa;ents with undocumented bradycardia (reflex syncope)
Indica;on for cardiac pacing in pa;ents with BBB
Indica;on for preven;on and termina;on of atrial tachyarrhythmias
ESC-‐2007 Class IA: LVEF≤ 35%,NYHA III-‐IV, LVEDD≥ 55 mm, QRS≥ 120 ms
ESC-‐2012 Class IA: LVEF≤ 35%,NYHA III-‐IV, QRS≥ 120 ms ;LVEF≤ 30%,NYHA II, QRS≥ 130 ms
Indica;on for CRT in pa;ents in sinus rhythm
ESC-‐2012 Class IIa: LVEF≤ 35%,NYHA III-‐IV, QRS≥ 150 ms ;LVEF≤ 30%,NYHA II, QRS≥ 150 ms
Indica;on for CRT in pa;ents in sinus rhythm
Ruschitzka et al NEJM 2013
LESSER-‐EARTH: N 88, QRS < 120 msec
Echo-‐CRT N=809, QRS < 130 msec, Classe NYHA III/IV and LV dyssyncrony (echo)
Rethin-‐Q trial: N=172, NYHA III, QRS < 120 msec and LV dyssyncrony (echo)
CRT does not reduce the rate of death or hospitaliza;on for heart failure and may increase mortality in pa;ents with narrow QRS Complex
Beshai et al NEJM 2007
Thibault et al Circula_on 2013
Cardiac-‐Resynchroniza;on Therapy in Heart Failure with a Narrow QRS Complex
Indica;on for CRT in pa;ents with permanent AF
Upgraded or de novo CRT in pa;ents with conven;onal PM indica;ons and HF
MRI in pa;ents with implanted cardiac devices (1/2)
MRI in pa;ents with implanted cardiac devices (2/2)
Scuola di Specializzazione in Mala/e dell’Apparato Cardiovascolare Dire8ore Prof. Massimo Volpe Facoltà di Medicina e Psicologia, Università di Roma Sapienza Anno Accademico 2013-‐2014 Dr.ssa Carmen Adduci
Proge8o Formazione Avanzata in Cardiologia nel Web 2014 Scuola di Specializzazione in Mala/e dell’Apparato Cardiovascolare
Dire8ore: Prof. Massimo Volpe
E-‐mail: massimo.volpe@uniroma1.it
Coordinatore: Dr. Giuliano Tocci E-‐mail: giuliano.tocci@uniroma1.it
Grazie per la Vostra A8enzione!