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High Risk Groups for SCD
Population Size
SCD Percent / Year
Total SCD / Year
High Coronary
Risk
Post M I
Heart Failure/
E F < 35%)
Syncope /
Heart Disease
Previous
VF / VT
0
1
2
5
10
(millions)
20
0 1 2
5 10 20 50
(percent)
0
50
100
200
(thousands)
300
Impact of F-U Time on NNT
20
17
17
14
14
9
5
3
MUSTT
2Y. 5Y.
5
10
4
MADIT 1
2Y.
11
3Y.
AVID
2Y. 3Y.
MADIT 2
2Y. 3Y.
COMPANION SCD-HeFT
1Y. 2Y.
2Y. 5Y.
U-Shaped Curve for ICD Efficacy
Goldenberg et al. J. Am. Coll. Cardiol. 2008;51;288-296
Of a total of 714 SCD cases (annual incidence 54 per 100,000),
LV function was assessed in 121 (17%)
The LVEF was severely reduced in 36 patients (30%),
mildly to moderately reduced in 27(22%), and normal in 58 (48%).
J Am Coll Cardiol 2006;47:1161– 6
TVNS
Katritsis DG, Camm L, European Heart Journal 2004 25, 1093-1099
Measurement of TWA with CH-2000
• 21 elettrodi, 14 standard e 7 speciali.
Adaptive cancellation
reduces noise due to
patient movement
Valt
Valt
Even Beats
Mean
Odd Beats
Elevato Valore Predittivo Negativo (97% al follow-up di 21 mesi)
Basso Valore Predittivo Positivo (19% al follow-up di 21 mesi)
Calo’ et al. IN PRESS
(J Am Coll Cardiol 2009;53:471–9)
- 48 pazienti con CAD ed indicazione a SEF
- ceMRI entro 32±6 giorni dal SEF
- “infarct surface area” e “infarct mass” hanno
identificato, meglio della FE, i pazienti con
substrato aritmico (TV monomorfa)
JACC 2005;45:1104-8.
101 DCM pts with the presence or absence of midwall fibrosis followed up prospectively for 658 ± 355 days for events
J Am Coll Cardiol 2006;48:1977– 85
Binary logistic regression analysis comparing the extent of late enhancement (%LGE), left ventricular endsystolic volume (LVESV), left ventricular end-diastolic volume (LVEDV), and left ventricular ejection
fraction (LVEF) as predictors of death or hospitalization.
There was a strong association between %LGE and outcome, and %LGE was the sole significant predictor of the
primary end point (odds ratio 1.12, 95% confidence interval 1.03 to 1.24, p = 0.02).
Different morphologies of fQRS
The fQRS included various RSR’
patterns with or without the Q wave
and was defined by the presence of
an additional R wave (R’ prime), or
notching in nadir of the S wave,
notching of R wave, or the presence
of more than one R prime
(fragmentation) in two contiguous
leads corresponding to a major
coronary artery territory.
Effects of recording site and
filtering on f-QRS.
Kaplan-Meier analysis showing
major cardiac events in patients
with fragmented QRS (fQRS
group) and without fragmented
QRS (non-fQRS group).
Average follow up was 57±23
months
JACC 2000
NEJM 2003
31 pts (30.8 ± 7 yrs) who fulfilled the criteria of the Task Force for ARVC/D diagnosis after noninvasive clinical
evaluation underwent RV electroanatomic voltage mapping and endomyocardial biopsy to validate the diagnosis
20 pts (group A; 65%) had an abnormal
RV electroanatomic voltage mapping
showing 1 area with low-voltage values
(<0.5 mV), surrounded by a border zone
(0.5 to 1.5 mV) that transitioned into
normal myocardium (> 1.5 mV).
Circulation 2005;111:3042-3050
Pts from group B had sporadic
disease and histopathological
evidence of inflammatory
cardiomyopathy (P < 0.0001).
11 pts (55%) with
electroanatomic low-voltage
regions received an ICD
because of life-threatening
ventricular arrhythmias,
whereas all but 1 pt with a
normal voltage map
remained stable on
antiarrhythmic drug therapy
(P = 0.02).
Three-dimensional electroanatomic voltage mapping enhanced accuracy for
diagnosing ARVC/D
(1) by demonstrating low-voltage areas that were associated with fibrofatty
myocardial replacement
(2) by identifying a subset of patients who fulfilled ESC/ISFC Task Force
diagnostic criteria but showed a preserved electrogram voltage, an
inflammatory cardiomyopathy mimicking ARVC/D, and a better
arrhythmic outcome.
Priori Circulation 2002
Brugada Circulation 2003