Electrophysiology Causes of Death in USA 1999 3 Etiology of SCA 4 SCA Risk Factors 5 Prior cardiovascular event Advancing age Hereditary factors African American Ethnicity 40 of all SCA occur in patients with known risk factors ID: 910481
Download Presentation The PPT/PDF document "Sudden Cardiac Arrest Morhaf Ibrahim, M..." is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
Slide2Sudden Cardiac Arrest
Morhaf Ibrahim, MD, FHRS
Electrophysiology
Slide3Causes of Death in USA 1999
3
Slide4Etiology of SCA
4
Slide5SCA Risk Factors
5
Prior cardiovascular event
Advancing age
Hereditary factors
African American Ethnicity
40% of all SCA occur in patients with known risk factors
Zipes
Circulation
1998
;98:2334-2351
b:
Zipes
JACC
2006
;48:e247-e346
Slide6Arrhythmia Cause of SCA
6
Slide7Underlying
Arrhythmias of SCA
7
Slide8LVEF and SCA
8
Slide9Heart Failure and SCA
9
Slide10Severity of Heart Failure
Modes of Death
10
Slide11Incidence of SCA vs.
Annual Sudden Deaths
11
Slide12AIVR
Slide13Nonsustained
Monomorphic VT
Slide14Nonsustained
LV VT
Slide15Sustained Monomorphic VT
72-year-old woman with CHD
Slide16Nonsustained
Polymorphic VT
Slide17Sustained Polymorphic VT
Exercise induced in patient with no structural heart disease
Slide18Bundle Branch Reentrant VT
Slide19Ventricular Flutter
Spontaneous conversion to NSR (12-lead ECG
)
Slide20VF with Defibrillation (12-lead ECG)
Slide21Wide QRS Irregular Tachycardia:
Atrial Fibrillation with antidromic conduction in patient with accessory pathway – Not VT
Slide22Treatments to Reduce SCA
22
Slide23AICD
Slide24Michel
Mirowski
24
Slide25SCA Prevention
Primary Prevention Trials
Trial
Risk Type
Clinical Relevance
MADIT
a
(1996)
EF
<35%
prior MI
NSVT, EP+
The survival benefits of ICD therapy were demonstrated in high-risk patients who had not experienced life-threatening VT/VF
MADIT
II
b
(2001)
EF
<30%
prior MI
The survival benefits of ICD therapy were demonstrated in high-risk patients who did not have documented
arrhythmias.
COMPANION
c
(2002)
EF
<30%
CAD; CHF
QRS >120
The survival benefits of CRT-D (defibrillation)
therapy were demonstrated in heart failure patients who did not have an ICD indication
SCD-
HeFT
d
(2005)
EF
<35%; CAD±MI or NICM
The survival benefits of ICD therapy were demonstrated in NYHA Class II or III CHF patients with an LVEF < 35%
CAD = coronary artery disease;
EP+ = positive for documented
episode of asymptomatic,
unsustained
ventricular tachycardia;
LVEF = Left ventricular ejection fraction;
MI = myocardial infarction; NSVT = non-sustained ventricular tachyarrhythmia; NICM = non-ischemic cardiomyopathy;
SCA = sudden cardiac arrest
;
25
By 2005, the mortality benefit of ICD therapy was clearly established for both primary and secondary prevention of SCA.
a: Moss
NEJM
1996;335:1933-1940 b: Moss
NEJM
2002;346:877-883 c: Bristow
NEJM
2004;350:2140-2150 d:
Bardy
NEJM
2005;352:225-237
Slide26Introduction to the
S-ICD
TM
System 26
Protection Without Touching the Heart
Slide27Subcutaneous ICD Therapy
27
The
S-ICD
TM
System
Entirely subcutaneous
Does not require leads in the heart
Sophisticated algorithms provide effective
detection
and
treatment
of VT/
VF
a,b
a: Gold
J
Cardiovasc
.
Electrophysiol
. 2012, 23:359-366 b:
Weiss
Circulation
2013
;128:944–953
Slide28Implantation of S-ICD
TM
System
A predictable implant that relies only on anatomical landmarks
28
Slide2929
Slide30Implanted
S-ICD
TM
Systems
Device location is well accepted by patientsa
30
Smith W, Hood M. HRS 2007 Abstract Presentation S-ICD System Comfort and Tolerability Study Heart Rhythm; 4(5) S210. b) Case studies are not necessarily representative of clinical performance. Case study performance may vary .
Slide31EFFORTLESS Registry
Broad Range of Clinical Indications
31
Patients with a broad range of cardiac conditions have received the S-ICD
TM
System
Lambiase
EFFORTLESS S-ICD Registry,
HRS 2012
, Boston, MA
Slide32Broad Range of Body
Habitus
32
Patients in all age groups and across a broad range of body habitus have received the S-ICD
TM
System
S-ICD System Commercial Implant Analysis, Q3 2012 (1079 patients). Data on File. Boston Scientific, San Clemente, California
Slide33Strong Candidates
No vascular access
History of recurrent TV lead infections/fractures
Renal failure, diabetes,
immuno
-compromised
Reasonable Candidates
Young patients with primary electrical problems
Patients with a primary prevention indication
Prior VF arrest
Prosthetic valves
Inappropriate Candidates
Patients with bradycardia pacing indications
Need for CRT
Recurrent monomorphic VT
33
Appropriate Use of the S-ICD
TM
System
Poole JE, Gold MR.
Circ
Arrhythm
Electrophysiol
2013;6:1236-1245
.
Slide34Thank you!