Day :
- Session 1
Session Introduction
Juergen Kuschyk
University of Heidelberg, Germany
Title: The subcutaneous implantable cardioverter-defibrillator – first single-center experience with other cardiac implantable electronic devices
Time : 11:10-11:40
Biography:
Kuschyk has completed his medical degree at the University of Münster, Germany at the age of 27. He is the director of Device Therapy at the University Medical Center Mannheim, Germany. He is senior consultant in Cardiology-Electrophysiology. He has published more than 100 papers in reputed journals and has been serving as an editorial board member of repute. He is international procter for S-ICD and CCM. From 2000-2015 he gave > 200 international presentations on device therapy. Center of Excellence for S-ICD. His main clinical research includes: Device therapy for prevention of sudden cardiac death and chronic heart failure.
Abstract:
The subcutaneous implantable cardioverter-defibrillator (S-ICD) is an implantable device for antiarrhythmic therapy with no intravascular leads.We describe the technical feasibility of combining the S-ICD with other cardiac implantable electronic devices (CIEDs), including pacemakers with trans-venous or epicardial electrodes. We also provide the first experience of combining S-ICD with catheter-based therapies including cardiac contractility modulation (CCM) and vagus nerve stimulation (VNS).Between 7/2011 and 11/2014 six patients received a CCM device and S-ICD, three patients with a single-chamber pacemaker using either trans-venous or epicardial pacing electrodes received S-ICD, and one patient with an implanted S-ICD received VNS. In all patients intraoperative S-ICD testing, crosstalk tests and postoperative ergometric testing were performed.In all 10 patients device implantations were successfully performed without complications. S-ICD therapy was shown to be technically feasible with concomitant CIED. Mean follow up was nearly 17 months. S-ICD testing and crosstalk testing before and during exercise enabled device programming across a broad range of test conditions and was associated with no subsequent evidence of adverse device interaction. None of the devices required permanent inactivation or removal and no patient received an inappropriate shock.In suitable patients, combining an S-ICD with CCM or pacemaker may provide an acceptable means to reduce the number of trans-vascular leads. S-ICD appeared safe with CCM over an intermediate follow-up period. Additional prospective randomized controlled trials examining S-ICD in conjunction with CIEDs are warranted.
Jeko Metodiev Madjarov
University of North Carolina, USA
Title: Extrapericardial placement of implantable cardioverter-defibrillator leads: A novel technique for cardiac anti-arrhythmic therapy
Time : 11:40-12:10
Biography:
Jeko Madjarov, is board-certified in general, vascular/endovascular, and cardiothoracic surgery. His clinical interests include adult cardiac and thoracic surgery; aortic surgery, including complex/endovascular aortic repair; and minimally invasive coronary and thoracic surgery. He is a key member of the complex lead extraction program in the department of cardiac electrophysiology. Dr. Madjarov has several patents in the field of diagnosis and treatment of cardiac arrhythmias, endovascular treatment of aortic disease, and complex chest wall reconstruction.Dr. Madjarov received his medical degree summa cum laude from Sofia Medical University, Bulgaria, and completed a cardiac surgery residency at St. Ekaterina University Hospital, Sofia, Bulgaria. In the U.S., he completed general surgery residencies at Yale-New Haven Hospital, New Haven, CT; and Baystate Medical Center/Tufts University School of Medicine, Springfield, MA. He then completed fellowships in vascular/endovascular surgery and cardiovascular/thoracic surgery at Carolinas Medical Center, Charlotte, NC - under Prof. Francis Robicsek. An active inventor, Dr Madjarov is leading several research studies and is also closely involved in the development of new medical technology. He has authored more than 20 publications in peer-review.
Abstract:
Transvenous pacing leads insertion provides good long-term results for implantable cardioverter-defibrillator (ICD). However many factors like venous occlusion, intracardiac shunting, previous surgery or risk of extraction may prohibit or complicate transvenous ICD lead placement. The indications for nontraditional placement of ICD leads have greatly expanded over the past decade especially with the growing population of Adult Congenital patients. The aim of this study was to evaluate the impact of extrapericardial placement of ICD leads for treating ventricular arrhythmia via AntiTachicardic Pacing (ATP) and/or Defibrillation.In vivo studies were performed in 9 female Yorkshire pigs (weight 46.2+/-6.1 kg). Surgical approach via left mini-thoracotomy. The first custom-made bipolar pacing lead was sutured extrapericardially at the level of the lateral wall of the left ventricle (LV) and the second lead was secured in a similar fashion at the level of the basal aspect of the right ventricle without opening the pericardium. The ICD generator was placed into the chest wall. A standard “Shock on T” pacing scheme induced ventricular fibrillation (VF).All ICD systems had acceptable defibrillation thresholds with energy tested at 21J, 29J, 37J x 5. There was no increase in impedance between the coil and generator. There were no inappropriate discharges. Each successful shock converted VF to normal sinus rhythm. The mean R-wave amplitude was 9 mV +/- 4 mV. The mean pacing impedance was 331 Ohms. The mean threshold was 4.8V @ 1.5ms.Extrapericardial placement of ICD leads has demonstrated good performance with stable defibrillator parameter. It appears to be a simple efficacious technique to ICD therapy and in some clinical situations can overcome limitations of transvenous or epicardial approaches as well as provide the ability to deliver ATP which is in stark contrast to currently available technology.
Abdullah A. Alabdulgader
Prince Sultan Cardiac Centre, Saudi Arabia
Title: Genetic and environmental risk factors of congenital heart defects: Etiological perspective
Time : 12:10-12:40
Biography:
Abdullah Al Abdulgader is the Professor of Congenital Cardiology/Electrophysiology and also General Directorate of Health. He has completed his undergraduate in King Faisal University 1991. He is founder and general director in Prince Sultan Cardiac Centre, General Director of King Fahad Hospital. He has received many local and international compliments and awards. A large number of Congratulatory Letters from the Presidents of the various Universities in Saudi and local educational and academic authorities has been received by him. He has got Congratulatory Letter from the Royal Highness Prince Salman Ibn Abdulaziz and Crowned Prince of Saudi Arabia.
Abstract:
Congenital heart defects are the most common congenital anomalies in human. They constitute the leading cause of congenital anomalies related deaths in all nations and contribute to major health as well as economic and psychological burden in individuals and nations worldwide. In spite of the explosive nature of genetics and epigenetics of cardiac dysmorphogenesis there is increasing level of evidence of the significant directive role of epidemiological data. This is due to the extreme complexity of signalling and transcriptional networks involved in heart development which emphasize the critical and complementary nature of epidemiological research to get closer to the absolute facts of human heart development. We, recently, finalized case-control project of epidemiology of Congenital Heart Defects (CHD) in Saudi live born infants. The main objective of this project was to shed light on probable environmental and genetic risk factors implicated in the etiology of Congenital Heart Defects (CHD) in Saudi population. Unique national sample was created representing one of the largest risk factors database in the history. The various genetic and environmental risk factors constituting 7327*412 information matrix. Parents were interviewed about a wide range of genetic, physiological, medical, occupational and environmental factors that occurred during the critical embryogenesis period. New insights and associations were discovered. This comprehensive database should encourage the international congenital heart community for complementary resources of knowledge in the field aimed toward historical collaboration to abort the process of cardiac dysmorphogenesis in human.
Guy Salama
University of Pittsburgh,USA
Title: Relaxin suppresses atrial fibrillation (AF) in spontaneously hypertensive (SHR) and aged rats through electrical and extracellular matrix remodeling via Wnt signaling pathways
Time : 12:40-13:10
Biography:
Guy Salama completed his PhD in Biophysics and Biochemistry and a postdoctroal fellowship at the University of Pennsylvania. He is a pioneer in the development of optical probes of membrane potential, high spatial and temporal-resolution imaging of electrical activity and Ca2+ transients and the elucidation of arrhyhtmia mechanisms. Dr. Salama has made significant contributions to elucidate the mechanisms underlying sex differences in long QT-related arrhyhtmias and demonstrated the genomic modulation of cardiac ion channels by estrogen. He has published more than 125 papers in top-tiered journals and has served on numerous study sections for the NIH and the AHA.
Abstract:
Relaxin, a hormone first described in pregnancy, has more recently been shown to have important cardiovascular effects. Relaxin activates a wide range of signaling pathways through its receptors, RXFP1/2 which are expressed in most organs. RXFP1 signaling stimulates cAMP, NO and several growth factors and inhibits angiotensin-II and TGF-β effects. RLX increases systemic arterial compliance and reverses fibrosis in multiple organs. In the RELAX-AHF trials, patients with acute decompensated heart failure (HF) received RLX (i.v. 2-days) resulting in reduced mortality (37%, 6-months-later) compared to standard of care. Our studies showed that RLX suppresses atrial fibrillation in spontaneously hypertensive and in aged rats through a marked increase in conduction velocity (CV). CV elevation was associated with the remodeling of the extracellular matrix (↓fibrosis: ↓collagen I&III, ↓TGFβ-1, ↓SMA-α, ↑MMP-6&9) and of electrical properties (↑Connexin43 (Cx43) phosphorylation, ↑INa, ↑Nav1.5). Here, we show for the first time a close interplay between RLX and Wnt signaling. Male aged rats (24-months) were treated with RLX (400µg/kd/day, 2-weeks) or a vehicle delivered with implantable mini-pumps. Langendorff hearts were optically mapped, then analyzed by immuno-fluorescence, voltage-clamp and RT-PCR. RLX-treatment increased Wnt1 (80%) and β-catenin (72%) at intercalated disks (ID) and reversed the lateralization of Cx43 (without changing Cx43 levels) increasing and their co-localization with β-catenin at ID. RLX also reduced Wnt3a (83%) and increased Nav1.5 (80%) and INa (46%) (p<0.02, n ≥ 4 hearts/group). These robust genomic effects of RLX may explain its long-lasting protective actions in HF patients who were treated with RLX (iv) for merely 2-days.
Thomas Deneke
Heart Center Bad Neustadt, Bad Neustadt, Germany
Title: Esophageal Lesions related to atrial fibrillation ablation
Biography:
Thomas Deneke is head of the department of interventional electrophysiology in one of the largest german heart centers since 2010. He is Professor for internal medicine, cardiology and rhythmology at the university of Bochum in germany.
Abstract:
Atrioesophageal fistula (AEF) is a rare but devastating complication of atrial fibrillation (AF) ablation (incidence 0.01 to 0.2%). Asymptomatic thermal esophageal lesions (EDEL) related to AF abaltion occur in up to 60% of patients and are considered a precursor for AEF. Due to the rarity of AEF systematic analysis of related factors is impossible and EDEL have been used as a surrogate endpoint evaluating the risk factors for esophageal damage. In our expereience EDEL occur in 8.1% of AF ablation cases when using cautious ablation at the posterior wall with a maximum of 25W irrigated radiofrequency (RF) ablation. Current studies indicate a higher incidence of EDEL when using non-insulated thermal esophageal temperature monitoring during RF ablation (32.5% vs. 6.9%, p<0.01) compared to not using any tempearture monitoring at all. Using insulated thermal esophageal temperature probes produces comparable incidences of EDEL (7.5%) during RF ablations. Using optimized high-irrigation tip catheters or cryo-balloon 2nd generation is related to an incidence of EDEL of 12 to 18%. Out of a total of 2897 patients including 237 with EDEL 0.03% of erythemas and 0.09% of esophageal ulcers proceed to perforation. Systematic algorhythm show to deal with patients with EDEL are being evaluated within the german working group on arrhythmias.
Vladimir Ermoshkin
Russian New University, Moscow, Russia
Title: New theory of cardiac arrhythmias in humans
Biography:
Vladimir Ermoshkin graduated Physics Department of Moscow State University named Lomonosov in 1978. He worked in SIC "Resonance", worked in RosNOU, biophysicist. Starting in 2012, he has published 5 articles on cardiology in prominent magazines, and 5 times spoke at medical conferences in Russian Peoples' Friendship University.
Abstract:
A new attempt to study the mechanism of arrhythmias and sudden cardiac death (SCD) analysis. Information search in the literature, participate in conferences, discussions with Russian leading cardiologists.I was able to show that when considering the arrhythmia mechanisms, researchers have forgotten about the possibility of CMC excitations by mechanical pulses. Tests on the device "Cardiocode" were carried out. Under the influence of stress can be opened large arteriovenous anastomoses (AVA). Periodically, the pressure change in the arteries and veins. Vena - cava expands, increases tone, and pulse waves start to path through the AVA on the walls of the vena cava to right heart. Mechanical impulses can excite the CMC from various points of the atria or ventricles, disrupting the sinus rhythm. The result: appear extra systoles, tachycardia attacks, blocking blood flow and to any peripheral venous network sites, swelling. Longevity attacks of tachycardia and arrhythmia can lead to progressive fibrosis of the heart because of myocardial ischemia. This increases the likelihood of the onset of fibrillation and SCD. Unhealthy lifestyle, the presence of opening \ closing AVA can sometimes lead to a lot of diseases. To get rid of attacks cardiac arrhythmias and to get SCD prevention is necessary in some way to suppress the mechanical waves, jogging on circuit: aorta- artery- AVA- vein- vena cava- atria- ventricles. That is why the extra hearts beats occur with the same coupling intervals or the strictly identical periods of beats. In such cases “reentry†phenomenon has a mechanical nature.
Kamal Alghalayini
King Abdulaziz University hospital, Saudi Arabia
Title: Clinical characteristics of atrial fibrillation in Saudi women and its clinical impact in a tertiary university hospital
Biography:
Kamal Alghalayini completed his board in internal medicine on 2004, then he continue his training in cardiology with sub specialty in heart failure and Imaging , currently he is the Chairman of Department of Medicine and Director of non-invasive lab at King Abdulaziz University hospital , Jeddah, Saudi Arabia.
Abstract:
Objective: The aim of this study is to evaluate the characteristics of atrial fibrillation in Saudi women and its clinical impact of the common clinical practice on mortality and morbidity. Subjects and Methods The study was conducted on 84 women with atrial fibrillation ; all of them were subjected to complete medical history and clinical examination including complete cardiac clinical examination, electrocardiogram, Echocardiogram, blood pressure measuring as well as thyroid examination. Laboratory examination was performed to detect levels of international normalized ratio, thyroid stimulating hormone (TSH), triiodothyronine, thyroxine , triglyceride, low-density and high-density lipoprotein as will as hospitalizations, stroke and in-hospital mortality. Results The mean age of our patients was 61.8 years old with an average Body Mass Index 28.45 kg/m2, the mean hemoglobin level in all patients was 12.2 g/dl and the mean TSH level for all patients was 3.75 mIU/L. The target INR was achieved in 58% of all treated population, 70% of our patient sample had more than one hospital admission and (19%) had suffered a stroke. Conclusion This study confirms the management gap in women with atrial fibrillation and the negative impact on the clinical outcome, indicating the urge to increase the attention to the treatment plans designed for such patients.
- Track: Translational Science in Arrhythmia
- Workshop
Session Introduction
Juergen Kuschyk
Medical Faculty Mannheim of the University of Heidelberg, Germany
Title: Cardiac Contractility Modulation (CCM) and Subcutaneous Defibrillator (S-ICD) - Clinical Evidence, implantation technique, indications/patient selection and pitfalls
Time : 14:50-16:20
Biography:
Juergen Kuschyk has completed his Medical Degree at the University of Münster, Germany. He is the Director of Device Therapy at the University Medical Center Mannheim, Germany. He is senior consultant in Cardiology-Electrophysiology. He has published more than 100 papers in reputed journals and has been serving as an Editorial Board Member of repute. He is international procter for S-ICD and CCM. From 2000-2015 he gave >200 international presentations on device therapy. His main clinical research includes: Device therapy for prevention of sudden cardiac death and chronic heart failure.
Abstract:
In the last decades, defibrillator therapy has revolutionized treatment of patients at risk for sudden cardiac death. Multiple clinical trials have shown the benefit of implantable cardioverter–defibrillators (ICD) for primary and secondary prevention of sudden cardiac death. Being an entirely subcutaneous system, the S-ICD avoids important periprocedural and long-term complications associated with transvenous implantable cardioverter–defibrillator (TV-ICD) systems. Cardiac contractility modulation (CCM) is a device-based heart failure therapy with 3 intracardiac leads that enhances contractile strength of the myocardium independent of the synchrony of myocardial contraction. CCM signals are non-excitatory high voltage electrical impulses that are applied during the absolute refractory period. CCM has been proven to improve Quality of Life, exercise capacity and left ventricular parameters and might decrease mortality. In this unique and interactive workshop a detailed and stepwise instruction will be offered on implantation technique of S-ICD and CCM systems including life-videos, case reports, voting questions and an approach for the concomitant implantation of both systems. A special section will be dedicated to adaequate patient selection for both systems and future developments will be discussed.
- Video Presentation
Session Introduction
Vladimir I Ermoshkin
Russian New University, Russia
Title: Arteriovenous anastomoses and cardiovascular diseases
Time : 16:45-17:00
Biography:
Vladimir I Ermoshkin has completed his graduation from Physics Department of Moscow State University in 1978 and worked in RosNOU as Biophysicist. From 2011, he has published 5 articles on cardiology in prominent magazines, and had 5 oral presentations at medical conferences in Russian Peoples' Friendship University.
Abstract:
A new attempt to study the unknown role of the arteriovenous anastomoses (AVA).The methodology used in this study is an information search in literature, participation in conferences, discussions with Russian leading cardiologists. Researchers consider that the AVA are important for the regulation of blood supply to certain organs. AVA are involved in the mechanism of thermal, humoral and receptors regulation. However, it is believed that the role of small or large AVA in human circulatory system is still poorly understood. We have found that along with the positive role, the anastomoses, especially large AVA, periodically have pathological effects on the cardiovascular system. The device Cardiocode was used for testing. Large arteriovenous anastomoses (AVA) can be opened under the influence of stress. Periodically, the pressure change in the arteries and veins. Vena cava expands, its wall’s tone increases and pulse waves start to path through the AVA along the elastic walls of the vena cava to the right atrium. Mechanical impulses can excite heart from various points of the atria or ventricles, disrupting the sinus rhythm. The results are as follows: Appearance extrasystoles, tachycardia attacks, at the same time the blood flow is blocked on almost all the peripheral segments of circulatory system and edemata appearance. Increased venous pressure stops the capillary circulation, which eventually leads to heart failure, even in a healthy heart. Serious metabolic disorder appears which leads to disease comorbidity and sudden cardiac death (SCD).Unhealthy way of life and presence of large AVA can sometimes lead to a variety of diseases. To get rid of the attacks of cardiac arrhythmias and the prevention of SCD we need to find some way to suppress the mechanical waves running through AVA, as “reentry” phenomenon has a mechanical nature. It is necessary to continue studying the AVA to develop new measures for neutralizing the pathological events associated with the AVA.
Satoru Takeno
Kindai University, Japan
Title: The impact of growth –related changes in the AV node on incidence of AVNRT in children
Time : 17:00-17:15
Biography:
Satoru Takeno has graduated from Akita University School of Medicine in 2001. After receiving training for general pediatrics and pediatric cardiology, he completed his postgraduate study at Mahidol University, Thailand. He is an assistant professor at Kindai University, and engages in pediatric electrophysiology and catheter ablation.
Abstract:
Atrioventricular nodal reentrant tachycardia (AVNRT) is one of the common form of supraventricular tachycardia in adult population. The presence of dual AV node physiology is one of the key factors for developing AVNRT, because the existence of the two different pathways caused passive current generated from one to the other (electrotonic interaction), causing the prolongation of the effective refractory period in the fast pathway. Meanwhile, the incidence of AVNRT is relatively uncommon in children. The relative frequency of AVNRT increases with age, suggesting an age-dependent anatomic or functional basis for the development of the tachycardia. It is known that the incidence of dual AV node physiology increases and the effective refractory period in the fast pathway prolongs with age. Those conditions are considered to increase the likelihood of inducing the tachycardia. Morphologically, the length of the rightward nodal extension, a possible anatomic substrate for the slow pathway, also increases with age. Therfore, it is speculated that the morphologic change in the rightward nodal extension brings about electrophysiologic conditions. To verify the hypothesis, we examined the correlation between the length of the slow pathway and the effect of the electrotonic interaction, and it demonstrated that the length of the slow pathway had a strong positive correlation with the effect of the electrotonic interaction. The result supported the idea that the prolongation of the rightward nodal extension had a strong impact on the incidence of AVNRT in children.
- Special Session
Session Introduction
Abdullah A. Alabdulgader
Prince Sultan Cardiac Centre, Saudi Arabia
Title: Modulation of heart rate variability: A novel nonpharmacological modality for lowering blood pressure in hypertensive patients
Time : 10:00-11:00
Biography:
Abdullah Al Abdulgader is the Professor of Congenital Cardiology/Electrophysiology and also General Directorate of Health. He has completed his undergraduate in King Faisal University 1991. He is founder and General Director in Prince Sultan Cardiac Centre, General Director of King Fahad Hospital. He has received many local and international compliments and awards. A large number of Congratulatory Letters from the Presidents of the various Universities in Saudi and local educational and academic authorities has been received by him. He has got Congratulatory Letter from the Royal Highness Prince Salman Ibn Abdul-Aziz and Crowned Prince of Saudi Arabia.
Abstract:
This study examined the efficacy of teaching emotional self-regulation techniques supported by heart rhythm coherence pattern (Heart Rate Variability modulation (HRV)) training as a means to quickly lower blood pressure (BP) in patients diagnosed with hypertension. To the best of our knowledge, an investigation of their ability to produce immediate reductions in BP had not been published in the medical literature. The study was a randomized controlled design with 62 hypertensive participants who were divided into three groups. An analysis of covariates was conducted to compare the effectiveness of three different interventions on reducing the participants’ BP. The modulation of HRV to coherence pattern was associated with a significantly greater reduction in mean arterial pressure in the two groups who used the intervention as compared with the relaxation-plus-medication group. Additionally, the group not taking medication that used the intervention also had a significantly greater reduction in systolic BP than the relaxation- plus-medication group. These results suggest that self-regulation techniques that incorporate the intentional generation of positive emotions to facilitate a shift into the psycho-physiological coherence state are an effective approach to lowering BP. Change in the physiological set-point for homeostatic regulation of BP is thought to be the underlying mechanism. Further studies should examine if large scale implementations of such heart-based coherence techniques could have a significant impact on reducing risk of mortality and morbidity in hypertensive patients.
- Session 2
Session Introduction
Mostafa Nawar
University of Alexandria, Egypt
Title: New score to predict response to cardiac resynchronization therapy
Time : 11:30-12:00
Biography:
Moustafa Mohamed Nawar completed his MBBch in 1975, MSc cardiology 1980, and MD cardiology 1986.Currently he is the Prof. of Cardiology and Head of EP lab, Faculty of Medicine, Alexandria University.
Abstract:
Cardiac resynchronization therapy (CRT) has been used to treat advanced cases of heart failure. How to predict who will respond to CRT remains an important and largely unanswered question. To assess and identify the best predictors of CRT response.170 Patients with heart failure and LVEF<35% were included, the predictors of response assessed including preimplantation clinical, electrocardiographic and echocardiographic variables. CRT response was assessed after 6m.Independent pre implantation predictors of response were the QRS duration>150msec, non-ischemic cardiomyopathy, TAPSE>15 mm, sinus rhythm, absence of COPD and absence of history of renal disease. A new CRTscore to predict responders to CRTwas successfully developed. The score consists of maximum 9 point. The CRT response rate has been markedly different according to the CRTscore with very high response rate if CRTscore>6.The new CRTscore can be useful in patient selection in order to improve the CRT response rate. Validation of the score in different population is highly recommended.
Soraya Siabani
Kermanshah University of Medical Sciences, Iran
Title: Epidemiology of congenital heart defects in Iran
Time : 12:00-12:30
Biography:
Soraya Siabani has completed her Medical Doctorate (MD) from Kermanshah University of Medical Sciences (KUMS) in Iran at the age of 25 years, and her PhD from the University of Sydney Faculty Medicine in Australia 2015. She is working as a researcher and faculty member at KUMS now. Soraya has published more than 18 papers in reputed journals (Persian and English), and been serving as an editorial board member of Novelty in Biomedicine (NBM).
Abstract:
Congenital heart defects accounts for more than 30% of all major congenital anomalies worldwide. Regional factors play an important role in the prevalence and incidence of congenital anomalies. Congenital heart defects affects approximately 4-8 per 1000 live births worldwide. Iran is likely faced to a greater incidence of congenital anomalies including CHDs, due to specific cultural factors (e.g. consanguineous marriages) and being exposed to hazardous biochemical materials abused during periods of conflicts (1980-1988).The aim of this systematic review was to summarize the incidence, prevalence and mortality of CHDs in Iranian. We evaluate all related studies published in EMBASE, Web of Sciences, CINAHL, CINHAL, Google Scholar and PubMed from 2000 to 2015. In addition, we consider the studies conducted by Iranian researchers which are mostly published in the Persian (language) and therefore missed by international databases. Also references listed from relevant articles have been searched for related papers.
Abdullah A. Alabdulgader
Prince Sultan Cardiac Centre, Saudi Arabia
Title: Extra cardiac anomalies (ECA) in 2020 subjects with congenital cardiovascular malformation (CCVM) and control: Etiological perspective
Time : 12:30-13:00
Biography:
Abdullah Al Abdulgader is the Professor of Congenital Cardiology/Electrophysiology and also General Directorate of Health. He has completed his undergraduate in King Faisal University 1991. He is founder and general director in Prince Sultan Cardiac Centre, General Director of King Fahad Hospital. He has received many local and international compliments and awards. A large number of Congratulatory Letters from the Presidents of the various Universities in Saudi and local educational and academic authorities has been received by him. He has got Congratulatory Letter From the Royal Highness Prince Salman Ibn Abdulaziz and Crowned Prince of Saudi Arabia.
Abstract:
Association of Congenital Cardiac Malformation with Extra Cardiac Anomalies is well documented. The main objective of this investigation was to analyze the frequency of extra-cardiac malformations and the proportion of chromosome aberrations among live-born infants with Congenital Cardiac Malformation (CCM) in an attempt to generate hypothetical theories of CCM genesis. The study results showed that out of 1010 Congenital Cardiac Malformation (CCM) compared to 10101 normal individuals, 288 were affected by extra cardiac anomalies (28.5%). Atrio-ventricular Septal Defect (AVSD) was found to be the most common CCM associated with ECA (72%) while Dextro-Transposition of Great arteries (D-TGA) was the lowest (8.7%). Syndromes were the commonest extra cardiac anomalies (37%) with congenital cardiac malformation. Complex heart defects such as Hypo-plastic Left Heart syndrome (HLHS) and Double Outlet Right Ventricle (DORV) were infrequently associated with CCM. Statistically significant associations were found between some CCM and certain systems. CCM with ECA associations and incidence of frequent chromosomal aberrations in Saudi population reflect importance of underlying genetic factors which may have pleiotropic effects and shared common pathways. The directive nature of these epidemiological associations is crucial for guidance of our efforts in the genetic and epigenetic fields. In this context molecular and bioinformatics approaches to uncover regulatory gene networks may provide insights needed to understand cardiogenesis and Congenital Cardiac Malformation etiology in human.
Louise Segan
Alfred Hospital, Australia
Title: Bachmann's bundle atrial tachycardia: Electrophysiological mapping and qualitative outcomes
Biography:
Louise Segan completed her MBBS at Monash University in 2013. She is currently a basic physician trainee at the Alfred Hospital in Melbourne, Australia, and intends to pursue advanced training in Cardiology. Her main areas of interest are arrhythmias and cardiac imaging.
Abstract:
Focal atrial tachycardia (AT) is an uncommon but important cause of SVT, often incessant, highly symptomatic and significantly impacting on quality of life. Bachmann’s Bundle (BB) has not been previously described as a site of AT.We retrospectively identified cases of AT from the database of two tertiary referral centres between 1997 and 2014. We analysed the electrophysiological characteristics of BB AT, and collected follow up data including symptom scoring by the Canadian Cardiovascular Society Severity of Atrial Fibrillation (CCS-SAF) and SF-8 scores.BB AT was confirmed by the anatomical position of earliest atrial activation on fluoroscopy or CARTO electro-anatomical map (figure 1). We identified 5 cases of BB AT from 546 AT cases (0.91%). 4 patients were female, the mean age at presentation was 32.6 ± 7.1 years. No patient had a history of prior cardiac surgery, significant valvular disease or other cardiac arrhythmia.AT was spontaneous and incessant in 2 patients, induced with programmed electrical stimulation (PES) alone in 2 cases and PES with isoprenaline infusion in 1 case. Sustained and mappable AT was evident in all patients with mean cycle length of 402 ± 37 ms.Endocardial activation times (shown as mean ± SD) relative to P wave onset demonstrated; His A later than P wave onset or on time in all patients (9 ± 10 ms), proximal CS later than P wave onset in all patients (26 ± 14 ms), and distal CS later than P wave onset in all patients (58 ± 11 ms). The earliest endocardial activation at the site of successful ablation was 23 ± 6 milliseconds ahead of P wave onset during tachycardia. The mean number of radiofrequency applications was 10 ± 8. One patient had recurrence requiring a second ablation. Mean CCS-SAF scores pre and post-ablation showed significant improvement from class 3 to class 0 respectively (p<0.001). SF-8 physical component summary scores improved frompre-ablation mean of 27.5 ± 6.6, post-ablation mean 54.9 ± 4.5 (p<0.01). SF-8 mental component summary scores improved from a pre-ablation mean of 33.0 ± 11.3 to post-ablation mean 51.4 ± 16.1 (p=0.09). At study follow up (min 1 year, max 12 years) all patients were free of arrhythmia without medication.BB is an uncommon site for AT that causes significant morbidity, it can be successfully with good long-term rhythm control and objective improvement in symptoms and physical function.
Javier GarcÃa Reyes
Universidad Nacional de Colombia, Colombia
Title: Successful extended cerebrocardiopulmonary resuscitation of a sudden death patient: A case report
Biography:
Javier Garcia Reyes is a Colombian Physician from National University of Colombia, has become anesthesiologist at the age of 29 years from Colegio mayor de nuestra señora del Rosario Medical School, also he has a graduate diploma of Clinical Epidemiology at Colegio mayor de nuestra señora del Rosario Medical School. Actually he is the chief department of anesthesia in two hospitals in Bogota- Colombia, Clinica LaFont of plastic surgery and Hospital Engativa.
Abstract:
This is the case of a 63-year-old patient, who is a plastic surgeon and has a history of aortic valve replacement, hypertension, pacemaker and anticoagulation, who experien- ced cardiac sudden death in the OR. Basic and advanced life support maneuvers were initiated; there was evidence of ventricular fibrillation and the patient was defibrillated 4 times unsuccessfully. Epinephrine, bicarbonate, amiodarone and lidocaine were administered. The patient alternated between ventricular fibrillation, pulseless electrical activity and asystole. Resuscitation was maintained throughout the process which lasted one hour and 45 min, including transfer to a third level clinic where the patient was considered to be asystolic. Following an additional discharge and amiodarone, the patient recovered spon- taneous circulation; the vital signs were normalized and the patient remained in the ICU under hemodynamically stable conditions. After 18 h, the patient woke up with no evident neurological damage and remained in the ICU for one month for treatment of the ischemic- reperfusion syndrome. After 20 more days of physical therapy in his hospital room, the patient was discharged with no neurological deficit and a recommendation for home-based rehabilitation. Three months later, the patient is doing perfectly well and leading an active family, social and labor life. This narrative discussion considers some interesting aspects reported by other authors on the topic, based on a bibliography search in Medline, Lilacs, Scielo, and Ovid.
Abdullah A. Alabdulgader
Prince Sultan Cardiac Centre, Saudi Arabia
Title: Extra cardiac anomalies (ECA) in 2020 subjects with Congenital cardiovascular malformation (CCVM) and control: Etiological perspective
Biography:
Abdullah Al Abdulgader is the Professor of Congenital Cardiology/Electrophysiology and also General Directorate of Health. He has completed his undergraduate in King Faisal University 1991. He is founder and general director in Prince Sultan Cardiac Centre, General Director of King Fahad Hospital. He has received many local and international compliments and awards. A large number of Congratulatory Letters from the Presidents of the various Universities in Saudi and local educational and academic authorities has been received by him. He has got Congratulatory Letter From the Royal Highness Prince Salman Ibn Abdulaziz and Crowned Prince of Saudi Arabia.
Abstract:
Association of Congenital Cardiac Malformation with Extra Cardiac Anomalies is well documented. The main objective of this investigation was to analyze the frequency of extra-cardiac malformations and the proportion of chromosome aberrations among live-born infants with Congenital Cardiac Malformation (CCM) in an attempt to generate hypothetical theories of CCM genesis. The study results showed that out of 1010 Congenital Cardiac Malformation (CCM) compared to 10101 normal individuals, 288 were affected by extra cardiac anomalies (28.5%). Atrioventricular Septal Defect (AVSD) was found to be the most common CCM associated with ECA (72%) while Dextro-Transposition of Great arteries (D-TGA) was the lowest (8.7%). Syndromes were the commonest extra cardiac anomalies (37%) with congenital cardiac malformation. Complex heart defects such as Hypo-plastic Left Heart syndrome (HLHS) and Double Outlet Right Ventricle (DORV) were infrequently associated with CCM. Statistically significant associations were found between some CCM and certain systems. CCM with ECA associations and incidence of frequent chromosomal aberrations in Saudi population reflect importance of underlying genetic factors which may have pleiotropic effects and shared common pathways. The directive nature of these epidemiological associations is crucial for guidance of our efforts in the genetic and epigenetic fields. In this context molecular and bioinformatics approaches to uncover regulatory gene networks may provide insights needed to understand cardiogenesis and Congenital Cardiac Malformation etiology in human.
M. Moghaddam
Jam Hospital, Iran
Title: Atrial flutter and atrial fibrillation combination RF catheter ablation
Biography:
M. Moghaddam is the Professor of Cardiology, Tehran Medical Sciences University, Member of Iranian Cardiology Board exams. Head of Cardiology Section, Director of EP Lab., Jam Hospital, Tehran, Iran and also graduated in Cardiology from Tehran University on 1985. He got Fellowship of Electrophysiology, Milwaukee Heart Institute, university of Wisconsin, USA, 1993.
Abstract:
Atrial Fib & Atrial Flutter are two kind of atrial arrhythmia with mechanism of reentry.Site of origin of atrial Fib in 90% cases is PVs. Also around the CS-OS and SVC and IVC junction to RA could be the origin of APCs initiating Atrial Fib. Atrial Flutter (AF) has a macrorentery circuit in the RA. Objective: RFCA is applicable in the patients with A.F and A.Fib with single site lesion.We studied 3 patients with AF and A.Fib , after locating CS and halo Catheters we induced AF which converted to A.Fib before sinus rhythm appearance. Prominent APCs with a little different AA intervals were seen around CS OS.APCs .RF energy was delivered to the isthmus between CS OS and IVC , and bilateral block was showed with CS and Halo catheter pacing. Then we could not induce AF, also no APCs was seen.After 12 to 6 months fallow up no patients experienced any arrhythmia without any anti arrythmic agent , neither 48 hours holter monitoring disclosed any arrhythmia. Coincidence of AF and A.Fib is common . In these cases the site of origin of A.Fib could be the isthmus region and RFCA of these area would eradicate both of them.
- Paediatric and Adult Congenital Heart Disease
- Track 1: Translational Science in Arrhythmia
Location: Park Regis North Quay 293 North Quay Brisbane QLD 4000, Brisbane, Australia
Session Introduction
Vladimir Ermoshkin
Russian New University, Moscow, Russia
Title: New theory of cardiac arrhythmias in humans
Biography:
Vladimir Ermoshkin graduated Physics Department of Moscow State University named Lomonosov in 1978. He worked in SIC "Resonance", worked in RosNOU, biophysicist. Starting in 2012, he has published 5 articles on cardiology in prominent magazines, and 5 times spoke at medical conferences in Russian Peoples' Friendship University.
Abstract:
A new attempt to study the mechanism of arrhythmias and sudden cardiac death (SCD) analysis. Information search in the literature, participate in conferences, discussions with Russian leading cardiologist. I was able to show that when considering the arrhythmia mechanisms, researchers have forgotten about the possibility of CMC excitations by mechanical pulses. Tests on the device "Cardiocode" were carried out. Under the influence of stress can be opened large arteriovenous anastomoses (AVA). Periodically, the pressure change in the arteries and veins. Vena - cava expands, increases tone, and pulse waves start to path through the AVA on the walls of the vena cava to right heart. Mechanical impulses can excite the CMC from various points of the atria or ventricles, disrupting the sinus rhythm. The result: appear extra systoles, tachycardia attacks, blocking blood flow and to any peripheral venous network sites, swelling. Longevity attacks of tachycardia and arrhythmia can lead to progressive fibrosis of the heart because of myocardial ischemia. This increases the likelihood of the onset of fibrillation and SCD.Unhealthy lifestyle, the presence of opening \ closing AVA can sometimes lead to a lot of diseases. To get rid of attacks cardiac arrhythmias and to get SCD prevention is necessary in some way to suppress the mechanical waves, jogging on circuit: aorta- artery- AVA- vein- vena cava- atria- ventricles. That is why the extra hearts beats occur with the same coupling intervals or the strictly identical periods of beats. In such cases “reentry†phenomenon has a mechanical nature.
Vladimir Ermoshkin
Russian New University, Moscow, Russia
Title: New theory of cardiac arrhythmias in humans
Biography:
I graduated Physics Department of Moscow State University named Lomonosov in 1978. I worked SIC "Resonance", worked in RosNOU, biophysicist. Starting in 2012, I have published 5 articles on cardiology in prominent magazines, and 5 times spoke at medical conferences in Russian Peoples' Friendship University.
Abstract:
A new attempt to study the mechanism of arrhythmias and sudden cardiac death (SCD) analysis. Information search in the literature, participate in conferences, discussions with Russian leading cardiologists. I was able to show that when considering the arrhythmia mechanisms, researchers have forgotten about the possibility of CMC excitations by mechanical pulses. Tests on the device "Cardiocode" were carried out. Under the influence of stress can be opened large arteriovenous anastomoses (AVA). Periodically, the pressure change in the arteries and veins. Vena - cava expands, increases tone, and pulse waves start to path through the AVA on the walls of the vena cava to right heart. Mechanical impulses can excite the CMC from various points of the atria or ventricles, disrupting the sinus rhythm. The result: appear extra systoles, tachycardia attacks, blocking blood flow and to any peripheral venous network sites, swelling. Longevity attacks of tachycardia and arrhythmia can lead to progressive fibrosis of the heart because of myocardial ischemia. This increases the likelihood of the onset of fibrillation and SCD.Unhealthy lifestyle, the presence of opening \ closing AVA can sometimes lead to a lot of diseases. To get rid of attacks cardiac arrhythmias and to get SCD prevention is necessary in some way to suppress the mechanical waves, jogging on circuit: aorta- artery- AVA- vein- vena cava- atria- ventricles. That is why the extra hearts beats occur with the same coupling intervals or the strictly identical periods of beats. In such cases “reentry†phenomenon has a mechanical nature.
- Case Report in Arrhythmia
- Young Researcher Forum