Τεχνολογικές εξελίξεις: αυξάνουν την αποτελεσματικότητα η απλά διευκολύνουν την επέμβαση

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1 Τεχνολογικές εξελίξεις: αυξάνουν την αποτελεσματικότητα η απλά διευκολύνουν την επέμβαση Γεώργιος Ανδρικόπουλος, MD, PhD, FESC, Διευθυντής Α Καρδιολογικής Κλινικής και Τμήματος Ηλεκτροφυσιολογίας - Βηματοδότησης Ερρίκος Ντυνάν Hospital Center

2 Presenter Disclosure Information The presenter has received honoraria for lectures and advisory boards from the following pharmaceutical and biotechnology companies: Amgen AstraZeneca, Bard, Bayer Healthcare, Boehringer Ingelheim, Boston Scientific, Bristol-Myers Squibb, ELPEN, Galenica, Lilly, Medtronic, Menarini, MSD, Pfizer, Sanofi, Servier, StJude, Vianex.

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4 Συστήματα χαρτογράφησης CARTO 3 Electromagnetic mapping (EM) Current based mapping NavX 3D transthoracic electrical field Calculation of X-Y-Z impedance coordinates

5 Rhythmia TM Mapping System Boston Scientific

6 Arctic Front Advance ST 40% Shorter Tip than Arctic Front Advance Designed to: Expand Achieve Mapping Catheter s ability to measure time-to-effect Ease entry into sheath via thermal fusing of distal balloon neck Maintain stability and support to preserve occlusion while Achieve is proximally positioned near balloon tip

7 Kuchynka P., et al. Biomed Res Int. 2015;2015:

8 Lalani G., Trikha R, Krummen D.,Narayan S. Circ J 2014; 78:

9 Gianni C., et al. Heart Rhythm Dec 17. pii: S (15)

10 LSPV LAA LIPV LAA LSPV LIPV (PAF, female 68 yrs, AF ablation 6/7/2011)-G.Andrikopoulos

11 Near-zero x-ray in arrhythmia ablation using a 3- dimensional electroanatomic mapping system: A multicenter experience. 442 pts underwent RFCA First 195 with fluoroscopic guidance Fluoroscopy time = 1159 sec Acute success rate = 97% Procedure time= 87 min Next 297 with electroanatomic mapping (Ensite Velocity) Fluoroscopy time = 14 sec Acute success rate = 96% Procedure time= 91 min Giaccardi M, et al. Heart Rhythm Jan;13(1):150-6.

12 De Ponti et al. World J Cardiol 2015 August 26; 7(8):

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14 Χάρτης δυναμικών με Carto σε ασθενή που έχει υποβληθεί σε cryoablation (PA view)

15 CONCLUSION: The area of the posterior LA wall ablation with the cryoballoon catheter is wide and antral, and the resulting posterior LA wall debulking could be a part of the cryoballoon efficacy beyond discrete PV isolation Kenigsberg D., et al. Heart Rhythm2015;12:

16 Χάρτης δυναμικών με Carto σε ασθενή που έχει υποβληθεί σε cryoablation (LAO view)

17 St Jude Medical - Contact force indicator - NavX

18 Graphic User Interface Parameters The user interface captures all Contact Force information at a glance. Ball Indicator for directionality Total force value Lateral force value Axial force value LSI value Stability Indicator FTI value Force History Window Reset button Reset baseline between ablations Reset FTI / LSI during ablations ID A EN (06/14)

19 1 η Γενιά cryoballoon

20 2 η Γενιά cryoballoon

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22 Arctic Front Advance ST 40% Shorter Tip than Arctic Front Advance Designed to: Expand Achieve Mapping Catheter s ability to measure time-to-effect Ease entry into sheath via thermal fusing of distal balloon neck Maintain stability and support to preserve occlusion while Achieve is proximally positioned near balloon tip

23 Απομόνωση RSPV με Cryoballoon 2 ης vs 3 ης γενιάς 2 nd generation cryoballoon 3 rd generation cryoballoon Αρχείο Γ. Ανδρικόπουλου, 2015

24 Background: Completed occlusion of right inferior pulmonary vein (RIPV) during cryoballoon ablation is often challenging. Purpose: We sought to evaluate the efficacy of cryoballoon ablation in RIPV in comparison to the other veins of the left atrium. Methods: Eighty consecutive patients (56 males, average age 61±12) underwent pulmonary vein isolation using a cryoballoon catheter (Arctic Front, Medtronic, MN, USA). Results: Department of Electrophysiology, Henry Dunant Hospital center, Submitted for publication 2016

25 Europace Advance Access published January 2, 2014

26 Ablation of Cavotricuspid Isthmus-Dependent Flutter Using a Mini-Electrode-Equipped 8-mm Ablation Catheter: Case Series. Tzeis S, Pastromas S, Andrikopoulos G. Hellenic J Cardiol Jan-Feb;57(1):53-8.

27 Circ Arrhythm Electrophysiol. 2014;7: Atrial fibrillation ablation using the nonfluoroscopic catheter visualization technology is safe. Procedure time (135 minutes) is not prolonged. A dramatic reduction in fluoroscopy time and dose was achieved.

28 Remote Navigation Systems A. The Sensei System (Hansen)

29 Remote Navigation Systems B. The NIOBE system (Stereotaxis)

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