Επιλογή ασθενών και παρακολούθηση τους Βασίλειος Π. Βασιλικός Καθηγητής Καρδιολογίας Διευθυντής Γ Καρδιολογικής Κλινικής ΑΠΘ
Cardiac Diagnostics Landscape 24-Hour Holter Event Recorder 14-30 Day MCOT Insertable Cardiac Monitor 2.5 Million 1.5 Million 250,000 25,000
Confirmation of success (33 centers)
7-day, Holter
7-day, Holter
Continuous monitoring vs snapshots Ιmplanted pacemaker device (Medtronic AT500)
Hindricks et al. Circ Arrhyth Electrophysiol 2010
Catheter ablation achieved a substantial reduction in AF/AFL/AT burden Verma et al, JAMA 2013
The percentage of asymptomatic AF/AFL/AT in patients before and after ablation Verma et al, JAMA 2013
The percentage of asymptomatic AF/AFL/AT in patients before and after ablation 12% patients have only asymptomatic episodes Verma et al, JAMA 2013
42% 58%
UNMASKING Study: Definitions Sudden AF Onset: AF No triggers preceding AF Triggered AF Onset: AF PAC* trigger preceding AF *Premature Atrial Contraction 18
Incidence of late AF recurrences in patients with (group 3, group 4) and without (group 1) early recurrences.
Summary 1. Early post-ablation success = long-term success 2. For patients with AF recurrences, Reveal XT diagnostic data can be used to identify those patients who will likely benefit from an early second ablation. 3. In the UNMASKING study population, the re-ablation strategy employed directly lead to better patient outcomes than just using standard-of-care strategies. 20
The trend of the monthly AF % in patients within each group
Incidence of atrial fibrillation (AF) recurrences by intention-to-treat at the 36-month follow-up examination
A Revolutionary System The Complete Monitoring Solution Improved CareLink User Interface Wireless Reveal LINQ ICM MyCareLink Patient Monitor Cellular Simplified Insertion Procedure Patient Assistant Mobile Alerts Streamlined Reports All patient and clinical data are fictitious and for demonstration purposes only
87% Smaller* than Reveal XT ICM Linear dimensions rounded to the nearest mm Volume rounded to the nearest tenth of a cc *Compared to Reveal XT ICM
87% Smaller* with Enhanced Capabilities The Smallest, Most Powerful Insertable Cardiac Monitor 20% more data memory* Improved AF-detection algorithm 3-year longevity for long-term monitoring 6 MR-Conditional at 1.5 and 3.0 Tesla *Compared to Reveal XT ICM Reveal LINQ ICM has been demonstrated to pose no known hazards in a specified MR environment with specified conditions of use. Please see Reveal LINQ ICM clinician manual for more details.
Συµπεράσµατα
Συµπεράσµατα Ιδιαίτερη πρόοδος στη διαγνωση ασυµπτωµατικών αρρυθµιών
Συµπεράσµατα Ιδιαίτερη πρόοδος στη διαγνωση ασυµπτωµατικών αρρυθµιών Ασθενείς υψηλού κινδύνου για υποτροπή αρρυθµίας
Συµπεράσµατα Ιδιαίτερη πρόοδος στη διαγνωση ασυµπτωµατικών αρρυθµιών Ασθενείς υψηλού κινδύνου για υποτροπή αρρυθµίας Υψηλού κινδύνου ασθενείς για διακοπή αντιπηκτικής αγωγής
Συµπεράσµατα Ιδιαίτερη πρόοδος στη διαγνωση ασυµπτωµατικών αρρυθµιών Ασθενείς υψηλού κινδύνου για υποτροπή αρρυθµίας Υψηλού κινδύνου ασθενείς για διακοπή αντιπηκτικής αγωγής Ασθενείς σε αποµακρυσµένες περιοχές
Older age Female sex Prior AF hospitalizations Recent hospital procedure experience