Le nuove tecnologie Le nuove tecnologie hanno modificato il nostro approcciohanno modificato il nostro approcciodiagnostico-terapeutico alle aritmie?diagnostico-terapeutico alle aritmie?

Antonino De StefanoAntonino De Stefano

Cardiologo Ambulatoriale Cardiologo Ambulatoriale ASL TO1 Torino – ASL TO3 Collegno ASL TO1 Torino – ASL TO3 Collegno

XXIII Congresso Nazionale ANCEXXIII Congresso Nazionale ANCE

CerviaCervia (RA) 10 – 13 Ottobre (RA) 10 – 13 Ottobre 2013 2013

Centro Congressi Hotel Dante Centro Congressi Hotel Dante

• Ablazione transcatetereAblazione transcatetere• Chiusura dell’auricolaChiusura dell’auricola• ICD - CRT-P e CRT-DICD - CRT-P e CRT-D• ILR - Implantable Loop RecorderILR - Implantable Loop Recorder• Devices Remote MonitoringDevices Remote Monitoring• Genetica molecolareGenetica molecolare

• Ablazione transcatetereAblazione transcatetere• Chiusura dell’auricolaChiusura dell’auricola• ICD - CRT-P e CRT-DICD - CRT-P e CRT-D• ILR - Implantable Loop RecorderILR - Implantable Loop Recorder• Devices Remote MonitoringDevices Remote Monitoring• Genetica molecolareGenetica molecolare

Figure 2 Anatomic distribution of atrial tachycardias (A) Common anatomic distribution of focal atrial tachycardias showing rough percentage distribution recorded in our laboratory; the atrioventricular annuli have been removed. (B) Common anatomic distri...

Geoffrey Lee , Prashanthan Sanders , Jonathan M Kalman

Catheter ablation of atrial arrhythmias: state of the art

The Lancet Volume 380, Issue 9852 2012 1509 - 1519

http://dx.doi.org/10.1016/S0140-6736(12)61463-9

Figure 3 Three-dimensional electroanatomical mapping of focal atrial tachycardias Focal site of early activation (red) is shown, with radial propagation away from that central site. The activation map was superimposed onto the patient's cardiac CT scan..

Geoffrey Lee , Prashanthan Sanders , Jonathan M Kalman

Catheter ablation of atrial arrhythmias: state of the art

The Lancet Volume 380, Issue 9852 2012 1509 - 1519

Figure 4 Right atrial flutter circuits Anatomical circuits of typical atrial flutter (A) and lower loop re-entry (B). The atrioventricular annuli that sit anteriorly (in front) have been removed for clarity. Red arrows represent the activation path for ea...

Geoffrey Lee , Prashanthan Sanders , Jonathan M Kalman

Catheter ablation of atrial arrhythmias: state of the art

The Lancet Volume 380, Issue 9852 2012 1509 - 1519

http://dx.doi.org/10.1016/S0140-6736(12)61463-9

Figure 5 Atypical flutter circuits Red arrows represent the activation path for each circuit. Yellow arrows represent passive activation wavefronts. Grey areas represent areas of spontaneous electrical scar on the posterior left atrial wall. Perimitral fl...

Geoffrey Lee , Prashanthan Sanders , Jonathan M Kalman

Catheter ablation of atrial arrhythmias: state of the art

The Lancet Volume 380, Issue 9852 2012 1509 - 1519

http://dx.doi.org/10.1016/S0140-6736(12)61463-9

Figure 6 Three-dimensional (3D) mapping and ablation of atypical flutter circuits 3D electroanatomical map of an atypical flutter circuit, termed dual-loop left atrial flutter (A), and an atypical flutter in a patient who has had previous surgical repair ...Geoffrey Lee , Prashanthan Sanders , Jonathan M Kalman

Catheter ablation of atrial arrhythmias: state of the art

The Lancet Volume 380, Issue 9852 2012 1509 - 1519

Figure 8 Ablation of paroxysmal atrial fibrillation (A) Three-dimensional (3D) mapping system images from a paroxysmal atrial fibrillation ablation procedure. A cardiac CT scan is done before the procedure and the 3D left atrial image is imported...

Geoffrey Lee , Prashanthan Sanders , Jonathan M Kalman

Catheter ablation of atrial arrhythmias: state of the art

The Lancet Volume 380, Issue 9852 2012 1509 - 1519

Figure 4 Mapping and ablation of ventricular tachycardia with electroanatomic and intracardiac echocardiographical imaging Images obtained during substrate mapping of the left ventricle in a patient with ventricular tachycardia caused by an old inferior .

Roy M John , Usha B Tedrow , Bruce A Koplan , Christine M Albert , Laurence M Epstein , Michael O Sweeney , Amy Le...

Ventricular arrhythmias and sudden cardiac death

The Lancet Volume 380, Issue 9852 2012 1520 - 1529

• Ablazione transcatetereAblazione transcatetere• Chiusura dell’auricolaChiusura dell’auricola• ICD - CRT-P e CRT-DICD - CRT-P e CRT-D• ILR - Implantable Loop RecorderILR - Implantable Loop Recorder• Devices Remote MonitoringDevices Remote Monitoring• Genetica molecolareGenetica molecolare

• Ablazione transcatetereAblazione transcatetere• Chiusura dell’auricolaChiusura dell’auricola• ICD - CRT-P e CRT-DICD - CRT-P e CRT-D• ILR - Implantable Loop RecorderILR - Implantable Loop Recorder• Devices Remote MonitoringDevices Remote Monitoring• Genetica molecolareGenetica molecolare

• Ablazione transcatetereAblazione transcatetere• Chiusura dell’auricolaChiusura dell’auricola• ICD - CRT-P e CRT-DICD - CRT-P e CRT-D• ILR - Implantable Loop RecorderILR - Implantable Loop Recorder• Devices Remote MonitoringDevices Remote Monitoring• Genetica molecolareGenetica molecolare

• Ablazione transcatetereAblazione transcatetere• Chiusura dell’auricolaChiusura dell’auricola• ICD - CRT-P e CRT-DICD - CRT-P e CRT-D• ILR - Implantable Loop RecorderILR - Implantable Loop Recorder• Devices Remote MonitoringDevices Remote Monitoring• Genetica molecolareGenetica molecolare

• Ablazione transcatetereAblazione transcatetere• Chiusura dell’auricolaChiusura dell’auricola• ICD - CRT-P e CRT-DICD - CRT-P e CRT-D• ILR - Implantable Loop RecorderILR - Implantable Loop Recorder• Devices Remote MonitoringDevices Remote Monitoring• Genetica molecolareGenetica molecolare

New Method for Heart Studies Continuous electrocardiography of active subjects

over long periods is now practical

Norman J. Holter (Helena, 1 febbraio 1914 – 21 luglio 1983) fisico

The Holter Research Foundation, Helena, Montana Abstract

I have proposed that orthodox electrocardiography be implemented, both for research and medical purposes, by the use of long-period, continuous recording of heart potentials with a portable, self-contained instrument—the electrocardiocorder together with semiautomatic methods for the rapid analysis of the resulting voluminous data. An electronic system to make this concept practical has

been developed in our laboratory and typical results are described in this article.

Science 20 October 1961: Vol. 134 no. 3486 pp. 1214-1220