I PD-I-3 VA ICD 2006 NYHA ~ LVEF 35% a ICD SCD-HeFT ICD MADIT- ICD a CABG-Patch ICD EF b MADITø MADIT- MUSTT EPS EPS 19 EPS 5/19 VA PD-I-4 Holter LP f
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1 J Arrhythmia Vol 23 (Suppl) 2007 PD-I-1 OACIS 95% 6.4 ( ( ), 0.2 ( ), respectively MADIT LVEF 30% % % MADIT 12.1% p=.001), ICD direct PCI OACIS (Osaka Acute Coronary Insufficiency Study % EF, n= % CCR (n= vs. 77.8, ml/min, p=.009 ICD 54.7% % % % CCR<30`ml/min PD-I-2 HIJ HIJgroup MADIT-II SCD- HeFT 1 HIJ 1999 ~ EF) 53% EF40% % % 18% 10% 7% 50% MADIT-II % 4% ICD NNT HIJ 2001~ EF42% CAD) 613 DCM) EF35% % %NSVT % % 35% 2% 40% 7% EF35% 23% 9% EF35% CAD, DCM, NSVT Propensity-Score EF35% 1.5 SCD-HeFT % 11% ICD 23.7%, NNT15.6 SCD-HeFt ICD MADIT-II ICD ICD EF35% DCM, CAD 118
2 I PD-I-3 VA ICD 2006 NYHA ~ LVEF 35% a ICD SCD-HeFT ICD MADIT- ICD a CABG-Patch ICD EF b MADITø MADIT- MUSTT EPS EPS 19 EPS 5/19 VA PD-I-4 Holter LP fluctuation, T wave variability, QT dispersion Brugada LP LP LP fluctuation: LPF Signal-averaged ECG LP, T wave alternans (TWA), QT dispersion (QTD LPF T wave variability (TWV), QTD 59 NYHA % VT (NSVT 52 83% ALPF, BTWV, CQTD Ela Medical ALP QRS F-QRS, RMS40, LAS40 LPF- BTWV 10`mV CQTD 12 V1 V6 QT QTD 5% 15% NSVT LPF 34% vs 13%, TWV 100% vs 25% QTD: 110`ms vs 90`ms LP F-QRS, RMS40, LAS40 19%, 24%, 16% RMS40 RMS40 LPF 16% vs 13% TWV 38% vs 25% QTD: 100`ms vs 90`ms TWV LPF, TWV, QTD 119
3 J Arrhythmia Vol 23 (Suppl) 2007 PD-I-5 MADIT-, SCD-HeFT NSVT EPS ICD ICD ICD ICD ICD NSVT, EPS MADIT- MADIT NNT (number needed to treat MADIT- PD-I-6 $80,000 ICD EPS TWA SAE EPS ABCD EPS EPS ICD NSVT EPS, SAE 154 NSVT 35 ICD SCD ACC/AHA/ESC SCD SCD LVEF SCD LVEF MI SCD LVEF MADIT MI LVEF SCD microvolt T- wave alternans (M-TWA M- TWA SCD ABCD SCD M-TWA a SCD LVEF M-TWA 120
4 J Arrhythmia Vol 23 (Suppl) 2007 PD-II (Vf) (BrS) n=15, Vf Vf BrS n=17 BrECGn=14 ST type 1 ECG BrS 73% BrS 40% BrECG 16% (p 0.05) BrS 3 ST V1 BrS mm BrS mm, BrECG mm (p 0.05) BrS 38% Vf ICD BrS SCN5A BrS 1 exons 21 3 mrna RT-PCR SCN5A SCN5A SCN5A B BrS BrS Vf type1 ECG SCN5A B PD-II-2 Brugada HV 2 RVOT RVOT QRS (S-QRS) ERP (1 Mean Delay (MD) 400 ms ERP S- QRS (2 Mean Increase Delay (MID) 400 ms ERP S-QRS S-QRS 400 ms S-QRS MD CA+S AS C 52 8 ms ms 28 4 ms CA+S AS C MID , CA+S AS C EPS SAECG Brugada (Br) RVOT Br (CA) 7 (S) 11 (AS) Br ARVC RfQRSd RfQRSd cut-off 40Hz (RfQRSd:40) 100Hz RfQRSd:100 ARVC RfQRSd:40 RfQRSd:100 filtered QRS duration fqrsd ( vs ms Br SAECG V2 V5 filtered QRS duration (RfQRSd, LfQRSd) RfQRS-LfQRSd CA 2 (29 10, 14 11, 7 5 ms RfQRSd RfQRSd:40 RfQRSd:100 ( vs ms, p RfQRSd S-QRS 122
5 II PD-II-3 Brugada QRS Brugada (Heart Rhythm 2006;3: Brugada Brugada Brugada 10 Brugada 10 Z QRS (WTECG) (20, 50, 80, 100, 150Hz) TECG Brugada 10-50Hz (80-150Hz) Brugada QRS (80-150Hz) 80Hz (P80) Brugada P WTECG Brugada QRS Brugada Na PD-II-4 Brugada Brugada SCN5A 20 Brugada V1 V3 coved ST ST full stomach test V1 V3 coved ST T full stomach test ICD I 123
6 J Arrhythmia Vol 23 (Suppl) 2007 PD-II-5 Brugada ST-RR QT-RR Brugada ST QT Brugada ST-RR QT-RR Holter Brugada 35 VF V2,V5 Holter (SCM6000, Fukuda) 1 V2 J 40msec ST (mm) V5 QT 15 RR ST/RR QT/RR 6 2 VF 1 1 ST/RR-slope (mm/sec) 18 24:00 0 6:00 ( vs , p 0.05) ST/RR-slope 2 ST/RR-slope ( vs , p 0.05) ( vs , p 0.01) 3 QT/RR-slope QT-RR 4 VF , 6-12, 12-18, ,2,2,19 (59%) Brugada RR QT ST/RR 18:00 RR ST VF PD-II-6 Brugada Br-ECG 2002 V1-3 J 2mm ST coved (Type 1) saddle-back Type 2 VF Br-ECG 14 (2.87%) Type %) Type %) Type % 3 12 VF Type VF Brugada (Br-ECG) 0.05% 0.28% Brugada (BS) (SSS) SCN5A SSS Br-ECG Br-ECG (VF) SSS Type 1 Br- ECG VF SSS Br-ECG (Type 1) 0.82% SSS Type 1 Br- ECG VF ICD BS SSS % ECG 124
7 II PD-II-7 Restitution Kinetics VF phase 1 notch phase 2 reentry (Ito) Na (INa,slow) (IKr) (5mg/kg+10mg/min) (0.01mg/kg) RVOT ERP MAPD slope max RVOT MAPD ms ms (p 0.01) RVOT MAPD ms ms (p 0.03) 600 ms 400 ms RVOT VF RVOT MAPD ms ms p 0.01) RVOT MAPD slope max VF VF RVOT ERP RVOT MAPD RVOT MAPD restitution curve slope max Ito PD-II-8 Brugada dome loss of dome APD phase 2 reentry VF PVC PVC VF Brugada Brugada 1. Brugada Brugada N ST VF 2. Brugada VF/ VF/ 10.7%/ICD VF/ 0.7%/ 0.4%/ Type 1 / K + (I to ) K + (HR=5.45 (I K ) (I Ca-L fast I Na ) AP 1 notch dome (loss of dome)- P=0.03) / + Type %/ / ST 256 AP 125
8 III PD-III PT-INR PT-INR PT-INR PT-INR (p 0.05) PT-INR (p 0.01) PD-III-2 D D-dimer ( g/ml) Low risk D-dimer 1 2 -PI 70% 16 (7 ) 2 -PI INR PT-INR D- dimer 2 - PI PT- INR D-dimer 2 - ( 2 -PI) high risk 275 D-dimer 2 -PI PT-INR Low risk 109 high risk 166 D-dimer INR High risk (45%) 127
9 J Arrhythmia Vol 23 (Suppl) 2007 PD-III-3 (NVAF) NVAF (A, N=58) (B, N=68) 75 (C N=24) A 2.1% 1 B 2.0% mg/ 2.2% (INR; ) 1.5% C 3.9% 8.4% 1 C B B A (P 0.05) 0.9% 0.5% NVAF 60 2 PD-III-4 (NVAF) (TEE) NVAF 12 NVAF 1288 TEE 297 (stroke/tia SMA ) D-dimer 15mm Maze 5 1 PV isolation D-dimer , % 2.7% 31 Maze3 2 PV isolation 1 TEE stroke Cox D-dimer TEE NVAF 128
10 III PD-III PT-INR 1.5 K INR K _ 500 1,
11 IV PD-IV-1 QRS QRS 180ms 180ms 32 DDD VVI 86 QRS QRS QRS vs ms, p V/0.5ms, mV QRS ms ms p QRS ms p QRS QRS PD-IV-2 (RVSP) (RVAP) 41 RVSP15 ICD RVSP (AVB) 89 (SSS) 125 (PAF) SSS 70% SSS RVSP ms RVAP ms RVSP AVB QRS RVSP 148ms RVAP 176ms RVSP (p=0.01) RVSP dislodge R RVSP ICD dislodge ICD 15-25J SSS PAF RVSP AVB SSS 131
12 J Arrhythmia Vol 23 (Suppl) 2007 PD-IV-3 (RVA) dyssynchrony VVI blood pressure oscillation: BPO RVS RVA RVS VVI RVA RVS Dual chamber RVA 9 RVS 8 DDD VVI, Cardiac index (CI) (TPRI) (BRS) Task force Monitor VVI BPO Paced QRS duration RVA DDD VVI VVI RVS RVA CI TPRI RVA DDD RVS VVI VVI RVA RVS RVS RVS VVI BPO RVS RVS PD-IV-4 RVA RVOS 40 RVOS 20 RVA 20 septal-to-posterior wall motion delay (SPWMD) QRS BNP QRS RVOS RVOS msec vs. RVA msec p SPWMD RVOS RVOT msec vs. RVA msec p BNP RVOS (RVOT pre pg/ml post 99 60pg/ml RVA pre pg/ml post pg/ml) RVOS RVA QRS SPWMD 132
13 IV PD-IV-5 SPECT (RVAP) SPECT (cardiograf ) RVAP 40 RVAP P EF % QRS msec 24 PD-IV-6 50 N EF % QRS msec SPECT cardiograf cardiograf AHA segmentation 17 peak-filling rate (PFR) Dyssynchrony Index (DI)= 17 R 100/RR P N DI ( vs , p=0.32) P global PFR N ( vs , p=0.01) PFR global PFR , vs , p=0.02, 0.04) RVAP QRS 133
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