Cardiac Arrhythmias 2003: Proceedings of the 8th International Workshop on Cardiac Arrhythmias

883 Pages·2004·21.73 MB·English

by  F. Lombardi

Cardiac Arrhythmias 2003
Springer-Verlag Italia Sr!.
Cardiac Arrhythmias 2003
Edited by
Antonio Raviele
Proeeedings of the
8th International Workshop
on Cardiae Arrhythmias
(Venice, 5-8 Qetober 2003)
, Springer
ANTONIO RAVIELE, MD
Divisione di Cardiologia
Ospedale Umberto 1
Via Circonvallazione 50
1-30174 Venezia Mestre
© Springer-Verlag Italia 2004
Originally published by Springer-Verlag Italia. Milan in 2004
Softcover reprint ofthe hardcover 1st edition 2004
ISBN 978-88-470-2177-8 ISBN 978-88-470-2137-2 (eBook)
DOI 10.1007/978-88-470-2137-2
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Preface
The field of cardiac arrhythmias has been evolving so fast during the last years
that scientific meetings are frequently necessary to present technological
advances, to communicate results of relevant and innovative researches, to
assess the impact of recently developed diagnostic and therapeutical tools, to
discuss controversial aspects, and to reach a consensus on the most appropriate
evaluation and management of specific problems. This is the main reason why
in 1988 we started to organize a biannual International Workshop on Cardiac
Arrhythmias. Since then many editions of the workshop have taken place and
over the years the fame and popularity of the event have increased continuously.
This book contains the Proceedings of the Eighth Edition of the Workshop
held in Venice at the Fondazione Giorgio Cini from the 5th to the 8th of October
2003. During the meeting all the principal aspects of the different arrhythmias,
from epidemiology to physiopathology, electrogenetic mechanisms, diagnosis,
prognosis, treatment, pshycological implications and economic costs have been
discussed among the numerous experts and participants.
The book is divided in thirteen sections, each dedicated to a different topic:
atrial fibrillation: clinical aspects and cardioversion; medical treatment of atri
al fibrillation: rhythm control and rate control; atrial fibrillation: electrical
therapy, transcatheter and surgical ablation; atrial fibrillation: prevention of
thromboembolic complications; supraventricular tachyarrhythmias: diagnosis
and treatment; ventricular arrhythmias and sudden death; implantable car
dioverter defibrillator: practical aspects, indications and cost-effectiveness;
out-of-hospitals cardiac arrest and public access defibrillation; syncope: cur
rent evaluation and management; sick sinus syndrome: clinical aspects and
pacing issues; hemodynamics and cardiac pacing; cardiac resynchronization
therapy: mechanisms, technical and clinical aspects; pacemaker/ICD complica
tions: detection and management.
In my opinion, the book represents a comprehensive and modern overview
of all pertinent aspects of cardiac arrhythmias and should be of interest not
only to electrophysiologists and experts of the sector but also to general cardi
ologists, internists and medical students. I hope it will contribute to a better
diffusion of current knowledge on cardiac arrhythmias and motivate research
es in this field.
VI Preface
Many recognized authors have contributed to this volume. I am deeply
indebted to all of them. Without their dedicated efforts and talents this book
would not have been completed. I also wish to express my appreciation to
Springer-Verlag and its staff, in particular Donatella Rizza, Executive Editor, for
the great professionalism and meticulous attention to all the details of the ed
itorial process. I am especially grateful to Rita Reggiani, Project Manager of
Adria Congrex, for the exceptional skill and enthusiasm in preparing the work
shop. Moreover, I would like to thank my colleagues at Umberto I Hospital, Drs.
De Piccoli, Di Pede, Bonso, Gasparini, Giada, Themistoclakis, Zuin, Rigo for
their support in the organization of the meeting and their scientific collabora
tion over the years.
Also the personal involvement and help of Gloria Leandro, Susanna
Orbolato, Stefani a Damiani and other members of the secretarial and nurse
staff at my institution is sincerely appreciated. A special word of gratitude to
my mentor, professor Piccolo, whose example and advices continue to represent
an inestimable guidance and stimulus. Finally, my sincere thanks to my wife
Carmen and my children, Francesca and Michele. Their continuous encourage
ment, assistance and patience helped me during the long hours of preparing
the meeting and editing the book.
Antonio Raviele
Table of Contents
ATRIAL FIBRILLATION: CLINICAL ASPECTS AND CARDIOVERSION
Sympathetic and Vagal Fibrillation: Do They Exist?
F. Lombardi, F. Tundo, F. Colombo, S. Belletti, D. Tarricone 3
"Lone" Atrial Fibrillation in Athletes: A Consequence Of Long-Term Intensive
Sport Practice
F. Naccarella, F. Furlanello , A. Bertoldi, S. Sdringola Maranga, G. Lepera,
R. Cappato . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Predicting Atrial Fibrillation in Patients with Hypertension: Can We Do It?
R.G. Tieleman, H.J.G.M. Crijns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
What is the impact of Atrial Fibrillation on the Clinical Course of
Hypertrophic Cardiomyopathy?
F. Cecchi, I. Olivotto ..... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Atrial Fibrillation in Heart Failure: Prognostic Significance and Management
G.v. Naccarelli, B.J. Hynes, D. Wolbrette, M. Khan, L. Bhatta, S. Samii,
J.Luck .......................................................... 37
Atrial Fibrillation After Cardiac Surgery: What's All the Fuss About?
D.G. Wyse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
"Pill in the Pocket": How Effective and Safe Is this Strategy for Treatment
of Recurrences of Atrial Fibrillation?
A. Capucci, G.Q. Villani, G. Rusticali, M.F. Piepoli ..................... 51
Cardioversion of Recent Onset Atrial Fibrillation: Which Drug to Prefer in the
Individual Patient?
P.E. Vardas, E.M. Kanoupakis ...................................... 57
VIII Table of Contents
Pretreatment with Antiarrhythmic Drugs: Is It Useful to Avoid Immediate
and Early Postcardioversion Recurrences?
G. L. Botto, M. Luzi, A. Sagone ...................................... 65
Is Echocardiography Useful to Predict Successful Cardioversion of Atrial
Fibrillation and Long-Term Maintenance of Sinus Rhythm?
B. De Piccoli ..................................................... 71
Does the Policy of Repeated Early Cardioversion for Recurrences of Atrial
Fibrillation Work?
E. Bertaglia ...................................................... 79
MEDICAL TREATMENT OF ATRIAL FIBRILLATION:
RHYTHM CONTROL AND RATE CONTROL
Which Is the Ideal Drug for Chronic Prophylaxis of Atrial Fibrillation?
G. Boriani, M. Biffi, I. Diemberger, C. Martignani, C. Camanini, C. Valzania,
G.Domenichini, I. Corazza, A. Branzi ................................ 85
ACE Inhibitors and Angiotensin Receptor Blockers: a New Effective
Non-Conventional Approach to Prevent Atrial Fibrillation
A.H. Madrid, C. Escobar, J.M.G. Rebollo, I. Marin, E. Bernal, L Limon,
S.Nannini, J. Peng, C. Moro ........................................ 93
Rate Control of Atrial Fibrillation: By How Much Should the Ventricular
Rate be Lowered?
P. Alboni, L. Gianfranchi, G. Fuca, F. Pacchioni, G. Corbucci ............. 99
Ablate and Pace: Is This Still a Valid Option?
M.Brignole ...................................................... 107
Transvascular Parasympathetic Stimulation for Ventricular Rate Control
During Atrial Fibrillation: A Bionic Approach
P. Schauerte, M. Schmidt, T. Schimpf, J. Plisiene, M. Zarse, K. Mischke '" 117
Management of Atrial Fibrillation: Is it Already Time to Update the Recent
ACC/ AHA/ESC Guidelines?
D.G. Wyse ....................................................... 127
ATRIAL FIBRILLATION: ELECTRICAL THERAPY, TRANSCATHETER
AND SURGICAL ABLATION
Atrial Fibrillation Suppression: What Role Does It Have?
A. Schuchert ..................................................... 137
Table of Contents IX
Dual-chamber ICDs: How Effective and Safe Are They in the Treatment
of Atrial Tachyarrhythmias?
J. Kautzner, P. Peichl .............................................. 141
Ablation of Atrial Fibrillation: Are We Still "Learning While Burning"?
J.A. Salerno-Uriarte, R. De Ponti, M. Tritto, M.E. Lanzotti, R. Marazzi,
G. Spadacini, P. Moretti ........................................... 149
Ablation of Atrial Fibrillation: Is a Cure at Hand?
B. K. Lee, M. M. Scheinman . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159
Atrial Fibrillation: Anatomical Guidance Is Superior to Electrophysiological
Guidance for Ablation
C. Pappone, V. Santinelli ........................................... 167
Atrial Fibrillation: Catheter Laser Balloon Ablation
A. Bonso, S. Themistoclakis, A. Rossillo, A. Raviele .................... 173
Isolation of Pulmonary Veins Using Cryothermal Technologies
A. C. Skanes, A. D. Krahn, R. Yee, G. J. Klein ........................... 177
Ablation of Atrial Fibrillation by Radiofrequency:
Circular Energy Delivery
T. Lewalter, H. Bielik, J. Schrickel, A. Bitzen, J.O. Schwab, A. Yang,
B. Liideritz ...................................................... 189
Catheter Ablation of Atrial Fibrillation: What Are the Risks and
Complications and How Do We Avoid Them?
s. Themistoclakis, A. Bonso, A. Rossillo, A. Raviele .................... 195
Risk Stratification and Prevention of Thromboembolism: What Is the
Role of Intracardiac Echocardiography?
A. Rossillo, N.F. Marrouche, E.B. Saad, o. Wasni, M. Bhargava, D. Bash,
S. Beheiry, M. Wexman, B. Strunk, E. Pisano, R. Fanelli, A. Bonso,
S. Themistoclakis, D. Erciyes, W.I. Saliba, R.A. Schweikert, J. Brachmann,
A.Raviele,A.Natale ............................................... 205
Radiofrequency and Microwave Ablation of Atrial Fibrillation During
Open Heart Surgery: What Are the Long-Term Results?
A. Venturini, V. Cutaia, A. Asta, D. Mangino, R. Moretti, E. Polesel,
A. Terrini, C. Zussa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215
Minimally Invasive Surgical Approach to Radiofrequency Ablation of Atrial
Fibrillation: Is the Game Worth the Candle?
c. Piorkowski, G. Hindricks, H. Kottkamp . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221
x
Table of Contents
ATRIAL FIBRILLATION: PREVENTION OF THROMBOEMBOLIC
COMPLICATIONS
What Is the Best Practical Scheme for Initiating Oral Anticoagulant
Treatment in Outpatients with Atrial Fibrillation?
R. Cazzin, P. Serra, C. Fusilli ....................................... 231
How Intense Should Anticoagulation Be at the Time of Cardioversion
to Reduce the Risk of Thromboembolism?
N. Baldi, v'A. Russo, V, Morrone, L. Di Gregorio, L. Liconso, G. Polimeni .. 235
Warfarin Underuse for Nonvalvular Atrial Fibrillation: How to
Adjust Our Aims?
G. Di Pasquale, E. Cere, A. Lombardi, B. Sassone, S. Biancoli, R. Vandelli .. 241
SUPRAVENTRICULAR TACHYARRHYTHMIAS: DIAGNOSIS AND TREATMENT
Palpitations of Unknown Origin: How Frequent Are Supraventricular
Arrhythmias?
F. Giada, A. Raviele . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251
Acute Termination of Atrial Flutter: Class III Drugs or Transesophageal
Pacing?
A. Bonso, S. Themistoclakis, A. Rossillo, A. Raviele .................... 257
Atrial Flutter Induced by Class IC Drugs/Amiodarone: What Are the
Long-term Results of Cavo-tricuspidal Isthmus Ablation?
P. Delise, N. Sitta, L. Coro, L. Sciarra, E. Marras ........................ 263
Non-Isthmus-Dependent Atrial Flutter: How to Locate and Ablate
the Re-entry Circuit
I. Mangat, M. M. Scheinman ....................................... 271
Complex Supraventricular Tachycardia Ablation: What Is the Role
of Alternative Technology?
M. Tritto, R. De Ponti, G. Spadacini, M. Lanzotti, P. Moretti, B. Molinari,
R.Marazzi,J.A.Salerno-Uriarte .................................... 285
Late Atrial Tachyarrhythmias After Repair of Congenital Heart Disease
What is the Mechanism and How Can They Be Localized and Ablated?
R. Mantovan ..................................................... 293
Late Atrial Arrhythmias as a Complication After Valvular Heart Surgery:
Is There A Place for Prevention?
D. Mangino,A.Asta,A. Venturini, E. Polesel, R. Moretti,A. Terrini, C. Zussa . . 301