Le nuove tecnologie hanno modificato il nostro approccio diagnostico-terapeutico alle aritmie? Antonino De Stefano Cardiologo Ambulatoriale ASL TO1 Torino – ASL TO3 Collegno XXIII Congresso Nazionale ANCE Cervia (RA) 10 – 13 Ottobre 2013 Centro Congressi Hotel Dante

Ablazione transcatetere Ablazione transcatetere Chiusura dell’auricola Chiusura dell’auricola ICD - CRT-P e CRT-D ICD - CRT-P e CRT-D ILR - Implantable Loop Recorder ILR - Implantable Loop Recorder Devices Remote Monitoring Devices Remote Monitoring Genetica molecolare Genetica molecolare

Ablazione transcatetere Ablazione transcatetere Chiusura dell’auricola Chiusura dell’auricola ICD - CRT-P e CRT-D ICD - CRT-P e CRT-D ILR - Implantable Loop Recorder ILR - Implantable Loop Recorder Devices Remote Monitoring Devices Remote Monitoring Genetica molecolare Genetica 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

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

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

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

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

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

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

Ablazione transcatetere Ablazione transcatetere Chiusura dell’auricola Chiusura dell’auricola ICD - CRT-P e CRT-D ICD - CRT-P e CRT-D ILR - Implantable Loop Recorder ILR - Implantable Loop Recorder Devices Remote Monitoring Devices Remote Monitoring Genetica molecolare Genetica molecolare

Ablazione transcatetere Ablazione transcatetere Chiusura dell’auricola Chiusura dell’auricola ICD - CRT-P e CRT-D ICD - CRT-P e CRT-D ILR - Implantable Loop Recorder ILR - Implantable Loop Recorder Devices Remote Monitoring Devices Remote Monitoring Genetica molecolare Genetica molecolare

Ablazione transcatetere Ablazione transcatetere Chiusura dell’auricola Chiusura dell’auricola ICD - CRT-P e CRT-D ICD - CRT-P e CRT-D ILR - Implantable Loop Recorder ILR - Implantable Loop Recorder Devices Remote Monitoring Devices Remote Monitoring Genetica molecolare Genetica molecolare

Ablazione transcatetere Ablazione transcatetere Chiusura dell’auricola Chiusura dell’auricola ICD - CRT-P e CRT-D ICD - CRT-P e CRT-D ILR - Implantable Loop Recorder ILR - Implantable Loop Recorder Devices Remote Monitoring Devices Remote Monitoring Genetica molecolare Genetica molecolare

Ablazione transcatetere Ablazione transcatetere Chiusura dell’auricola Chiusura dell’auricola ICD - CRT-P e CRT-D ICD - CRT-P e CRT-D ILR - Implantable Loop Recorder ILR - Implantable Loop Recorder Devices Remote Monitoring Devices Remote Monitoring Genetica molecolare Genetica molecolare

New Method for Heart Studies Continuous electrocardiography of active subjects over long periods is now practical Norman J. HolterNorman J. Holter (Helena, 1 febbraio 1914 – 21 luglio 1983) fisicoHelena1 febbraio luglio1983fisico 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 pp