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S31-3 Atrial Remodeling in Heart Failure
Symposia Symposium 31. Arrhythmia 2: Atrial Fibrillation in Heart Failure S31-1 Blockade of Aldosterone Receptors Prevents Atrial Structural and Electrical Remodeling in Rats with Hypertension by Chronic Nitric Oxide Inhibition Tetsuo Minamino. Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan Recent clinical studies suggest that the activation of rennin-angiotensin systems plays an important role in the development of atrial remodeling. However, it has not determined the role of aldosterone in this condition. Thus, we developed hypertensive heart failure in rats by the chronic inhibition of NO synthesis and investigated the role of the aldosterone in atrial remodeling. Ten-week-old male Wistar-Kyoto rats were randomly divided into 3 groups: the control, the L-NAME (an inhibitor of NO synthase), the L-NAME+eplerenone (a blocker of aldosterone receptor). The chronic inhibition of NO synthesis increased systolic blood pressure and decreased LV dp/dt max/LVSP. The extent of fibrosis was increased in atrium and ventricle, both of which were attenuated by eplerenone without affecting blood pressure. Eplerenone attenuated the increase in the expression of molecules associated with fibrosis such as collagen and matrix metalloproteinase in atrial tissues. Furthermore, the sustained duration of AF induced by transesophageal burst pacing was prolonged by L-NAME, which was prevented by eplerenone. Blockade of aldosterone receptors prevents cardiac dysfunction and atrial electrical and morphological remodeling in rat hypertensive failing hearts. S31-2 Ablation Therapy of Atrial Fibrillation in Heart Failure Koichiro Kumagai. International University of Health and Welfare, Japan Congestive heart failure and atrial fibrillation (AF) often coexist, and each adversely affects the other with respect to management and prognosis. Evidence from the AFFIRM investigators highlights the potential benefit of maintaining sinus rhythm if it could be achieved without the adverse effects of antiarrhythmic drugs. Catheter ablation for AF has been established as an effective therapeutic option for AF that is resistant to pharmacologic rhythm or rate control, with successful long-term maintenance of sinus rhythm in the absence of treatment with antiarrhythmic drugs reported in the majority of patients. Though the results of catheter ablation have been improving, with the success rate reported as more than 80% for paroxysmal AF, ablation of chronic AF has been more difficult and has required more extensive ablation. The results can be expected to improve with a better understanding of the substrate maintaining AF and with the development of more effective techniques. Curative ablation of AF offers the unique opportunity to maintain sinus rhythm without antiarrhythmic drugs, which can have deleterious effects. Several studies have demonstrated that restoration and maintenance of sinus rhythm by catheter ablation without the use of drugs in patients with heart failure and AF improve cardiac function, symptoms, exercise capacity, and quality of life. S31-3 Atrial Remodeling in Heart Failure Shin-Ann Chen. Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan Abstract not available at time of printing.
S43 S31-4 Initial Study on the Characterization of Atrial Fibrillation in Epicardial Mappingal Research Zuxiang Fang. Fudan University, Shanghai, China Atrial fibrillation is a very complex cardiac electrophysiology phenomenon. While AF, atrium are in the chaos state, every local atrial muscle depolarization is in the quickly irregular and asynchronization situation, either by anatomical or functional cause. From the view of fundamental research or surgical cure we need find out the rapid excite focus and their propagation path even astable. We designed a flexible electrodes patch consist of 64 electrodes array in matrix arrangement, which can acquire epicardium ECG in their site respectively, then amplify each ch annel signal, through ADC feed its into computer. By the statistic analysis algorithm and plot software developed by ourselves, four kind of maps would display one the screen. They are waviness plot, isochrome plot, statistical exciting frequency plot and propagation pathway statistic plot. Especially the waviness plot could show the actually depolarization wave propagation manner in movie and the last one could show the direction of wavefront everywhere covered by electrode. We think it would useful for operation and help understand the basic theory. Symposium 32. Arrhythmia 3: ICD/CRT-D S32-1 ICD/CRT-D Therapy in Asia Jiunn-Lee Lin. National Taiwan University, Taipei, Taiwan ROC Despite the time lag in technology development and clinical trial confirmation, the implementation of implantable cardioverter-defibrillator (ICD) and additional cardiac resynchronization therapy (CRT-D) for hemodynamic-collapsing ventricular tachyarrhythmia (VT/VF) or relevant sudden cardiac death in Asia have been upsurging. The majority of the countries in Asia are targeted at secondary prevention of ICD in patients with documented VT/VF and structural heart disease or primary electrical diseases. However, some countries have moved gradually toward primary prevention, particularly for patients with low left ventricle ejection fraction (EF) post-infarction, ion channelpathy and hypertrophic cardiomyopathy with familial sudden death. Meanwhile, the socio-economic load to the expanding ICD application in depicted patient population is unsurprisingly overwhelming. On the other hand, in CRT-D therapy for drug-refectory heart failure (HF), the progress in Asia is likewise fast. In most countries, the application of CRT-D is focusing on HF patients with wide QRS (130 or 120 ms), low EF (35%) and documented VT/VF, as suggested in AHA/ACC/ESC. Whether or how much of these sophisticated and not-cheap-at-all devices would be cost-beneficial is another open question. In conclusion, in Asia, contemporary ICD/CRT-D therapy has been largely following the guidelines of AHA/ACC/ESC. Nevertheless, the following socio-economic influence is to be censored. S32-2 ICD/CRT-D Therapy in Japanese Patients with Left Ventricular Systolic Dysfunction Akihiko Shimizu, Takashi Nitta, and ICD administrators of JHRS. ICD committee of the Japanese Heart Rhythm Society (JHRS), Japan Purpose and Methods: To comprehend the current status of ICD and CRT-D in patients (pts) with LV systolic dysfunction (LVEF 40%), we studied by using the on-line data-base.
S43 S31-4 Initial Study on the Characterization of Atrial Fibrillation in Epicardial Mappingal Research Zuxiang Fang. Fudan University, Shanghai, China Atrial fibrillation is a very complex cardiac electrophysiology phenomenon. While AF, atrium are in the chaos state, every local atrial muscle depolarization is in the quickly irregular and asynchronization situation, either by anatomical or functional cause. From the view of fundamental research or surgical cure we need find out the rapid excite focus and their propagation path even astable. We designed a flexible electrodes patch consist of 64 electrodes array in matrix arrangement, which can acquire epicardium ECG in their site respectively, then amplify each ch annel signal, through ADC feed its into computer. By the statistic analysis algorithm and plot software developed by ourselves, four kind of maps would display one the screen. They are waviness plot, isochrome plot, statistical exciting frequency plot and propagation pathway statistic plot. Especially the waviness plot could show the actually depolarization wave propagation manner in movie and the last one could show the direction of wavefront everywhere covered by electrode. We think it would useful for operation and help understand the basic theory. Symposium 32. Arrhythmia 3: ICD/CRT-D S32-1 ICD/CRT-D Therapy in Asia Jiunn-Lee Lin. National Taiwan University, Taipei, Taiwan ROC Despite the time lag in technology development and clinical trial confirmation, the implementation of implantable cardioverter-defibrillator (ICD) and additional cardiac resynchronization therapy (CRT-D) for hemodynamic-collapsing ventricular tachyarrhythmia (VT/VF) or relevant sudden cardiac death in Asia have been upsurging. The majority of the countries in Asia are targeted at secondary prevention of ICD in patients with documented VT/VF and structural heart disease or primary electrical diseases. However, some countries have moved gradually toward primary prevention, particularly for patients with low left ventricle ejection fraction (EF) post-infarction, ion channelpathy and hypertrophic cardiomyopathy with familial sudden death. Meanwhile, the socio-economic load to the expanding ICD application in depicted patient population is unsurprisingly overwhelming. On the other hand, in CRT-D therapy for drug-refectory heart failure (HF), the progress in Asia is likewise fast. In most countries, the application of CRT-D is focusing on HF patients with wide QRS (130 or 120 ms), low EF (35%) and documented VT/VF, as suggested in AHA/ACC/ESC. Whether or how much of these sophisticated and not-cheap-at-all devices would be cost-beneficial is another open question. In conclusion, in Asia, contemporary ICD/CRT-D therapy has been largely following the guidelines of AHA/ACC/ESC. Nevertheless, the following socio-economic influence is to be censored. S32-2 ICD/CRT-D Therapy in Japanese Patients with Left Ventricular Systolic Dysfunction Akihiko Shimizu, Takashi Nitta, and ICD administrators of JHRS. ICD committee of the Japanese Heart Rhythm Society (JHRS), Japan Purpose and Methods: To comprehend the current status of ICD and CRT-D in patients (pts) with LV systolic dysfunction (LVEF 40%), we studied by using the on-line data-base.