Introduction
3,000,000,000
Sign of life
Cardiac Electrophysiology
Study of heart beat and its disorders
Outline
- Heart rhythm disorders
- Slow heart rates
- Fast heart rates
- Introduction to rhythm abnormalities involving a fast heart rate
- Development of electrophysiology studies and ablation therapy
- Implantable defibrillators for preventing sudden death
SVT - The racing heart
Palpitations
Supraventricular tachycardia
The heart as an electrical organ
Electricity and life - Luigi Galvani, Italy 1780
Augustus Waller - Late 1800s
Forsmann - 1929
Electrophysiology studies - Catheters
Catheters in the heart
Recording / seeing the signals
Understanding the mechanism of tachycardias - Durrer 1960s
Understanding reentry
Durrer D, Schoo L, Schuilenburg RM, Wellens HJ. The role of premature beats in the initiation and the termination of supraventricular tachycardia in the Wolff-Parkinson-White syndrome. Circulation. 1967 Nov;36(5):644-62. doi: 10.1161/01.cir.36.5.644
Technology - Stimulator
Tachycardia in WPW
Reentry as common mechanism
DC for ablation
Radiofrequency
RF ablation today
Electroanatomic mapping
Electroanatomic mapping
Arrhythmias and sudden death
Abdul Kalam 1931-2015
1 in 7 deaths in the US
Heart Disease and Stroke Statistics—2018 Update: A Report From the American Heart Association https://doi.org/10.1161/CIR.0000000000000558
Early, bystander CPR
Ventricular arrhythmias as cause
Early defibrillation
External defibrillators
The general population and the individual
Heart failure post myocardial infarction
Mirowski - 1960s
History of development
- Young Polish Cardiologist
- Trained in France
- Joined Professor Harry Heller in Israel in 1963
Professor Harry Heller
- Recurrent ventricular arrhythmias
- DC cardioversion
- Dies suddenly (1966)
Idea for ICD
- Early defibrillation can be life saving
- Implanted device that can defibrillate ?
- Scepticism, moved to USA
Early results - 1969
First report - 1970s
Evolution
ICD today
Trials, patient groups
Anthony Van Loo
Summary
- Electrophysiology - The study and treatment of heart rhythm disorders
- Excellent example of synergistic cooperation between science and technology
- Paroxysmal palpitations - Ablation procedures with success rate > 90%
- ICD implantation, routine procedure, saves lives in selected patients