Paul Wang Future of Arrhythmia 2011.pdf - Chinese American

76 Pages·2011·13.39 MB·English

The Future of Arrhythmia
Management
Paul J. Wang, MD
Professor of Medicine
Director, Stanford Cardiac Arrhythmia
Service
Stanford University School of Medicine
Share my thoughts regarding major problems

and needs in Arrhythmia Diagnosis and Device
Therapy
My thoughts about What we need to know

Speculate about Timeline of the Future

Encourage you to join in innovating for the

future
AHA Mission
Reduce Cardiovascular Death (36% of all

deaths)
Reduce Cardiovascular Morbidity

I need to convince you these are
major problems
Direct and Indirect Cost of Heart Disease

$430 Billion
Atrial Fibrillation 2.2 Million

Heart Failure 5 million

Sudden Cardiac Death 300,000

Arrhythmia device industry exceeded coronary

stent expenditures $5 Billion per year
A 20 year old man, who is a college

basketball player, runs across the
basketball court. He collapses. He is
found in ventricular fibrillation. An
Automatic External Defibrillator is used
and he is resuscitated.
What advances made this possible and

what are the future needs in the field?
Sudden Death
Over 1,000 death per day in U.S.

Survival decreases by 10% with every 1

min to defibrillation
Most common cause coronary artery

disease/left ventricular dysfunction
Cardiomyopathy, hypertrophic

cardiomyopathy, right ventricular
dysplasia, anomalous coronary arteries,
long QT, aortic aneurysm, Brugada
syndrome, idiopathic VF, Commotio Cordis
Poor Survival from Cardiac Arrest
Survival from cardiac arrest

VF< 10%
7-10% decline in survival per

minute
Strategies to Decrease Sudden
Death
Disease prevention

Identify patients at risk

Decrease likelihood of arrhythmia – drugs,

ablation
Respond to arrhythmia – implantable

defibrillator
Improve resuscitation

Improve monitoring

Improve response to arrhythmia

SCD/year in the US
100%
90%
Post MI High Risk

80%
Prior Cardiac Arrest

70%
CHF
60%
Post MI Low
50%
?
Risk
40%
General
Population
30%
CAD No MI
20%
General Population
10%
0%
From Myerburg
Role of Automatic External
Defibrillator
Automatic external defibrillator- designed

for layperson use to automatically detect
ventricular tachycardia/ventricular
fibrillation and shock patient