Symposium 10
3月27日［土］08:00-09:30
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What have the advances in cardiac implantable electronic devices (CIEDs) changed?: Current status and the near future.
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生体工学の劇的な技術進歩と共に植込み型心臓電気デバイス（cardiac implantable electronic devices [CIEDs]）は急速に進化しました。徐脈に対するペースメーカ、致死性不整脈に対する抗頻拍ペーシングと電気除細動（ICD）、そして進行した心不全に対する心臓再同期療法（CRT）は今日、世界で広く使用されています。ICDとCRTは心不全患者において重要な治療のひとつであり、再入院率と死亡率を低下させます。着用型自動除細動器（WCD）、リードレスペースメーカ、完全皮下植込み型除細動器（S-ICD）、植込み型ループレコーダーも既に数年前より本邦でも臨床使用が可能となっています。そして、ヒス束ペーシングや左脚ペーシングが新たな生理的ペーシング法として登場し、進行した心不全への有効性が期待されています。
遠隔モニタリング（RM）はCIEDs植込み患者の新たな、そして標準的なフォローアップ方法であり、進行した心不全や心房細動合併患者でもその有用性が指摘されています。さらに、近年、遠隔血行動態モニタリングデバイスが開発され、欧米では既に日常診療で使用されています。
このようにCIEDsは単なる刺激装置ではなく、すでに心臓のモニタリングおよび治療機器であり、今後さらなる進歩と普及が期待されます。本シンポジウムでは心血管疾患の診断と治療におけるCIEDsの現状と今後について討論したいと考えています。
With dramatic technological advances in biomedical engineering, cardiac implantable electronic devices (CIEDs) have undergone a rapid development: Pacemakers for bradycardia, anti-tachycardia-pacing and cardioversion/defibrillation (ICD) for lethal tachyarrhythmias, and cardiac resynchronization therapy (CRT) for advanced congestive heart failure are widely used around the world today. Implantable devices such as ICDs and CRTs are cornerstones of the modern treatment in heart failure patients, reducing the re-admission rate and mortality in this population. Wearable cardioverter-defibrillators, leadless-pacemakers, subcutaneous ICDs, and miniaturized implantable loop recorders have already been available in Japan for some years. His bundle pacing and left bundle pacing have also emerged as a new strategy for a physiological ventricular activation and might be effective in patients with advanced heart failure.
Remote monitoring (RM) has become a new standard of care in the follow-up of patients with CIEDs, and it might be quite useful in patients with advanced heart failure and concomitant atrial fibrillation. Furthermore, a remote hemodynamic monitoring device has recently been developed and is now often used in daily clinical care in both Europe and the United States.
Thus, CIEDs are not just electrical stimulation devices, but have already become reliable heart monitoring and therapeutic equipment, and further future developments and dissemination are expected. In this symposium, we would like to discuss the current status and near future of CIEDs for the diagnosis and treatment of cardiovascular disease.
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Hiroshi Tada
Department of Cardiovascular Medicine, University of Fukui, Fukui
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Paul Friedman
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, USA
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Paul Friedman
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, USA
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Nobuhiko Ueda
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita
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Toshiaki Sato
Division of Advanced Arrhythmia Management, Kyorin University School of Medicine, Mitaka
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Yuji Ishida
Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki
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Eiichi Watanabe
Department of Cardiology, Fujita Health University Bantane Hospital, Nagoya
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