bluuebunny/crossref_metadata_2025 huggingface dataset:
854Predictors of ventricular tachyarrhythmia in patients with implantable cardioverter-defibrillator and non-ischaemic systolic heart failure
Authors: Jedrzejczyk-Patej E , Mazurek M , Lazar M , Pruszkowska-Skrzep P , Podolecki T , Kowalczyk J , Kowalski O , Kalarus Z , Lenarczyk R
Published: June 2020

Funding Acknowledgements

none

OnBehalf

none

Background

The benefit of an implantable cardioverter-defibrillator (ICD) in patients with ischaemic heart failure (HF) has been well proven but the benefit of ICD in subjects with non-ischaemic systolic HF is less well-established. Consequently, there is very limited evidence which patients with non-ischaemic HF would benefit most from receiving an ICD.

Aim

To determine the incidence and predictors of ventricular arrhythmia in patients with ICD and non-ischaemic systolic HF.

Methods

Study population consisted of 420 consecutive patients with ICD and non-ischaemic systolic HF monitored remotely (on a daily basis) between 2010 and 2017 in tertiary care university hospital, in a densely inhabited, urban region of Poland. Sixty-six percentage of patients had cardiac resynchronization therapy with defibrillator (CRT-D).

Results

During the median follow-up of 1645 days (range: 507-3515) sustained ventricular arrhythmia occurred in 100 patients (23.8%). Of those, ventricular fibrillation (VF), ventricular tachycardia (VT) or VT/VF (combined) occurred in 10 (10.0%), 77 (77.0%) and 13 (13.0%) patients, respectively. Patients with versus without ventricular arrhythmia did differ with respect to baseline variables such as: left ventricular end diastolic diameter (LVEDD) - median of 67 mm [49-82] vs 62 mm [46-78]; post-inflammatory HF (17 vs 9.7%, P = 0.045); atrial fibrillation/atrial flutter - AF/AFL (57 vs. 38.1%, P = 0.0009); supraventricular arrhythmia (SVT) - any supraventricular arrythmia >100/min other than AF/AFL (27 vs. 15.9%, P = 0.01); and left ventricular ejection fraction - EF (25 vs. 28%, P = 0.01). No differences were observed for age, sex, NYHA class, mitral regurgitation, common comorbidities (including diabetes and chronic renal disease) or concomitant medications. On  multivariable regression analysis, LVEDD (HR 1.05, 95% CI 1.004-1.09, P = 0.03), AF/AFL (HR 1.81, 95% CI 1.21-2.72, P = 0.004) and SVT (HR 1.91, 95% CI 1.21-3.01, P = 0.006) were identified as independent predictors of sustained ventricular arrhythmia in patients with ICD and non-ischaemic HF. All-cause mortality in patients with VT/VF was significantly higher than in subjects without sustained ventricular arrhythmias (33% vs. 20%, P = 0.03).

Conclusions

Ventricular arrhythmia occurred in 23.8% of patients with systolic non-ischaemic HF during 4.5 years of observation and was associated with significantly worse prognosis compared with subjects free of VT/VF. Left ventricular dimension, atrial fibrillation/atrial flutter and supraventricular tachycardia were identified as independent predictors for ventricular arrhythmia.
739SERCA2 Cys674 modification lead to ventricular arrhythmia due to impaired sarcoplasmic reticulum Ca2+ handling
Authors: Ito K , Yada H , Toya T , Osaki A , Kagami K , Yumita Y , Ido Y , Takase B , Adachi T
Published: June 2020

Background

Sarcoplasmic reticulum Ca2+-ATPase2 (SERCA2) plays an important role in intracellular Ca2+ handling. Under pathological conditions, oxidative stress leads to irreversible oxidation of Cys674 on SERCA2 which causes intracellular Ca2+ overload. Intracellular Ca2+ overload is known as the cause of ventricular arrhythmia, but the relation between SERCA2 function and ventricular arrhythmia remains unclear.

Purpose

To investigate the role of Cys674 on SERCA2 in the intracellular Ca2+ handling and the induction of ventricular arrhythmia.

Methods

We employed SERCA2 Cys674Ser heterozygote knock-in mice (SKI) which mimics oxidative modification of Cys674 on SERCA2. Continuous infusion of angiotensin (ANG) (3mg/kg/day) or distilled water were performed both in wild type mice (WT) and SKI for a week. After 1 week, electrophysiological study and intracellular Ca2+ transient measurement were performed.

Results

ANG elevated blood pressure and represented cardiac hypertrophy with fibrosis similarly both in WT and SKI. The mRNA expression of calcium/calmodulin-dependent protein kinase-II (CaMKII), ryanodine receptor (RyR) and sodium-calcium exchanger (NCX) was increased in SKI heart compared with WT. QTc interval was prolonged in SKI compared with WT, which was markedly prolonged with ANG infusion. Under programmed electrical stimulation, only SKI with ANG showed high incidence of pacing induced ventricular arrhythmia (0/11 in WT/SKI control, 0/14 in WT with ANG vs. 8/14 in SKI with ANG, P < 0.01). In Ca2+ transient measurement, the peak Ca2+ transient amplitude (F/F0) was decreased (WT: 1.81 vs. SKI: 1.46, P < 0.01) and the time to 50% of cytosolic Ca2+ extrusion (T50) was prolonged (WT: 152.6ms vs. SKI: 202.3ms, P < 0.05) in SKI with ANG, suggesting decreased sarcoplasmic reticulum Ca2+ content and impaired SERCA2 activity in SKI with ANG. Intraperitoneal administration of dantrolene sodium (DAN) which inhibit Ca2+ leakage from RyR receptor normalized decreased F/F0 and prolonged T50 in SKI with ANG (Fig. 1 A, B). DAN also prevented QTc prolongation and decreased the incidence of ventricular arrhythmia in SKI with ANG (8/14 in SKI with ANG vs. 2/13 in SKI with ANG + DAN, P < 0.05) (Fig. 2).

Conclusions

The loss of thiol on Cys674 under pathological condition resulted in impaired Ca2+ handling and high incidence of ventricular arrhythmia which were ameliorated by inhibition of Ca2+ leakage through RyR. Oxidative modification of Cys674 on SERCA2 might contribute to Ca2+ mishandling and arrhythmogenesis.

Abstract Figure.
P1011Cryptogenic stoke and asymptomatic atrial fibrillation in a real world population: a single centre, implantable loop recorder study
Authors: Faustino M , Di Stefano V , Franciotti R , Furia N , Di Girolamo E , Bonanni L , Onofrj M , De Angelis M V
Published: June 2020

Funding Acknowledgements

None

Background

The incidence of atrial fibrillation (AF) in cryptogenic stroke (CS) patients has been studied in carefully controlled clinical trials, but real-world data are limited.

Purpose

Aim of this study was to investigated the incidence of AF in clinical practice among CS patients with an implantable cardiac monitor (ICM) recommended (IIA) for AF detection.

Methods

Patients with CS admitted to our Stroke Unit were included in the study. Patiens received an ICM and were monitored for up to 2 years for AF detection (in-hospital clinic and remote monitoring). All detected AF episodes (≥30 sec) were considered.

Results

From March 2016 to March 2019, 58 patients (mean age 68 ±12 years, 67% male) received an ICM to detect AF after a CS.  No patients were lost during follow-up.

AF was detected in 23 patients (40% overall; AF group mean age 72 ± 11 years; 65% male) after a mean time of 6 months from ICM implantation (ranging from 2 days up to 2 years) and 8 months after CS (ranging from 1 month up to 2 years). In these AF patients anticoagulant treatment was prescribed, and no further stroke was reported.

Conclusions

AF episodes were detected via continuous monitoring with ICMs in 40% of implanted CS patients. AF after CS was asymptomatic and thus unlikely to be detected by strategies based on intermittent short-term recordings. Therefore, ICMs should be considered as part of daily practice in the evaluation of CS patients.

Abstract Figure 1. Detection rate over time
P1157Defibrillation threshold with subcutaneous implantable-cardioverter defibrillator implanted using an intermuscular 2-incision approach
Authors: Biffi M , Ziacchi M , Martignani C , Lavalle C , Piro A , Diemberger I
Published: June 2020

Funding Acknowledgements

NO FUNDING

OnBehalf

Rhythm Detect Registry

Background

Current subcutaneous implantable cardioverter–defibrillators (S-ICD) deliver 80J, and the conversion test is usually conducted by delivering shock energy of 65 J to ensure a safety defibrillation margin of at least 15 J. However, little is known about the real safety margin in real life clinical practice.

Purpose

To determine the defibrillation threshold (DFT) with S-ICD and to investigate its association with clinical characteristics.

Methods

De novo S-ICD patients were  consecutively enrolled and DFT was evaluated using a pre-specified step-up protocol at implantation.

Results

35 patients, BMI 25 ± 4 kg/m2, left ventricular ejection fraction (LVEF) 48 ± 19%, underwent S-ICD implantation. The generator was positioned in an intermuscular pocket and a 2-incision technique was applied in all patients. The mean DFT was 30 ± 10J and the DFT was >30J in 7 (20%) patients. A single patient had a >40J DFT. The time to shock was 11 ± 3 seconds and the shock impedance was 67 ±21 Ohm at the lowest effective energy. The DFT was comparable in patients with LVEF ≤35% (33 ± 15J) versus >35% (29 ± 5J, p = 0.278), and in patients with BMI ≤25 kg/m2 (30 ± 5J) versus >25kg/m2 (31 ± 14J, p = 0.864).

Conclusions

We observed low DFT and low shock impedance in patients who received S-ICD with an intermuscular 2-incision approach. The S-ICD defibrillation success rate at ≤30J was 80%, while 97% of patients were defibrillated at ≤ 40J. We found no difference in DFT according to the LVEF or the BMI.
250Efficacy of multi-electrode linear irreversible electroporation
Authors: Buist T J , Groen M H A , Wittkampf F H M , Loh K P , Doevendans P A , Van Es R , Elvan A
Published: June 2020

Background

 We investigated the efficacy of linear irreversible electroporation (IRE) ablation in a porcine model. 

Methods

The study was performed in 6 pigs (weight 60-75kg). After median sternotomy and opening of the pericardium, a pericardial cradle was formed and filled with blood. A linear 7 polar 7F electrode catheter with 2.5mm electrodes and 2.5mm inter-electrode spacing was placed in good epicardial contact. A single IRE application was delivered using 50 Joules (J) at 1 site and 100 J at 2 other sites, in random sequence, using a standard monophasic defibrillator connected to all 7 electrodes connected in parallel. The pericardium and thorax were closed and after 3 weeks survival animals were euthanized. 82 histological sections from all 18 electroporation lesions were analyzed.

Results

A total of seven 50 J and fourteen 100 J epicardial IRE applications were performed. Mean peak voltages at 50 J and 100 J were 1079.2 V ± 81.1 and 1609.5 V ± 56.8, with a mean peak current of 15.4 A ± 2.3 and 20.2 A ± 1.7, respectively. Median depth of the 50J and 100J lesions were 3.2 mm (interquartile range [IQR], 3.1 – 3.6) and 5.5 mm (IQR, 4.6 – 6.6) (P < 0.001), respectively. Median lesion width of the 50J and 100J lesions were 3.9 mm (IQR, 3.7 – 4.8) and 5.4 mm (IQR, 5.0 - 6.3), respectively(P < 0.001).  Longitudinal sections showed continuous lesions for 100J lesions.

Conclusion

 Epicardial linear application of IRE pulses is effective in creating continuous deep lesions.

Ablation characteristics and lesion size Peak voltageV Peak currentA Peak resistanceΩ SlicesN Depthmm Widthmm 50 J 1079.2 ± 81.1 14.5 ± 2.3 71.8 ± 15.6 26 3.2 (3.1 - 3.6) 3.9 (3.7 - 4.8) 100J 1609.5 ± 56.8 20.2 ± 1.7 80.0 ± 9.5 56 5.5 (4.6 - 6.6) 5.4 (5.0 - 6.3) P-value† <0.001 <0.001 Data is displayed as mean ± SD or median (interquartile range) where appropriate.†assessed by general linear mixed models

Abstract Figure. Transversal histological sections
237Role of wearable device recordings in clinical decision making - The wEHRAbles Young EP survey
Authors: Manninger M , Zweiker D , Njeim M , Antolic B , Kosiuk J , Svennberg E , Vanduynhoven P , Duncker D
Published: June 2020

Multiple wearable devices for rhythm analysis have been developed using either photoplethysmography (PPG) or handheld ECG. The aim of this survey was to assess how these technologies impact on physicians’ clinical decision-making regarding initiation of diagnostic steps, drug- and interventional therapy.

Methods

The present survey is conducted with support of the scientific network of EHRA Young EP and will be running from October 1st until December 31st, 2019. The online survey includes 10 questions on types of devices, advantages and disadvantages of wearable devices, gaps in evidence as well as case scenarios for patients with supraventricular arrhythmias, symptomatic and asymptomatic atrial fibrillation (AF). Here, we present preliminary data of the survey.

Results

So far, a total of 178 physicians from 34 different countries completed the survey. Mean age was 37 ± 8 years. Most participants work in university hospitals (66%) as electrophysiologists (69%) or cardiologists (21%).

Most participants would trigger further diagnostic steps if a patient with regular palpitations presented a recording of a regular tachycardia (89% for single-lead ECG vs. 86% for PPG), while a single-lead ECG would be sufficient to perform an invasive EP study in most participants (56% vs. 25% for PPG). Participants would be more reluctant to prescribing antiarrhythmic drug therapy in these patients (29% vs. 10%).

In a case scenario of a patient presenting a 30 seconds tracing from a single-lead ECG or PPG device suggesting AF, most participants would trigger further diagnostic steps, Figure 1. A single-lead ECG tracing from a symptomatic AF patient would trigger anticoagulation treatment to a higher extent than in asymptomatic patients (65% vs. 47%). As expected, initiation of antiarrhythmic drug therapy or ablation was suggested to a greater extent in symptomatic patients, Figure 1. PPG tracings would only rarely lead to further therapeutic steps regardless of symptomatology. As main advantages of wearable devices, participants stated faster diagnosis (66%), continuous monitoring opportunities (65%), patient involvement (64%), facilitation of screening (60%) and public availability of monitoring (53%). Main disadvantages participants stated were data overload (67%) and patient-driven instead of clinician-driven screening (43%). Most participants would like to see scientific society recommendations on the use of wearable devices (53%).

Conclusion

In this ongoing survey the preliminary results show that tracings from wearable devices suggestive of arrhythmias are most likely to trigger further diagnostic steps, and in the case of PPG recordings rarely therapeutic interventions. A majority of participants wanted scientific society recommendations on the use of wearables.

Abstract Figure 1
P993Incidence of atrial fibrillation early after cavotricuspid isthmus ablation
Authors: Krisai P , Streicher O , Meyre P , Haemmerle P , Steiner F , Reddiess P , Zeljkovic I , Pavlovic N , Ammann P , Roten L , Reichlin T , Madaffari A , Kuehne M , Novak J , Sticherling C
Published: June 2020

Background

Atrial fibrillation (AF) is a common finding in patients undergoing cavotricuspid isthmus ablation for isthmus dependent right atrial flutter (RAF). Little is known about the time of its occurrence.

Purpose

We aimed to investigate the incidence of AF early after RAF ablation in a well-defined, prospective cohort.

Methods

A total of 255 participants with RAF ablation from 5 centers and at least one completed follow-up were included. Structured clinical follow-up was performed at 3, 6 and 12 months including a 24 hour Holter-ECG. The endpoint was incidence of AF detected clinically or by Holter-ECG. Risk factors associated with the occurrence of AF were assessed using separate, univariate Cox proportional-hazards models.

Results

Mean age was 67 years, 80% were male and previous episodes of AF were known in 40%. Over a mean follow-up of 7.4 (±4.4) months AF was detected in 35 (13.7%) participants after RAF ablation (Figure A). After 3, 6 and 12 months AF was detected in 18 (7.1%), 30 (11.7%) and 34 (13.3%) patients. No difference in the incidence of AF after RAF ablation was found comparing patients with and without a history of AF (log-rank p value = 0.44) (Figure B). Comparing patients with and without AF during follow-up, there was no difference in age (68 vs 66 years, p = 0.36), sex (69 vs 81% male, p = 0.08), prior heart failure (29 vs 19%, p = 0.20), hypertension (43 vs 38%, p = 0.56) or left atrial volume (46.6 vs 39.6 ml, p = 0.10), but patients with previous AF had a lower left ventricular ejection fraction (LVEF) (45.7 vs 52.3%, p = 0.02). In separate, univariate Cox proportional-hazards models only increasing LVEF (Hazard ratio 0.97, 95% confidence interval (0.95; 0.99, p = 0.02)) was associated with a lower risk of incident AF after RAF ablation, but no other risk factor.

Conclusions

AF occurred in 13.7% of patients early after cavotricuspid isthmus ablation for RAF. There was no difference in the occurrence of AF between patients with and without previously known episodes of AF. Only impaired LVEF was associated with AF occurrence.

Abstract Figure
P1111Arrhythmogenic substrate detection in ischemic patients undergoing ventricular tachycardia ablation using multi-detector computed tomography: compared evaluation with cardiac magnetic resonance
Authors: Jauregui B , Soto-Iglesias D , Zucchelli G , Teres C , Ordonez A , Chauca A , Penela D , Acosta J , Fernandez-Armenta J , Linhart M , Perea R J , Doltra A , Ortiz-Perez J T , Bosch X , Berruezo A
Published: June 2020

Background

 Cardiac magnetic resonance (CMR) is capable of accurately identifying arrhythmogenic substrate (AS), leading to longer arrhythmia-free survival when used to guide ventricular tachycardia (VT) substrate ablation procedures. However, the use of CMR may be limited in certain centers or patient subsets. 

Purpose

 To evaluate the performance of multidetector cardiac computed tomography (MDCT) imaging in identifying heterogeneous tissue channels (HTCs) detected by CMR in ischemic patients undergoing VT substrate ablation.

Methods

 Thirty ischemic patients undergoing both CMR and MDCT before VT substrate ablation were included. Using a dedicated post-processing software, two blinded operators, assigned either to CMR or MDCT analysis, characterized the presence of CMR- and CT-channels, respectively. CMR-channels were classified as endocardial (layers <50%), epicardial (layers ≥50%) or transmural. CMR- vs. CT-channel concordance was considered when the orientation was the same and they were located in the same AHA segment.

Results

 Mean age was 69 ± 10 years; 90% were male. Mean left ventricular ejection fraction (LVEF) was 35 ± 10%. All patients had CMR-channels (n = 76), whereas only 26/30 (86.7%) had CT-channels (n = 91). Global sensitivity (Se) and positive predictive values (PPV) for detecting CMR-channels were 61.8% and 51.6%, respectively. MDCT performance improved in patients with epicardial CMR-channels (Se 80.5%), and transmural scars (Se 72.2%). In 4/11 (36%) patients with subendocardial MI, MDCT was unable to identify the AS.

Conclusion

 MDCT fails to detect the presence of AS in 36% of patients with subendocardial MI and shows a modest sensitivity identifying the presence of HTCs, although its performance improves in patients with transmural scar.

Abstract Figure. Multimodality imaging AS detection
P339Ser49Gly of beta1-adrenergic receptor is associated with hereditary sick sinus syndrome
Authors: Chernova A , Nikulina S , Shulman V , Voevoda M , Maksimov V
Published: June 2020

PURPOSE

The human beta(1)-adrenergic receptor (ADRB1), an important therapeutic target in cardiovascular diseases, has functional polymorphism on Ser49Gly. Our study aimed to confirm that beta(1)-adrenergic receptor polymorphisms affect hereditary sick sinus syndrome. 

METHODS

Polymerase chain reaction-restriction fragment length polymorphism was used to screen for Ser49Gly. We genotyped polymorphism Ser49Gly of the beta1-AR in 108 patients with hereditary sick sinus syndrome, 59 their healthy relatives and 198 control subjects. Structure of primers was as follows: common 5’-TTGCT-GCCTC-CCGCC-AGCGA-TG-3’, wild 5’-TTGCT-GCCTC-CCGCC-AGCGA-CA-3’, mutant 5’-TCACG-CACAG-CACGT-CCACT-GA-3’. 

RESULTS

Patients with the Ser49Gly genotype shaved associat with hereditary sick sinus syndrome more frequently than in controls and those with Ser49Ser and Gly49Gly (P < 0.01).The patients carrying 49 Gly in the ADRB1 gene was significantly higher odds in SSS than in patients without this allele (p < 0.05). Presence of a Gly49 allele was associated with an increased odds of having hereditary sick sinus syndrome. 

CONCLUSIONS

Our data suggest that patients with the Ser49Gly genotype and Gly49 allele of the beta(1)-adrenergic receptor gene are at increased risk to develop hereditary sick sinus syndrome.
1267Relationship between polymorphism of ADRA2B gene and primary cardiac conduction disorders
Authors: Chernova A , Nikulina S , Shulman V , Voevoda M , Maksimov V
Published: June 2020

Background

Cardiac conduction system (CCS) disease resulting in disrupted conduction and impaired cardiac rhythm is common with significant morbidity and mortality. Current treatment options are limited and rational efforts to develop cell-based and regenerative therapies require knowledge in molecular networks that establish and maintain CCS function. Recent genome-wide association studies (GWAS) have identified numerous loci associated with adult human CCS function, including ADRA2B.  

Materials and methods

A family examination was performed for 71 patients with atrioventricular block (AVB). The control group was formed by 657 patients without clinical ECG manifestations of cardiac diseases. All the examinees underwent ECG, echocardioscopy, electrophysiological examination of the heart. 

Results

by results of research, it has been established that the frequency of carriers of a homozygous genotype on rare allele (DD) among patients with AVB (43.7%±5.9) was higher in comparison with the controls (16%±1.4). The obvious tendency to decrease in carriers of a heterozygous genotype (ID) among patients with AVB (23.9%±5.1) in comparison with the control group (51.1%±2.0) has also been noted. 

Conclusions

 In this work, we revealed association between hereditary disturbances of cardiac conduction and polymorphism of 2-adrenergic receptor gene using clinical - genetic material for the first time.

Genotypes: AVB (n = 71) Control group (n = 657) р n %±m n %±m II 23 32,4 ± 5,6 216 32,9 ± 1,8 р>0,05 ID 17 23,9 ± 5,1 336 51,1 ± 2,0 р<0,001 DD 31 43,7 ± 5,9 105 16 ± 1,4 р<0,001 Allels: Allel I 63 32,9 ± 1,8 768 58,4 ± 1,4 р<0,001 Allels D 79 51,1 ± 2,0 546 41,6 ± 1,4 р<0,001 ОR; 95% CI OR 1,764;1,244-2,5 Genotype II 23 32,4 ± 5,6 216 32,9 ± 1,8 р>0,05 Genotypes ID + DD 48 67,6 ± 5,6 441 67,1 ± 1,8 р>0,05 ОR; 95% CI OR 0,978;0,58-1,65
P534Central sleep apnea in pacing-induced cardiomyopathy: prevalence, improvement by upgrading to cardiac resynchronisation therapy and impact on structural responder rates and long-term outcome
Authors: Barbieri F , Adukauskaite A , Heidbreder A , Brandauer E , Bergmann M , Senoner T , Rubatscher A , Schgoer W , Stuehlinger M , Pfeifer B , Bauer A , Hintringer F , Hoegl B , Dichtl W
Published: June 2020

Funding Acknowledgements

ÖNB Jubiläumsfondsprojekt Nr. 15974, ISR grant by Boston Scientific, St. Paul, MN, USA

Background

Central sleep apnea (CSA) in pacing induced cardiomyopathy (PICM) is poorly studied. Specifically, it is unknown whether upgrading from right ventricular pacing (RVP) to cardiac resynchronisation therapy (CRT) improves CSA.

Methods

Fifty-three patients with impaired left ventricular ejection fraction, frequent right ventricular pacing due to high-grade atrioventricular block and heart failure symptoms despite optimal medical therapy underwent upgrading to CRT. Within one month after left ventricular lead implantation (but still not activated), sleep apnea was assessed in all participants by single-night polysomnography (PSG). Nineteen patients with moderate or severe CSA defined by an apnea hypopnea index (AHI) > 15 events per hour were re-scheduled for a follow up PSG 3-5 months after initiation of cardiac resynchronization therapy. Of this cohort, thirteen patients with stable mild heart failure agreed to be randomized to CRT versus RVP in a cross-over design.

Results

CSA (AHI > 5 events per hour) was diagnosed in 26 (49.1%), OSA in 16 (30.2%) patients suffering from PICM . Eleven (20.8%) patients did not have any form of sleep apnea. Moderate to severe CSA (AHI > 15 events per hour) was significantly improved (without specific CPAP therapy) by 102 (96-172) days of CRT: AHI decreased from 39.4 events per hour at baseline to 21.6 by CRT (p < 0.001). Furthermore, CRT led to a substantial decrease in left ventricular endsystolic volumes: baseline 141 ml (103-155), significant improvement under CRT (102 ml, 65-138; p < 0.001), whereas no effect with ongoing RV-pacing (147 ml, 130-161; p = 0.865). Preexistent CSA did not affect the structural response of CRT (56.5% in patients with CSA, 62.5% of patients with obstructive sleep apnea and 54.5% in patients without sleep apnea; p = 0.901) and had no impact on major adverse cardiac events (p = 0.412) and/or survival (p = 0.623) during long-term follow-up.

Conclusions

CSA is highly prevalent in patients with PICM and is significantly improved by upgrading to CRT. Preexistent CSA does not hamper structural improvement and long-term outcome after upgrading to CRT. Thus, CSA seems to occur as a consequence of PICM, rather than as a pathophysiological mediator.

Abstract Figure.
911Which patients are most likely to benefit from the wearable cardioverter-defibrillator? Findings from the Swiss WCD registry
Authors: Kovacs B , Reek S , Linka A , Ammann P , Mueller A S , Reichlin T , Haegeli L , Steffel J , Saguner A M , Burri H , Duru F
Published: June 2020

OnBehalf

Swiss WCD Registry

Introduction

 The wearable cardioverter-defibrillator (WCD) has established itself as a temporary protection from sudden arrhythmogenic death in selected patients at risk. However, it is still of debate which patients and for what duration benefit from its use. Therefore, appropriate patient selection is key. Purpose: This study reports the results of the Swiss WCD registry with an emphasis on implantable cardioverter-defibrillator (ICD) implantation rate and ICD therapies.

Methods

 We retrospectively reviewed the indications, baseline characteristics and administered therapies in patients prescribed a WCD at 12 participating centers rom 2014 until 2018 in Switzerland. Further data on medical therapy, WCD therapy adherence, and ICD implantation rates were collected. 

Results

 456 patients were included in our study comprising of 66% of all Swiss patients prescribed a WCD in the examined time period. The mean age was 57 ±14 years, 18% were female and the mean ejection fraction (EF) was 32% ± 13. Indications for WCD use and appropriate shock rate are shown in the figure. Patients wore the WCD over a median of 58 days (range 1-455) with a median daily average wear-time of 22.6 hours (range 0.6-23.8). 17 appropriate therapies were administered by the WCD to a total of 12 patients leading to a therapy rate of 2.6% over a median wear-time of 16 days (range 2-79) and to a therapy rate of 3.9% in patients with ischemic cardiomyopathy (ICM) with an EF ≤35%. ICM with an EF ≤35% and bridging to ICD-implantation or heart transplantation as indication for WCD prescription were significantly associated with an appropriate therapy (p = 0.046 and 0.003, respectively). One patient with non-ischemic cardiomyopathy (NICM) received an appropriate therapy (0.8%). The mean EF in patients receiving an appropriate therapy by the WCD was also significantly lower (p = 0.04). No patient with wearing the WCD for congenital/inherited heart disease or risk stratification with an EF >35% had a therapy administered by the WCD. There were no inappropriate therapies during the investigated time period. After cessation of WCD use EF improved to 38% ±13; ultimately, 212 patients (46%) were implanted with an ICD. During a follow-up of 476 days (range 7-2347) 22 (9.8%) patients received an appropriate therapy by their ICD. Four of the 22 had prior appropriate therapy by the WCD.

Conclusions

 ICM with severely reduced EF was the most common indication for WCD use leading to a high rate of appropriate therapy by the WCD. This, however, did not translate in a higher rate of appropriate ICD-therapies during follow-up in this subpopulation possibly due to significant improvements in their ejection fractions. Patients with NICM or congenital/inherited heart disease seldom had an appropriate therapy by the WCD.

Abstract Figure. Indications for WCD use and therapy rate
P1187Pocket-Hematoma after cardiac implantable electronic devices surgery: a single centre study
Authors: Spighi L , Notaristefano F , Annunziata R , D"ammando M , Zingarini G , Verdecchia P , Cavallini C
Published: June 2020

Intro

Pocket hematoma is a common complication after pacemaker (PMK) or implantable cardioverter defibrillator (ICD) surgery. In this clinical setting anticoagulant and antiplatelet therapy are associated with an increased risk of hemorrhagic complications, but data are sparse.

Purpose

We examined  the impact of antiplatelet therapy and anticoagulation with vitamin K antagonists (VKA) or heparin on the risk of pocket hematoma. Materials and method: between august 2017 and june 2019, a total of 639 devices were implanted or replaced at our centre. Predictors of hematoma occurrence were determined by multivariate regression analysis. We used a specific definition of pocket hematoma: a) any palpable swelling in the pocket area requiring an unscheduled visit or prolonged hospitalization > 24 h or re-hospitalization for hematoma, b) interruption of antithrombotics, c) reoperation, d) hemoglobin drop > 2 g/dl or blood transfusion. The above criteria were assessed during hospitalization and up to 10 days after discharge. Results: the incidence of pocket hematoma was 7.5%. Among 639 patients (pts) including in the study 33.5% (214 pts) didn’ t take any antithrombotic therapy, 40.2 % (257 pts) were on single antiplatelet therapy (SAPT), 8.8 % (56 pts) were on dual antiplatelet therapy, 11.1 % (71 pts) were on uninterrupted VKA (mean INR 2). Heparin bridging was administered in 6.4% (41 pts). Ejection fraction (43 ±13 %) and  hemoglobin value before implantation (12.3 ±2.6 g/dL) in patients who developed hematoma were significantly lower compared with whose without hematoma. Patients with hematoma had a higher prevalence of congestive heart failure, ischemic cardiomyopathy and intake antithrombotic therapy. After adjusting for confounding factors with multivariate logistic regression only the use of dual antiplatelet therapy (OR 5.9 95% CI 1.5-21 p = 0.008) and the bridging with enoxaparin (OR 5.6 95% CI 1.4-22 p = 0.013) increased the risk of pocket hematoma. Single antiplatelet therapy (OR 2.6 95% CI 0.8-8.4 p = ns) and uninterrupted VKA (OR 0.9 95% CI 0.7-11 p = ns) did not increased the risk of pocket hematoma compared to no antithrombotic therapy. Pulse generator change and new device implant/upgrading (OR 1.8 95% CI 0.6-5.2 p = ns) carried the same haemorrhagic risk.

Conclusion

the use of DAPT or bridging with enoxaparin are highly predictive for the occurrence of perioperative pocket hematoma in patients scheduled for pmk/icd surgery. In contrast, single antiplatelet therapy and uninterrupted VKA  did not increase the risk of hematoma.
P421Efficacy of radiofrequency ablation and drug therapy of atrial fibrillation in patients with heart failure
Authors: Seliutskii S , Savina N , Chapurnykh A
Published: June 2020

Objective

to compare the efficacy of radiofrequency ablation (RFA) and drug therapy in patients with atrial fibrillation (AFib) and heart failure (HF) within 12-month follow-up.

Materials and methods

130 patients (men-75%, average age-62.8 ± 11.8 years) with AFib and HF with left ventricular ejection fraction (LVEF)<50% were included in a prospective study. In 107 (82%) of the included patients, intermediate LVEF was detected (40-49%). At the time of inclusion, paroxysmal AFib (PaAFib) was recorded in 60 (46%) of patients and persistent AFib (PeAFib) in 70 (54%). AFib RFA was performed in 65 patients, 65 patients continued to receive optimal antiarrhythmic therapy. Prior to the intervention and after 12 months, all patients underwent transthoracic echocardiography and quality of life (QoL) assessment using the SF-36 questionnaire.

Results

the freedom from AFib within 12 months follow-up period was registred in 49 (75%) of patients in the RFA group and 26 (40%) in the drug therapy group. After 12 month follow-up period we revealed increase of LVEF (p < 0.001), decrease of anteroposterior size (p <0.001) and volume (p < 0.001) of left atrium (LA), improvement of mental (p = 0.008) and physical (p = 0.048) health components according to the SF-36 questionnaire in the RFA group. In the group of drug rhythm control, after 12 months there was only the improvement of mental (p = 0.006) and physical p = 0.016) health components and it was much less than in RFA group (р<0.001). Similar results were received in patients who were free from Afib within 12 months in both groups.

Conclusions

in patients with AFib and HF with LVEF < 50%, restoration and maintenance of sinus rhythm using RFA was accompanied by an increase in LVEF, decrease of  LA size, and an improvement of QoL. In the group of drug therapy, there was a lower freedom from AFib and there was the slight improvement only in QoL.
P1371Catheter-induced premature ventricular complexes (pvc) may aid in the determination of optimal timing for clinical pvc ablation
Authors: Demir S , Akgun T , Gulsen K , Kup A , Uslu A , Kayan F , Kepez A
Published: June 2020

Background

There is significant interpatient variability regarding the timing of the earliest local activation relative to surface QRS during premature ventricular complex (PVC) ablation. The aim of the present study is to evaluate whether catheter-induced premature ventricular complexes (PVCs) produced at the presumptive ablation site may aid in the identification of the optimal timing of the earliest local activation for the successful ablation of clinical PVCs.

Methods

Sixty-three consecutive patients (35 males, age: 53.5 ± 14.4 years) without any exclusion criteria who had undergone PVC ablation between 01/07/2018 and 01/07/2019 constituted our study population.  Catheter-induced PVCs were generated at the site with presumptive PVC origin according to the ECG criteria during the procedure of PVC ablation. Five PVCs were induced by mechanical stimulation in separate points, and the time interval between the beginning of EGM at catheter tracing and the beginning of the QRS complex of each catheter-induced PVC was noted. The mode of five time intervals (Cath EGM-ECG) was used in the analysis. The time interval between the beginning of local EGM of clinical PVCs at the earliest site and the beginning of the QRS complex of clinical PVCs (PVC earliest EGM-ECG) was also noted. The value of Cath EGM-ECG as a reference for procedural success of ablation was evaluated by examining the relationship between Cath EGM-ECG and PVC earliest EGM-ECG.

Results

Fifty-two patients had successful ablation, and 43 of them (82.7%) had PVC earliest EGM-ECG values greater than or equal to Cath EGM-ECG. Eleven patients had procedural failure, and all of them had PVC earliest EGM-ECG values lower than Cath EGM-ECG (Table 1). A PVC earliest EGM-ECG value -1.5 ms greater than Cath EGM-ECG predicted successful ablation with a sensitivity of 90.4% and a specificity of 100.0% in the general patient population (Figure 1).

Conclusion

The results of the present study indicate that catheter-induced PVCs generated at the site of the presumptive source of origin of clinical PVCs may guide the timing of the earliest site during clinical PVC ablation. Further studies are required to validate our results and test the predictive value of Cath EGM- ECG interval for long-term success of PVC ablation.

Table 1 PVC earliest EGM-ECG < Cath EGM- ECG PVC earliest EGM-ECG ≥ Cath EGM- ECG Ablation successful (n:52) 9 (17.3%) 43 (82.7%) Ablation not successful (n:11) 11 (100.0%) 0 (0%) Outcome of ablation in general patient population according to the relationship between PVC earliest EGM-ECG and Cath EGM- ECG

Abstract Figure 1
P1059Recurrence of AF after pulmonary vein isolation: how many times?
Authors: Silverio Antonio P , Cortez-Dias N , Nunes-Ferreira A , Lima G , Aguiar-Ricardo I , Rigueira J , Santos R , Rodrigues T , Cunha N , Couto Pereira S , S Morais P , Sobral S , Carpinteiro L , J Pinto F , De Sousa J
Published: June 2020

Introduction

Ablation of atrial fibrillation (AF) by catheter is an effective therapy, particularly in cases of refractoriness to medical therapy. Pulmonary vein isolation (PVI) has a significative long-term recurrence rate of AF, but the recurrence factors after this procedure are poorly defined.

Purpose

To characterize the causes of AF recurrence after PVI and to evaluate complementary strategies that can optimize the therapeutic efficacy.

Methods

A single centre prospective study of patients (pts) with AF submitted consecutively to PVI since September 2004. The variables responsible for the recurrence of AF, the complementary strategies of optimization of AF ablation and the occurrence of other dysrhythmias were evaluated.

Results

A population of 521 pts were submitted to PVI as a primary strategy for AF treatment - 36.1% for paroxysmal AF, 32.5% for persistent AF <1 year, 14.5% persistent AF> 1 year.

Eighty-three pts needed to perform 2 ablations and 10 pts performed 3 ablations. The higher the number of AF ablations, the higher the incidence of atypical atrial flutter (2% in the 1st AF ablation, 17% in the 2nd and 44% after 3 ablations).

In the pts with recurrence of AF undergoing the 2nd ablation, it was verified that most of the pulmonary veins (PV) were not isolated, with an isolation rate of only 34.1% for the right inferior PV; 29.4% for superior PV right, 29.4% lower left VP, 28.2% upper left PV. In this group, in addition to a new PVI in the pts with re-conduction of PV, 45% performed complementary ablation strategies such as: ablation of the cavo-tricuspid isthmus (52.6%); ablation of the left atrium roof line (29%); mitral isthmus ablation line (26%); applications in the scar zone (26%); posterior atrial left line (8%), atrioventricular nodal reentrant atrioventricular ablation (5%), atrial tachycardia ablation (2.6%).

In the pts submitted to the 3rd ablation, again a low PV isolation rate was confirmed: only 44.4% for the both left PV and upper right PV, and 55.6% for the right lower VP. 33.3% also performed cavo-tricuspid isthmus ablation, 22.2% lower mitral isthmus isolation and 22.2% re-isolation of gaps in the roof or intracicritricial line.

Conclusion

This prospective study demonstrates a high rate of PV re-conduction after PVI and its role in AF recurrence. Therefore, the need for a more effective and definitive IVP technique is evident.
P1392Next generation sequencing in lone atrial fibrillation patients
Authors: Rudaka I , Rots D , Kalejs O , Gailite L
Published: June 2020

Background. Minor part of atrial fibrillation (AF) patients develops the disease without any well-known risk factors, which is a particular form of the disease, known as a lone AF. Rare genetic variants were described as causative for lone AF. The aim of this study was to investigate occurrence of rare genetic variants in lone AF patients.

Material and Methods. We performed Mendeliome sequencing for 21 lone AF patients. Lone AF was defined as AF in individuals younger than 65 years in the absence of cardiovascular or structural heart disease, endocrinologic or pulmonary disease, chronic kidney disease, obesity and excessive alcohol consumption. Data analysis was performed by current laboratory pipeline. We analyzed 453 cardiomyopathy, arrhythmias and sudden cardiac death related genes.

Results. In eight out of 21 (38%) lone AF patients rare likely pathogenic variants were found (Table 1.). Seven rare truncating TTN variants and one LMNA missense variant were observed. Four unrelated patients were positive for the same TTN variant c.13696 C > T; p.(Gln4566Ter). The same variant was previously found in ARVC patient in our laboratory. Segregation analysis and phenotyping of relatives is ongoing.

Conclusions. Rare genetic variants are common causes of the lone atrial fibrillation. TTN gene variant c.13696C > T; p.(Gln4566Ter) is a potential founder variant in the Baltic population.

Table 1. Genetic variants in lone AF Gender Age of AF onset Genetic variant Family history Male 53 LMNA: p.(Ser326Thr) AF in mother Male 11 TTN: p.(Trp31854Ter) AF in father Male 30 TTN: p.(GLn4566Ter) AF in uncle Female 45 TTN: p.(GLn4566Ter) Negative Male 37 TTN: p.(GLn4566Ter) AF in father Male 25 TTN: p.(GLn4566Ter) AF in father, maternal and paternal grandmother Female 60 TTN: p.(Arg27414Ter) Sudden cardiac death at the age of 50 in grand father Female 52 TTN: p.(Arg1012Ter) AF in mother
P1379Fluoroscopy requirement reduction using an esophageal cooling protocol during left atrial ablation
Authors: Zagrodzky J , Bailey S , Shah S , Kulstad E
Published: June 2020

Background

Ablation of the left atrium with radiofrequency (RF) energy is associated with some risks to the esophagus.  Cooling the esophagus has been used as one approach to reducing esophageal injury, most commonly with direct instillation of cold liquid via gastric tube placed in the esophagus.  A new esophageal cooling device avoids the risks of free liquid instillation by using a closed-loop system, and avoids the need for frequent repositioning or stopping of the procedure often required when utilizing luminal esophageal temperature (LET) monitoring.  This in turn may reduce fluoroscopy requirements for the procedure.

Purpose

Measure the difference in fluoroscopy time required during RF ablation using an esophageal cooling device protocol, and compare this to standard LET monitoring using single or multi-sensor temperature probes.

Methods

We obtained total fluoroscopy time per patient from records of RF ablation procedures performed by a two operators over a 12 month period.  We compared fluoroscopy times between patients treated with an esophageal cooling device to control patients who were treated with LET monitoring using either single-sensor or multi-sensor temperature probes.

Results

Fluoroscopy times were available for a total of 179 patients treated with an esophageal cooling device, and 118 patients treated with LET monitoring over the 12 month study period.  Mean fluoroscopy time for patients treated with esophageal cooling was 4.0 minutes (SD 4.9 minutes) with a median of 2.0 minutes (IQR 1.3 to 3.8 minutes).  Mean fluoroscopy time for patients undergoing LET monitoring was 5.5 minutes (SD 5.7 minutes) with a median of 3.0 minutes (IQR 1.9 to 8.4 minutes).  This difference represents a 27% reduction in mean fluoroscopy time, and a 33% reduction in median fluoroscopy time in the esophageal cooling group (p<.001, Mann-Whitney U test).

Conclusions

 Fluoroscopy requirements were reduced by 27% with an esophageal cooling device when compared to standard LET monitoring.
P373Arterial stiffness changes in patients with obesity and atrial fibrillation
Authors: Tarzimanova A , Podzolkov V I , Bragina A E , Pisarev M V , Gataulin R G , Oganesian K A
Published: June 2020

Objective To study the changes in arterial stiffness in patients with obesity and paroxysmal atrial fibrillation (AF).

Materials and methods The study included 82 obese patients. Forty-two of them (group I) had paroxysmal AF, their mean age was 60.9 ± 6.2 years. The control group (group II) included 40 obese patients in sinus rhythm with the mean age of 57.2 ± 6.5 years. 

We studied arterial stiffness using cardio-ankle vascular index (CAVI) measured by the VaSera device (VS-1000) in all the patients. Patients from group I were evaluated after 3 days of sinus rhythm restoration and maintenance. We also measured the anthropometric indicators which included body mass index, waist circumference, abdominal sagittal diameter, waist-to-hip and waist-to-height ratios.

Results There were no significant differences in body mass index between 2 groups. The waist-to-hip ratio was significantly higher in patients with obesity and paroxysmal atrial fibrillation than in obese patients in sinus rhythm and was 1.37 ± 0.09 and 0.84 ± 0.06, respectively (p = 0.002). The mean value of CAVI was 9.61 ± 1.51 and 6.42 ± 0.18 in group I and group II respectively; this difference was significant (p = 0.001). There was a strong positive correlation between CAVI and waist-to-hip ratio in the group I patients (p = 0.02). The results show that vascular stiffness is significantly higher in obesity patients with paroxysmal form AF.

Conclusion Positive correlations between increased arterial stiffness and anthropometric indicators confirm the role of visceral obesity in the development of AF.
P427Influence of ranolazine on cardioversion rate in patients with new onset atrial fibrillation and ischemic disease of the heart
Authors: Alyavi B , Uzokov J K , Abdullaev A X , Payziev D D
Published: June 2020

Background

Ranolazine is a piperazine derivative, mainly used as antianginal drug in patients with ischemic disease of the heart (IDH). Despite its antianginal effect, it has an antiarrhythmic effect by inhibiting of late sodium and rapid potassium rectifier current. Aim of the study was to assess the additional antiarrhythmic efficacy of ranolazine in patients with new onset atrial fibrillation (AF) and IDH.

Material and Methods

168 eligible patients with IDH and short duration of new onset AF were enrolled in this study. Among them, 92 were treated additionally ranolazine to the standart therapy – Group I while 76 only with standart therapy – Group II. The choice of antiarrhythmic drug for cardioversion was either amiodarone or propafenone at the discretion of the doctor. Primary endpoint was recovering of sinus rhythm. All statistical analysis were performed using student t-test.

Results

Mean age of patients was 66 ± 11.5 years, male 48% in ranolazine group (Group I) and 64.5 ± 12.0 years, male 46% in Group II, and there were no statistically significant differences between two groups. Both groups of patients were characterized by median AF episode duration of 12 (4; 24) hours. Amiadoron was administered in 70 % (n = 65) of patients in Group I and in 77% (n = 59); propafenon in 30% (n = 17) of patients in Group I and 23% (n = 17) in Group II. Cardioversion rate was significantly higher in Group I than Group II (87% vs. 74%, P < 0.05;). There were not observed safety endpoints in Group I whereas 3 safety endpoints (severe bradycardia and arterial hypotension) were observed in Group II (P > 0.05).

Conclusion

Adding ranolazine to the standard therapy in patients with IDH seems to have a beneficial role in restoring sinus rhythm in recent new onset AF.