bluuebunny/crossref_metadata_2025 huggingface dataset:
P1467Ambulatory implantation of cardiac rhythm management devices: a retrospective safety and cost-minimization analysis in a developing country
Authors: Laso Bayas J L , Ibarra Castillo R , Arias Cardenas V K , Zapata Coronel J A
Published: June 2020

Introduction

The monetary costs and safety of ambulatory implantation of cardiac rhythm management devices (CRMD) has been previously studied in many developed countries, but few of these analyses come from developing countries. Here we present a summary of complications and comparative costs of ambulatory implantation of CRMDs sourced from a set of cases logged in a large database of a public facility from a developing country, over a period of 6 years.

Purpose

To determine the number and type of complications in ambulatory implantation of CRMDs and to perform a cost-minimization analysis of the outpatient versus the implantation with hospital admission.

Methods

We performed a retrospective study using the database of CRMDs that included implantation procedures of unicameral (UNI) and bicameral (BI) pacemakers, implantable cardiac defibrillators (ICD) and generator replacements (RPL) from September 2012 to December 2018, in order to determine the number of patients that received the device in ambulatory and hospitalization regimens. Then, we reviewed the medical records to determine the complication rate during the first month in both modalities. Finally, we compared the ambulatory implant costs, including hospital day-care, against the costs of a two-day hospitalization, one of these being spent in an intermediate-care unit and the other in general hospitalization.

Results

We identified a total of 541 procedures; mean age 70 ± 14 years; 227 (42%) female patients. From these, 361 were ambulatory (66,7%), 45% being BI implantation, 38% RPL, 9% UNI implantation and 8% ICD implantation. Of this, 81% of the procedures were for AV block, 7% for sinus node dysfunction and 12% for sudden death prevention (primary or secondary). There were a significant lower number of complications in the ambulatory group (3,9%, n = 14) compared with the hospitalization group (11,6%, n = 15) p = 0,006 (X²) , with no CRMDs emergencies, fatal complications or emergency readmissions in either group. Complications included pneumothorax, deep venous thrombosis, endocarditis, lead displacement and local hematoma. The cost of an ambulatory CRMD implantation was 65 USD whereas  the same procedure with hospital admission was 675 USD, according with the payment units valid for our country. 

Conclusion

Ambulatory implantation of all CRMDS is feasible and safe. This modality implies a significant monetary saving that directly benefits the patients and the social security system. It can be done in a tertiary level hospital that can reach the whole quality standards for these interventions.
219A machine learning classification algorithm to detect patients with paroxysmal atrial fibrillation during sinus rhythm
Authors: Tachmatzidis D , Filos D , Chouvarda I , Mouselimis D , Tsarouchas A , Bakogiannis K , Antoniadis A , Fragkakis N , Maglaveras N , Vassilikos V
Published: June 2020

Background

Atrial fibrillation (AF) - the most common sustained cardiac arrhythmia - while not a life-threatening condition itself, leads to an increased risk of stroke and high rates of mortality. Early detection and diagnosis of AF is a critical issue for all health stakeholders.

Purpose

The aim of this study is to identify P-wave morphology patterns encountered in patients with Paroxysmal AF (PAF) and to develop a classifier discriminating PAF patients from healthy volunteers.

Methods

Three-dimensional 1000Hz ECG signals of 5 minutes duration were obtained through the use of a Galix GBI-3S Holter monitor from a total of 68 PAF patients and 52 healthy individuals. Signal pre-processing, consisting of denoising, QRS auto-detection, and ectopic beats removal was performed and a signal window of 250ms prior to the Q-wave (Pseg) was considered for every single beat. P‑wave morphology analysis based on the dynamic application of the k‑means clustering process was performed. For those Pseg that were assigned in the largest cluster, the mean P-wave was computed. The correlation of every P-wave with the mean P-wave of the main cluster was calculated. In case that it exceeded a prespecified threshold, the P-wave was allocated to the main morphology. For the remaining P‑waves, the same approach was followed once again, and the secondary morphology was extracted (picture). The P-waves of the dominant morphology were further analyzed using wavelet transform, whereas time-domain characteristics were also extracted.

A Support Vector Machine (SVM) model was created using the Gaussian Radial Basis Function kernel and the forward feature selection wrapper approach was followed. ECGs were allocated to the training, internal validation, and testing datasets in a 3:1:1 ratio.

Results

The percentage of P-waves following the main morphology in all three leads was lower in PAF patients (91.2 ±7.3%) than in healthy subjects (96.1 ±3.5%, p = 0.02). Classification between the two groups highlighted 7 features, while the SVM classifier resulted in a balanced accuracy of 91.4 ± 0.2% (sensitivity 94.2 ± 0.3%, specificity 88.6 ± 0.1%)

Conclusion

An Artificial Intelligence based ECG Classifier can efficiently identify PAF patients during normal sinus rhythm.

Abstract Figure.
P1475Impact of automatic screening and parasternal rights positions in the eligibility of patients with hypertrophic cardiomyopathy for subcutaneous automatic cardioverter defibrillator implant
Authors: Quesada Dorador A , Fernandez C , Quesada-Ocete B , Sancho-Peluz P , Quesada-Ocete J , Martinez J G , Jimenez-Bello J G , Climent Paya V , Paya R , Bochard B , Palanca V , Vano-Bodi J , Simon J M , Perez-Bosca J L , Belchi J
Published: June 2020

Background

A high percentage of failures in the detection of QRS and T wave in patients (pts) with hypertrophic cardiomyopathy (HCM) have been reported. This finding would prevent them from being eligible for an implantable subcutaneous automatic defibrillator (S-ICD). However, recently 2 changes in the detection have been proposed, automatic screening and the use of right parasternal position of the lead. 

The aim of our work was to study if the elegibility proportion of patients  was increased with both 2 advacements.

Methods

We included 31 patients (18 male)with a diagnosis of HCM and at least 1 risk factor for sudden death, in follow-up at the outdoor clinic of of 2 cardiology centers. We performed elegibility screening test in supine position and standing using both the automatic screening (AS) obtained by Boston Scientific Zoom Latitude programmer) and the manual (MS), to simulate the detection of the 3 vectors utilized in S-ICD detection. And both screens were registered with the surface electrodes in parasternal left and right position. A pte was considered eligible if at least one vector was correct in supine position and in standing position, well in parasternal left or right position.

Results

Using MS with left parasternal position, 22 patients (71%) were eligible.  Adding the right parasternal lead, the eligibility increased by 10%,  reaching 81%. In addition, in automatic screening, eligibility in right shifts (81%) it is 7% more than in the left and, with the addition of the rights to the left, the eligibility reaches up to 84%. Figure shows the three-lead ECG factors influencing screening pass vs failure.

Conclusion

AS, right parasternal lead position and the combination of right and left parasternal lead position, increase the eligibility of sICD candidates with HCM.

Abstract Figure. ECG factors influencing screening pass
853Could baseline electrical parameters be a marker of arrhythmia occurrence and poorer prognosis in implantable cardioverter defibrillator patients?
Authors: Zecchin M , Solimene F , D"onofrio A , Zanotto G , Iacopino S , Pignalberi C , Calvi V , Maglia G , Della Bella P , Quartieri F , Curnis A , Biffi M , Giacopelli D , Gargaro A , Pisano" E
Published: June 2020

Funding Acknowledgements

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Background/Introduction: Parameters routinely measured during cardiac devices implantation also depend on bioelectrical properties of the myocardial tissue.

Purpose

To explore the potential association of electrical parameters with clinical outcomes in implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy defibrillators (CRT-D) recipients.

Methods

In the framework of the Home Monitoring Expert Alliance, baseline electrical parameters for all implanted leads were compared by occurrence of all-cause mortality, adjudicated ventricular arrhythmia (VA) and atrial high rate episode lasting ≥7 days (7day-AHRE).

Results

In a cohort of 2,976 patients (58.1% ICD) with a median follow-up of 25 months, events rates were 3.1/100 patient-years for all-cause mortality,  18.1/100 patient-years for VA and 8.9/100 patient-years for 7day-AHRE.

At univariate analysis baseline shock impedance was consistently lower in groups with events than in those without, with a 40 Ohm cut-off  better identifying patients at high risk, but at multivariable analysis the adjusted-hazard ratios (HRs) lost statistical significance for any endpoint.

Baseline atrial sensing amplitude during sinus rhythm was lower in patients with 7-day AHRE as compared to those without (2.40 [IQ: 1.62-3.71] Vs 3.50 [IQ: 2.35-4.66] mV, p < 0.01). The adjusted-HR for 7-day AHRE in patients with atrial sensing >1.5 mV versus those with values ≤1.5 mV was 0.44 (95% CI:0.27-0.72), p = 0.001.

Conclusion

Despite in patients with events a lower baseline shock impedance was observed at univariate analysis, the association lost statistical significance at multivariable analysis. Conversely, low sinus rhythm atrial sensing (≤1.5 mV) measured with standard transvenous leads could identify subjects at high risk of long-lasting atrial arrhythmia.

Abstract Figure. AHRE occurrence by atrial sensing
48Remote monitoring of Heart Failure patients with a Multisensor ICD Algorithm: value of an alert-based follow-up strategy
Authors: Pecora D , Tavoletta V , Dello Russo A , De Ruvo E , Ammirati F , La Greca C , Favale S , Petracci B , Molon G , Montella G M , Santini L , Nozza C , Valsecchi S , Calo L
Published: June 2020

Background

The HeartLogic algorithm measures and combines multiple parameters, i.e. heart sounds, intrathoracic impedance, respiration pattern, night heart rate, and patient activity, in a single index. The associated alert has proved to be a sensitive and timely predictor of impending heart failure (HF) decompensation, and the HeartLogic alert condition was shown to identify patients during periods of significantly increased risk of HF events.

Purpose

To report the results of a multicenter experience of remote HF management with HeartLogic algorithm and appraise the value of an alert-based follow-up strategy.

Methods

The HeartLogic feature was activated in 104 patients (76 male, 71 ± 10 years, left ventricular ejection fraction 29 ± 7%). All patients were followed according to a standardized protocol that included remote data reviews and patient phone contacts every month and at the time of HeartLogic alerts. In-office visits were performed every 6 months or when deemed necessary.

Results

During a median follow-up of 13[11-18] months, centers performed remote follow-up at the time of 1284 scheduled monthly transmissions (10.5 per pt-year) and 100 HeartLogic alerts (0.82 alerts/pt-year). The mean delay from alert to the next monthly remote data review was 14 ± 8 days. Overall, the patient time in the alert state (i.e. HeartLogic index above the threshold) was 14% of the total observation period. HF events requiring active clinical actions were detected at the time of 11 (0.9%) monthly remote data reviews and at 43 (43%, p < 0.001) HeartLogic alerts. Moderate to severe symptoms of HF were reported during 2% of remote visits when the patient was out of HeartLogic alert condition and during 15% of remote visits performed in alert condition (p < 0.001). Out of 100 alerts, 17 required an in-office visit and 5 a hospitalization to manage the clinical condition. Overall, 282 scheduled and 56 unscheduled in-office visits were performed during follow-up. Any HF sign (i.e. S3 gallop, rales, jugular venous distension, edema) was detected during 18% of in-office visits when the patient was out of HeartLogic alert condition and during 34% of visits performed in alert condition (p = 0.002).

Conclusions

HeartLogic alerts are frequently associated with relevant actionable HF events. Events are detected earlier and the volume of alert-driven remote follow-ups is limited when compared with a monthly remote follow-up scheme. The probability of detecting common signs and symptoms of HF at regular remote or in-office assessment is extremely low when the patient is out of HeartLogic alert state. These results support the adoption of an alert-based follow-up strategy.
P328Satisfaction towards clinical training and academic activities among residents and early-career cardiologists
Authors: Nesti M , Tola G , Brunacci M , Santobuono V E , Dendramis G , Picciolo G , Lucciola M T , Russo V
Published: June 2020

Background

Because of the progress in diagnostic and therapeutic cardiovascular disease, the skills to be acquired during fellowship training has increased significantly. In particular, the evolution in arrhythmology and electrophysiology was fast in the last years. This could have created a gap between the training program during the fellowship and the new technologies, growing demand for re-defined educational requirements to ensure uniformity of knowledge and competence of those practicing in electrophysiology.

Purpose

The AIAC (Italian Association of Arrhythmology and Cardiostimulation) Young Pacing committee conducted a survey to obtain information the satisfaction on the educational and training obtained during the residency course by residents and young cardiologists (arbitrarily defined as age ≤ 40 years).

Methods

The survey was conducted from January to May 2019. Residents and young cardiologists were contacted to complete the survey by e-mail. They were asked to answer a questionnaire containing information about scholarly activity included satisfaction of educational and clinical proficiency in arrhythmology and electrophysiology and educational in electrophysiology after the residency.

Results

We obtained 334 answers to the survey. One hundred forty-six individuals (43.7%) were residents and 188 (56.2%) were young cardiologist.

In Electrophysiology Department, 3-6 months were dedicated to Clinical Arrhythmology for 135 partecipants (40.4%), 1-2 months to cardiac pacing for 132 partecipants (39.5%) and 1-2 months to EP Lab for 139 partecipants (41.6%).

Three hundred twenty-nine people responded to questions about satisfaction in educational. In terms of educational in Clinical Arrhythmology, 100 responders (30.4%) were "very satisfied", 105 (31.9%) were "satisfied" and 124 (37.7%) were "dissatisfied". About Cardiac Pacing, 84 responders (25.5%) were "very satisfied", 93 (28.3%) were "satisfied" and 152 (46.2%) were "dissatisfied". Only 51 (15.5%) participants were "very satisfied" with their training in Electrophysiology, whereas 81 (24.6%) were "satisfied" and 197 (59.9%) were "dissatisfied".

About self-assessed clinical proficiency in Arrhythmology at the end of fellowship, 30 responders (9%) defined themselves as completely confident in Clinical Arrhythmology, 126 (37.7%) in Ambulatory Electrophysiology (ECG Holter and device check), 28 (8.4%) in cardiac pacing, 10 (3%) in performing electrophysiological study and nobody in catheter ablation.

One hundred twenty-one (36.8%) participants improved their competence in Cardiac Arrhythmia Management attending courses after fellowship.

Conclusion

The survey underlines the need to fill a gap in order to address the needs of young interventional cardiologists and it may serve as a starting point for developing tailored educational initiatives.
P1506Prolonged and recurrent hospital admissions predict risk of cardiac implantable electronic device infections in hospitalized patients with bacteriaemia
Authors: Esteves A F , Marinheiro R , Parreira L , Mesquita D , Fonseca M , Farinha J M , Pinheiro A , Ferreira J , Amador P , Fonseca N , Silvestre I , Caria R
Published: June 2020

Background

As the use of Cardiac Implantable Electronic Devices (CIED) is expanding, the burden of device-related infections, particularly infectious endocarditis, is also increasing. Furthermore, with the increase in life expectancy, these devices are being implanted in patients who are older, with more serious co-morbidities and who are frequently hospitalized.

Purpose

To assess incidence and predisposing factors for infective endocarditis (IE) in hospitalized patients with CIED and nosocomial bacteraemia.

Methods

We performed a retrospective analysis of all hospitalized patients with CIED and positive blood cultures admitted to the Cardiology department between January 2012 and February 2019. Endocarditis was defined according to modified Duke criteria. We analyzed clinical parameters, device- and procedure-related characteristics, length of hospital stay and hospitalizations in the previous year.

Results

25 patients had positive blood cultures, 4 patients (16.0%) were diagnosed with infective endocarditis (median age 59.25 years, 75.0% male).

Patients characteristics are displayed in the Table.

In univariable analysis, the number and presence of hospitalizations in the previous year and the length of hospital stay was significantly associated with the possibility of endocarditis (respectively, OR 3.411, 95% CI 1.164-9.998, p-value 0.025; OR 18.000, 95% CI 1.375-235.686, p-value 0.028; and OR 1.047, 95% IC 1.001-1.096, p-value 0.046).

Conclusion

In this group of patients with positive blood cultures during hospitalization, the possibility of CIED infection was predicted by the length of hospital stay and the presence and number of hospitalizations in the previous year.

With CIED-IE Without CIED-IE p-value Age in years, median (IQR) 63 (16) 76 (16) 0.002 Heart failure, n (%) 4 (100%) 10 (47.6%) 0.105 LVEF in %, median (IQR) 21 (9) 51 (30) 0.008 LV dilation, n (%) 4 (100%) 8 (38.1%) 0.039 Device revision/upgrade/substitution, n (%) 2 (50.0%) 6 (28.57%) 0.570 LOS in days, median (IQR) 58.5 (83) 20 (15) 0.004 Hospital admissions in the previous year, n (%) 3 (75.0%) 3 (14.3%) 0.031 No. of hospital admissions in the previous year, mean (standard deviation) 1.67 (1.528) 0.29 (0.784) 0.005 Use of central venous access, n (%) 4 (100%) 4 (19.05%) 0.008 LOS – Length of Stay; LV – Left Ventricle; LVEF – Left Ventricle Ejection Fraction
P1106Fundamental differences and predictors of scar arrhythmogenicity in ischemic patients using cardiac magnetic resonance: a propensity score-matching study
Authors: Jauregui B , Soto-Iglesias D , Teres C , Ordonez A , Chauca A , Penela D , Acosta J , Fernandez-Armenta J , Perea R J , Prat-Gonzalez S , Ortiz-Perez J T , Berruezo A
Published: June 2020

Introduction

 Late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) permits to identify the arrhythmogenic substrate (AS) in ischemic patients. However, it is unknown why the majority of them never develop ventricular tachycardias (VT), irrespectively of their left ventricular ejection fraction (LVEF). 

Purpose

 To characterize the fundamental differences and potential predictors of scar arrhythmogenicity in post-myocardial infarction (MI) patients with and without VT.

Methods

 36 consecutive ischemic patients with no arrhythmia evidence underwent a LGE-CMR study 4 years after the MI (controls). Scar data were compared with those obtained from 49 ischemic patients referred for VT substrate ablation (cases). Propensity score matching (PSM) was performed to adjust for age, LVEF, scar mass, and time from MI. The myocardium was segmented in 10 layers (endo- to epicardium), characterizing the core, border zone (BZ) and BZ channels (BZCs) using a dedicated post-processing software.

Results

 Compared to controls, cases were significantly older (67.3 ± 9.1 vs. 56.5 ± 11), had lower LVEF (33.1 ± 10.1 vs. 51 ± 9.4), greater scar mass (33.9 ± 17.2 vs. 14.2 ± 11.6 g), BZ mass (21.1 ± 9.9 vs. 9.6 ± 7.6 g), core mas (12.6 ± 8.8 vs. ± g), number of BZC (2.9 ± 1.4 vs. 1.1 ± 1.1) and BZC mass (10.5 ± 4.2 vs. 2.3 ± 2.4 g) (p < 0.001 in all cases). After PSM (2:1) adjustment[BJG1] , cases had more BZCs (2.9 ± 1.4 vs. 2.2 ± 0.6; p = 0.01) and a greater BZC mass (10.5 ± 4.2 vs. 4.6 ± 2.6 g; p < 0.001). In the multivariable logistic regression analysis, the BZC mass was the only independent predictor of being a case [OR 2.3 (1.5–3.4); p < 0.001]. Receiver operating characteristic curve analysis identified a cut-off point of BZC mass >4.28 g (AUC 0.98; p < 0.001), showing 100% sensitivity and 91% specificity for cases’ discrimination.

Conclusions

 Compared with the cases, an otherwise similar control group (PS-matched for age, LVEF, scar mass, and time from MI) showed fewer BZC and a reduced BZC mass. BZC mass was the only independent predictor of being a case. A BZC mass cut-off point of > 4.28 g showed a 100% sensitivity and 91% specificity for the identification of ischemic patients with documented VT.

Abstract Figure. Mean BZC mass and ROC curve analysis
668Principal component analysis can identify ventricular regions with highest variability in the arrhythmogenic substrate of ventricular tachycardia patients
Authors: Thibault B , Richer L P , Relan J , Mcspadden L , Ryu K , Rivard L , Dyrda K , Dubuc M , Mondesert B , Cadrin-Tourigny J , Tadros R , Macle L , Khairy P , Gregoire J , Harel F
Published: June 2020

Introduction

Left ventricle (LV) substrate can be characterized by imaging modalities providing physiological variables (tissue perfusion, ischemia, etc.) grouped in a complex dataset. Principal Component Analysis (PCA) can identify the dataset variables that best explain its variance. Variables linked to substrate arrhythmogenicity will lead PCA to identify LV regions most influenced by the variables on a LV 3D geometry.

Purpose

To evaluate whether regions identified by PCA correspond to regions targeted by physicians in a ventricular tachycardia (VT) ablation procedure.

Methods

Ischemic VT subjects underwent SPECT/CT perfusion imaging (rest and stress) prior to LV voltage mapping with the cardiac mapping system. Co-registration allowed projection of ablation sites onto SPECT/CT geometries. PCA retrospectively analyzed the following dataset: tissue perfusion (rest and stress), tissue ischemia and the local (1cm2 sub-regions) stress-rest difference for: 1) standard deviation (STD) and 2) skewness (Skew). PCA components (PCAc) explaining ≥85% of the total variance were plotted on the LV 3D geometry to display regions highly influenced by the dataset variables (see figure below).

Results

Ten subjects (9 males, 66 ± 8 years old, LVEF 37 ± 11%) underwent co-registration. In 7/10 subjects, tissue perfusion (in PCAc#1) and ischemia (in PCAc#2) were most influential on LV regions variance. Ischemia and low perfusion (≤40%) areas equaled 32 ± 19 % of the LV with 21 ± 23% of these areas highly involved in the arrhythmogenic substrate (≥75% of explained LV variance). The location of 63 ± 18% of ablation sites were <1 cm from areas explaining ≥50% of LV variance.

Conclusion

Preliminary results showed that PCA can synthesize the influence of different perfusion derived variables, like tissue perfusion and ischemia, used in SPECT/CT imaging of the LV. Further analysis is needed to confirm whether this could be used to select VT ablation targets.

Abstract Figure.
P1493Cardiac contractility modulation in left ventricular systolic dysfunction: 1-year single Centre experience and clinical outcome
Authors: Matta M , Devecchi C , De Vecchi F , Barbonaglia L , Occhetta E , Rametta F
Published: June 2020

Funding Acknowledgements

None

Introduction. Cardiac contractility modulation (CCM) is a treatment option for patients suffering symptomatic chronic heart failure (CHF) with reduced ejection fraction (LVEF) despite optimal medical therapy, who are not eligible for or non-responders to cardiac resynchronization therapy (CRT). Despite randomized trials showing benefit in the short term, data on mid-term follow-up (over 12 months) are limited to small observational studies.

Purpose. The aim of this observation, prospective study is to assess the impact of CCM therapy on quality of life, symptoms, exercise tolerance and left ventricular function in a population of patients with CHF and moderate-to-severe left ventricular systolic dysfunction.

Methods. Consecutive patients suffering from CHF with LVEF <45%, symptomatic, in NYHA class > II despite optimal medical therapy, underwent CCM implantation at our Centre from October 2017 to October 2018. Enrolled patients underwent baseline evaluation and at 3, 6 and 12 months with transthoracic echocardiogram, ECG, clinical assessment, 6-min hall walking test and Minnesota Living With Heart Failure Questionnaire (MLWHFQ).

Results. Overall, 10 patients underwent CCM implantation (100% males, mean age 70 ± 8 years, 80% ischaemic cardiomyopathy, mean LVEF 29.4 ± 8%). All patients had at least one hospitalization for worsening heart failure during the previous 12 months. After a mean follow-up of 15 months, 9 patients were alive, while one patient died for worsening heart failure precipitated by pneumonia 2 months following CCM implantation. Among the remaining 9 patients, LVEF improved non-significantly to 32.2 ± 10% (p = 0.092), 6-min walking test distance improved from 170 ± 132 m to 305 ± 99 m (p < 0.001), mean NYHA class improved from 3.0 ± 0.4 to 1.6 ± 0.5 (p = 0.003) and MLWHFQ score improved from 59.0 ± 33 to 34.0 ± 38 (p = 0.037) (Figure 1). Only 2 patients have been hospitalized during the 12 months, for worsening heart failure and sustained ventricular tachycardia, respectively. Overall, a net clinical benefit was detected in 6 out of 9 patients. Among the responders, 2 patients were device-naïve, presenting LVEF > 35%; one patient was a CRT non-responder, while the remaining 3 had narrow QRS. All the non-responders patients had ischaemic cardiomyopathy, one of them with a moderately reduced LVEF and one with a CRT.

Conclusion. CCM is effective in improving quality of life, symptoms and exercise tolerance, and reduces hospitalizations in patients with symptomatic CHF on top of optimal medical and electrical therapy. The benefit in responders is maintained over one year after implantation, so this treatment should be considered for highly symptomatic patients suffering from CHF and reduced LVEF.

Abstract Figure 1
P507Cumulative comorbidity and survival in out-of-hospital cardiac arrest
Authors: Van Dongen L , Oving I , Beesems S G , Blom M T , Tan H L
Published: June 2020

Funding Acknowledgements

EU Horizon 2020 - 733381, CVON2017-15 RESCUED, CVON2018-30 Predict2, an unconditional grant from Physio-Control Inc., Redmond, WA USA.

OnBehalf

ARREST

Introduction

Multiple chronic health conditions have been associated with survival after out-of-hospital cardiac arrest (OHCA). The influence of cumulative disease burden on survival rates at successive stages of post-resuscitation care is unknown.

Purpose

To study the relationship between cumulative disease burden (Charlson Comorbidity Index [CCI]) and survival rates in the course of post-resuscitation care.

Methods

From a prospective community-based OHCA registry, 2544 OHCA patients aged ≥18y with presumed cardiac cause in 2010-2014 were included. CCI was determined using medical histories from general practitioners and hospital correspondence, and categorized into: no (CCI = 0), moderate (CCI = 1-2) or high (CCI≥3) disease burden. The following stages of post-resuscitation care were defined: (1) pre-hospital: from OHCA to hospital admission, (2) in-hospital: from hospital admission to hospital discharge. The association between CCI and overall survival and survival at successive stages of care was assessed using logistic regression analyses. Results were stratified according to sex.

Results

In the pre-hospital stage, no association between CCI and survival to hospital admission was found (OR 0.93, 95%CI 0.73-0.1.18, P = 0.61) (Figure 1). In contrast, during the in-hospital stage high CCI was significantly associated with lower survival rate (OR 0.41, 95% CI 0.27-0.61, P < 0.01) (Figure 1), but, when stratified according to sex (pinteraction= <0.01), this association was only statistically significant in men (OR 0.34; 95%CI 0.21-0.55; P < 0.01), and not in women (OR 0.68; 95%CI 0.31-1.50; P = 0.33). When assessed individually, OHCA patients with congestive heart failure (24.8% vs. 12.0%, P < 0.01), peripheral vascular disease (11.7% vs. 5.4%, P < 0.01), diabetes (22.0% vs. 13.2%, P < 0.01), renal disease (17.1% vs. 5.9%, P < 0.01), malignancy (17.8% vs. 9.6%, P < 0.01), chronic pulmonary disorder (19.9% vs. 13.7%, P < 0.01),  or dementia (0.3% vs. 3.0%, P < 0.01),  were less likely to survive during the in-hospital stage.

Conclusion

Pre-existing comorbidity burden plays a significant role in OHCA survival, but only during the in-hospital stage. In order to ultimately improve survival after OHCA, in-hospital care needs further study taking pre-existing comorbidity burden into account.

Abstract Figure 1
74Subclinical atrial fibrillation before and after acute medical illness or noncardiac surgery: insights from ASSERT
Authors: Mcintyre W , Wang J , Connolly S J , Benz A P , Conen D , Devereaux P J , Wong J A , Belley-Cote E P , Hohnloser S H , Capucci A , Lau C P , Gold M R , Whitlock R P , Healey J S
Published: June 2020

OnBehalf

ASSERT Investigators

Background

Atrial fibrillation (AF) is frequently detected perioperatively or during acute medical illness. It is unclear if such AF is reversible and unlikely to recur, or is a manifestation of paroxysmal AF.

Objective

To compare the prevalence of pacemaker-detected, subclinical AF (atrial rate >190 bpm) before and after hospitalization for noncardiac surgery or medical illness in patients without a history of clinical AF.

Methods

ASSERT enrolled patients who were >65 years old and had hypertension but no known AF. Pacemakers and defibrillators recorded episodes of subclinical AF. We identified participants who were hospitalized for noncardiac surgery or medical illness, and created heart rhythm profiles, centred on the day of hospitalization. We compared the prevalence of subclinical AF before and after hospitalization. We blanked the 30 days before hospitalization, because of uncertainty in defining the precise onset of illness.

Results

Among 2580 patients, 436 had a documented surgical or medical hospitalization. In the 30 days following a first hospitalization, 43 patients (9.9%) had >1 episode of >6 minutes of subclinical AF; 20 (4.6%) had >6 hours and 13 (3%) had >24 hours.

A higher proportion of patients had >1 episode of subclinical AF >6 minutes in the 30 days following a first surgical or medical hospitalization, as compared to the period between 30 and 60 days before hospitalization (9.9% versus 4.4%, P < 0.001). There was no significant difference when comparing 0-90 days after hospitalization to 30-120 days before (13.7% versus 10.6%, P = 0.1). Similar results were observed for the same comparisons with episodes >6 hours (4.6% versus 2.3%, P = 0.03 and 5.9% versus 5.6%, P = 0.8, respectively).

The majority of patients with subclinical AF in the 30 days following hospitalization had at least one episode of subclinical AF of the same duration in the 6 months prior (50% for episodes >6 minutes; 69% for >6 hours and 60% for >24 hours). Those who did have subclinical AF in the 30 days following hospitalization were more likely to have had subclinical AF in the past 6 months than those who did not (OR 7.2 95%CI 3.2-15.8 for episodes >6 minutes; OR 32.6, 95%CI 10.3-103.4 for >6 hours and OR 36.3 95%CI 9.0-146.0 for >24 hours).

Conclusions

The prevalence of subclinical AF increased following hospitalization for noncardiac surgery or medical illness.  However, most patients with subclinical AF following hospitalization had previously experienced similar episodes, particularly those with longer episodes of subclinical AF.
P1136Is there a negative impact of permanent pacemaker implantation in long-term outcomes after transcatheter aortic valve implantation?
Authors: Carvalho Mendonca T J , Patricio L , Oliveira M , Rodrigues I , Portugal G , Ramos R , Cacela D , Cunha P S , Kahlbau H , Fragata I , Fragata J
Published: June 2020

Introduction

Transcatheter aortic valve implantation (TAVI) is an established treatment in patients (P) with aortic stenosis. Despite the continuous developments of this procedure, high-grade conduction disturbances requiring permanent pacemaker (PPM) implantation is still a major and common complication of TAVI. Furthermore, long-term chronic right ventricular pacing has been associated with negative effects on ventricular function and heart failure (HF).

Aim

  to evaluate the long-term impact of PPM after TAVI focusing on mortality and HF hospitalization.

Methods

 We retrospectively examined P who underwent TAVI with a self-expanding valve from 2009 to 2018 at our institution. All P had pre-procedural clinical evaluation, including ECG, cardiac computed tomographic angiography and transthoracic echocardiography. P with previous PPM were excluded.

Results

 265P (57% male, mean age 81.4 years, 20% with left ventricular ejection fraction <40%) were analysed. Mean STS score and mean Euroscore II were 6.33% and 7.07%, respectively. Mean transvalvular gradient was 52.78 mmHg and mean aortic valve area 0.67 cm2. Forty-seven P (17%) underwent PPM implantation during the first 30 days after TAVI. P requiring PPM had higher prevalence of diabetes mellitus, chronic renal disease, atrial fibrillation and right bundle branch block. During a mean follow-up of 20.3 months, post-TAVI PPM was associated with similar mortality rate (29.8% vs. 25.6%, HR 1.28, 95% CI 0.72-2.29, p = 0.42) and similar cardiovascular mortality (9.8% vs. 6.4%, HR 0.72, 95% CI 0.21-2.4, p = 0.59) compared to P without PPM. There were no significant differences in HF hospitalization (4.9% vs. 2.4%, p = 0.47). Kaplan-Meier curves of total mortality and cardiovascular mortality according to the need for PPM post-TAVI were similar. 

Conclusions

 In P submitted to TAVI, PPM implantation is a relatively common finding, not associated with higher risk of total mortality, cardiovascular mortality or HF hospitalization in a long-term follow-up.
P380Simultaneous endo-epicardial mapping of the human right atrium: unravelling 3-dimensional excitation
Authors: Kharbanda R , Knops P , Van Der Does J M E , Kik C , Taverne Y J H J , Roos-Serote M C , Heida A , Oei F B S , Bogers A J J C , De Groot N M S
Published: June 2020

Funding Acknowledgements

Prof. Dr. NMS de Groot is supported by funding grants from CVON-AFFIP (914728), NWO-Vidi (91717339), Biosense Webster USA (ICD 783454) and Medical Del

Abstract

Introduction & Purpose

Mapping studies demonstrated that endo-epicardial asynchrony (EEA) and conduction disorders, mainly longitudinal dissociation, play an important role in the pathophysiology of atrial fibrillation (AF). The aim of our study was therefore to investigate the correlation between features of conduction disorders assessed in the endo- and epicardial plane and the degree of EEA.

Methods

In 80 patients (63 male (79%), age 66 ± 9 years, 31 history of AF (39%)) undergoing cardiac surgery, simultaneous endo-epicardial mapping (256 electrodes, interelectrode distance:2mm) of the inferior, middle and superior right atrium (RA) was performed during SR. Areas of conduction block (CB) were defined as conduction delays of ≥12ms, EEA as activation time differences of opposite electrodes of ≥15ms and transmural CB as CB at similar endo-epicardial sites.

Results

Amount of CB was highest at the endocardium (endo median:1.9% [0-21.6] vs. epi median:1.1% [0-19.2], all locations p < 0.025) and was more pronounced at the superior RA. Amount of conduction block at both the endo-epicardium combined was higher at the superior RA in patients with hypertension (p = 0.046). Likewise, prevalence of transmural CB and EEA,-up to 84ms-, significantly increased from inferior to superior RA (all p < 0.001). Transmural CB at the inferior RA appeared to be associated with a higher incidence of post-operative AF (p = 0.03). Degree of EEA was also highest at superior RA (superior: 17.5ms [16-21.75] vs mid: 17ms [0-20] and inferior: 0ms [0-17], p < 0.001). Prevalence of CB was correlated with prevalence EEA (r= 0.74-0.87; all locations p < 0.001). In patients with hypertension (p = 0.009), diabetes (p = 0.015) and hypercholesterolemia (p = 0.015), EEA degree was higher at inferior RA. Significantly more CB (p = 0.007) and EEA (p = 0.037) were observed in patients with a history of persistent AF compared to patients without AF history.

Conclusions

This study provides important insights into the complex 3-dimensional endo-epicardial excitation and arrhythmogenesis. Knowledge of 3-dimensional excitation during SR is essential to understand the substrate underlying AF in order to improve (ablative) AF therapy.
671Assessment of irrigated-tip radiofrequency catheter ablation lesion characteristics using different irrigation fluids on ex-vivo bovine myocardium
Authors: Candemir B , Baskovski E , Esenboga K , Yorgun H , Aytemir K , Eralp T
Published: June 2020

Introduction

Certain arrythmias, particularly of ventricular origin, necessitate deep lesions in order to achieve clinical success. The introduction of irrigated-tip radiofrequency (RF) catheters has allowed creation of deeper lesions and has decreased char formation. Although normal saline has been used as a standard solution, recent observations have suggested less ionic solutions may increase lesion depth. In this in-vitro study we aimed to characterize lesions created by irrigated-tip RF catheters using standard normal saline(NS), half-normal saline (HNS), and HNS-%2.5Dextrose (HNS-DEX/2) combination solutions.

METHODS

Bovine myocardium was placed firstly in ringer-lactate bath. Using irrigated-tip RF catheter ablation lesions were created serially using 30, 40, 50, 60, 70Watts with NS, HNS and HNS-DEX/2 as irrigation solutions. Lesion depths, steam pops and impedance drops were measured. Subsequently the experiment was repeated in normal saline bath.

RESULTS

Both HNS-DEX/2 and HNS irrigation solutions increase lesion depths when compared to normal saline (Table 1, Figure 1). Steam pops were more common and earlier with HNS-DEX/2 and HNS.

DISCUSSION AND CONCLUSION

Our findings suggest that less ionic irrigation solutions lead to increased lesion depths using similar RF power. If confirmed in-vivo, HNS and, particularly, HNS-DEX/2 as irrigation solution may increase ablation success for intramural/deep myocardial arrhythmic foci. Additionally, studies to assess safety of this strategy are necessary as intuitively deeper lesions may lead to more complications.

Table 1 Irrigation Solution/Bath solution 30W/30ml(Lesion depth mm)(Impedance drop) 40W/30ml(Lesion depth mm)(Impedance drop) 50W/30ml(Lesion depth mm)(Impedance drop) 60W/30ml(Lesion depth mm)(Impedance drop) 70W/30ml(Lesion depth mm)(Impedance drop) HNS+%2.5D / Ringer Lactate 470->61 4.583->63 5.074->62SP+(32s) 6.080->66SP+(27s) 7.577->65SP+(26s) HNS/ Ringer Lactate 3.590->65 4.580->63SP+(34s) 5.073->59SP+(33s) 5.580->56SP+(28s) 6.583->64SP+(22s) NS/ Ringer Lactate 3.077->60 472->59 4.576->61 5.081->56 674->55 SP+(30s) HNS+%2.5D/Normal saline 3.573->67 598->63 5.573->58SP+(28s) 697->76SP+(26s) 7.570->58SP (25s) HNS/Normal saline 3.563->58 4.066->52 4.567->52 5.575->52 788->60SP+(28s) NS/Normal saline 2.566->58 3.063->52 4.073->58 5.077->55 5.568->44 Lesions created by irrigated tip radiofrequency catheter with bovine myocardium

Abstract Figure 1
P1422Low incidence of major procedure-related adverse events of cryoballoon ablation in real practice: an interim analysis of the Russian national prospective cryoablation registry
Authors: Lubimceva T , Topchyan A , Davtyan K , Poleschenko Y A , Artiykhina E , Tarasiyk E , Kosonogov A , Kryzhanovsky D , Korolev S , Kolunin G , Sagitov I , Nechepurenko A , Gasimova N , Mikhaylov E , Lebedev D
Published: June 2020

OnBehalf

On Behalf Of the National Cryoballoon Registry Investigators

Background

Cryoballoon ablation (CBA) is an effective strategy for atrial fibrillation (AF) management. The Russian Cryoballoon Atrial Fibrillation Ablation Registry (NCT03040037) is a prospective observational multicenter national registry that aims to provide real-world efficacy, safety and outcomes of this technology.

Methods

A specialized Web-based registry platform was developed for prospective data entry. The platform consists of 8 sections: AF ablation clinic experience and operator experience, patient characteristics, CBA procedure characteristics, periprocedural patient management (including drug therapy),  12-moths follow-up with scheduled and unscheduled visits, redo procedure characteristics, early and late procedure-related complications. Patient inclusion criteria were the following: indications for AF catheter ablation, planned CBA, a signed informed consent.

Results

To date thirty-one clinics have joined the Registry, and 830 patients (477 males, a mean age 65.4 ± 11.3 years) were included. The mean BMI was 33.2 ± 3.3 kg/m2. Paroxysmal AF was presented in 688 pts, persistent AF – 111 pts, long standing persistent AF – 31 pts. The main underlying diseases were hypertension (75%), coronary artery disease (11%), chronic heart failure (25%); less commonly - hypertrophic cardiomyopathy (1.4%) and dilated cardiomyopathy (0.7%). The mean LA diameter was 45.4 ± 10.2 mm, and LVEF was 65.4 ± 12.6%.

Periprocedural anticoagulant therapy included

uninterrupted NOACs (313 pts), bridge anticoagulation (327 pts), uninterrupted warfarin (45 pts), anticoagulation initated only after CBA (32 pts). The mean temperature of cryoablation was -44.6 ± 16.3 C. Transesophageal echo-guided  CBA was performed in 92 cases , intracardiac echocardiography-guided - in 465 cases. There were 5 (0.6%) cases of hemopericardium, and pericardiocentesis was required in 1 (0.1%) case only. Periprocedural TIA was diagnosed in 1 (0.1%) patient with bridge anticoagulation, no stroke occurred. Transient phrenic nerve injury was detected in 18 (2.1%) patients, persistent palsy – in 1 (0.1%) patient. Two cases of esophageal injury were reported, no surgery was required and healing was reported in both patients. The data collection is ongoing.

Conclusion

We report early results of the ongoing national CBA Registry. There was a low number of major procedure-related adverse events in real clinical practice among centers with different AF ablation experience. Long-term follow up of the included patients will be reported in the future.

Abstract Figure. Antithrombotic therapy and CBA
P927Electrophysiological features in children with premature ventricular contractions
Authors: Alekseeva K , Kruchina T , Gordeev O , Ginzburg I , Novik G , Egorov D
Published: June 2020

Background

Premature ventricular contractions (PVCs) is the one of the most frequent arrhythmias in children. There is no clear understanding regarding the causes of PVCs in children without structural heart diseases. There is also little information about the state of the conduction system (CS) of the heart in children with PVCs. Purpose:The aims of the study were to estimate the electrophysiological properties of the sinus node (SN) and atrioventricular node (AVN) in children with PVCs, and to evaluate the effect of atropine test on the frequency and nature of the PVCs. Methods: 167 children(54(32,3%) girls and 113(67,7%) boys with PVCs without structural heart disease were examined. Mean age at the time of the first examination was 14,5 ± 5,3years (6-18 years). Examination included: ECG, 24-hour Holter monitor (HM), echocardiogram, treadmill test, transesophageal pacing study (TEPS), atropine test.Results:The duration of the PVCs was 3,3 ± 1,5years (6-14 years). The burden of the PVCs was 7-29% according to HM data. 5(3%) children had syncope. Frequent PVCs were recorded in 43(25,7%) patients, single PVC in 59 (35,3%), and the rest of children did not have PVCs during TEPS. SN recovery time (SNRT) was 1118,1 ± 292,4ms (541-2300ms) which exceeded the age-dependent limit in 23(13,7%) children. Corrected SNRT was 350,1 ± 171,1ms (41-1317ms), which exceeded the age-dependent limit in 15(8,9%) children. Max.rate of 1:1 conduction through AVN was 166,7 ± 39,1 imp/min (90-220 imp/min); in 16(9,6%) children it was less than 120 imp/min, while 8 (4,8%) children had enhanced AV nodal conduction (more than 200imp/min). The effective refractory period (ERP) of AVN was 325,1 ± 91,7ms (190-650ms), exceeding the age norm in 18(10,7%) children. 16(9,6%) children had a discontinuous AV nodal conduction. The frequency of stimulation which suppressed PVCs was 100-160imp/min. Atropine test was performed in 100(59,9%) children (0,1% sol. Atropini sulfatis 0,02 mg/kg IV). After administration of atropine the increase in heart rate constituted 7-131%, with an average of 57%. The SNRT was 665,5 ± 154,4 ms (406-1512ms), maximal rate of 1:1 conduction through AVN was 213,2 ± 31,9 imp/min (150-270 imp/min). Among patients who initially had PVCs during TEPS, after atropine test PVCs disappeared in 61(59,8%) children, in 16(15,7%) children there was a significant decrease, and 4(3,9%) patients had an increase in the number of PVCs and episodes of stable ventricular bigeminy, and in 1(0.9%) child there were short runs of ventricular tachycardia (up to 8 QRS complexes).Conclusions: In children with PVCs normal electrophysiological parameters of cardiac CS were noted in most cases.  In 35% of children there was a hypervagotonic influence on SN or AVN, and in 75,5% cases there was a disappearance or decrease in PVCs after atropine test. This suggests that the preferential nature of PVCs in children without structural heart diseases is autonomic system dependent