bluuebunny/crossref_metadata_2025 huggingface dataset:
P989Incidence of appropriate implantable cardioverter defibrillator therapy and sudden cardiac death in cardiac sarcoidosis - a systematic review and meta-analysis
Authors: Franke K , Marshall H , Kennewell P , Pham H D , Rattanakosit T , Aboustate N , Tully P , Mahajan R
Published: October 2019

Background

Implantation of implantable cardioverter defibrillator (ICD) is a Class IIb indication in patients with Cardiac Sarcoid and with LVEF 36%-49% despite immunosuppression and optimal heart failure therapy.

Purpose

This systematic review and meta-analysis aimed to provide an estimate on the incidence of ventricular arrhythmias and risk of sudden cardiac death (SCD) in patients with CS.

Methods

The terms “Cardiac Sarcoidosis*” AND “Implantable Cardioverter Defibrillator” AND “Sudden Cardiac Death” were searched on PubMed, EMBASE, and Scopus on 21st of September 2018 yielding 759 articles. After exclusions, 12 studies met inclusion criteria.

Results

The 12 studies consisted of 612 patients with CS of which 534 had ICD implanted for primary or secondary prevention. Assuming appropriate device therapy as a surrogate for SCD, the annual incidence of appropriate ICD therapies and SCD combined was 6.3% (95% CI; 3.5%-9.1%) in primary prevention cohorts, 11.6% (95% CI; 7.8%-15.3%) in secondary prevention cohorts, and 8.7% (95% CI; 6.0%-11.5%) in both cohorts. The mean left ventricular ejection fraction (LVEF) was pooled as 59±7 (n=155) in primary prevention cohorts and 48±15 (n=48) in secondary prevention cohorts. However, the LVEF was 35±13 (n=28) in those with appropriate ICD therapy, and 49±16 (n=47) in those with ICDs without therapy.

Incidence of SCD in Combined Cohorts

Conclusion

The incidence of ventricular arrhythmias and SCD is high not only secondary but also in primary prevention cohorts of CS. This data supports the role of implanting ICDs for primary prevention in patients with CS with mild to moderate reduction in LVEF.

Acknowledgement/Funding

None
P993Diagnostic accuracy of cardiac magnetic resonance and endomyocardial biopsy for arrhythmogenic right ventricular dysplasia/cardiomyopathy and myocarditis
Authors: Della Rocca D G , Casella M , Dello Russo A , Gasperetti A , Fassini G , Catto V , Tundo F , Riva S , Ribatti V , Dessanai M A , Pizzamiglio F , Moltrasio M , Carbucicchio C , Natale A , Tondo C
Published: October 2019

Introduction

Patients with myocarditis may fulfill the cardiac magnetic resonance (CMR) criteria set forth by the 2010 Task Force for arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C), thereby increasing the risk of misdiagnosis.

Purpose

We sought to evaluate the role of CMR and endomyocardial biopsy (EMB) in the differential diagnosis between myocarditis and ARVD/C.

Methods

Consecutive patients presenting with ventricular arrhythmias, underwent a complete diagnostic work-out, which included CMR and EMB. The final diagnosis served as the gold standard to assess the diagnostic accuracy of CMR and EMB.

Results

Overall, 74 consecutive patients presenting with VAs underwent a complete diagnostic workout at our institution. The cohort was 70.3% male, with a mean age of 38.9±12.1 years. A final diagnosis of ARVD/C was made in 30 (40.5%) patients, whereas 19 (25.7%) had a diagnosis of myocarditis.

The McNemar's test showed significant differences in the diagnostic performance of EMB and cardiac MRI (p=0.003 for ARVD/C, p=0.04 for myocarditis).

At receiver operating characteristic (ROC) analyses, the area under the curve (AUC) to discriminate between controls and ARVD/C patients was 0.711 (95% CI: 0.59–0.83) for MRI and 0.944 (95% CI: 0.88–1.00) for biopsy (p<0.001). The AUC to discriminate between controls and patients with myocarditis was 0.656 (95% CI: 0.51–0.80) for MRI and 0.893 (95% CI: 0.80–0.99) for biopsy (p=0.006).

Diagnostic performance of CMR and EMB

Conclusion

Even though CMR has good diagnostic performances as single technique, a complete diagnostic work-out including EMB may frequently reduce the risk of misdiagnoses.
P997Improving left atrial appendage occluder size determination by using 3-dimensional printing model of the left atrial appendage
Authors: Cho I , Shin S Y , Kim W D , Kim Y D , Cha M J , Jung H G , Won H Y , Lee W S , Kim T H , Kim C J , Kim S W , Choi Y
Published: October 2019

Introduction

Given the complexity of left atrial appendage (LAA) structure, current 2D based LAA occluder (LAAO) size prediction system using transesophageal echocardiography (TEE) has limitations.

Objective

To assess the accuracy of LAAO size determination method by implantation simulation using a 3D printed model compared with a conventional method based on TEE.

Methods

We retrospectively reviewed 57 cases with percutaneous LAAO using Amplatzer Cardiac Plug and Amulet from 2014 to 2018. We excluded cases without cardiac CT (21 cases) or with peri-device leakage or inappropriate position of the device on six months follow up TEE (6 cases), or with paroxysmal atrial fibrillation (2 cases). We finally included 28 cases with anatomically and physiologically properly implanted LAAO, using the final size of the implanted devices as a standard for the size prediction accuracy. We generated 3D printing model from cardiac CT images. LAAO size was determined with device implantation simulation using 3D printing model and occluder devices (Figure C), and conventional 2D TEE measurements by two experienced cardiologists who were blinded to the size of the finally implanted device.

Results

The accuracy in size of 3D printed left atrium (LA) models, compared with CT image sources, were validated by measuring the distance between artifacts which were intentionally implanted to LA model during image processing. There was minimal bias (−0.11 mm) between 3D images and printed LA models (Figure A). As plotted in Figure B, LAAO sizing by implantation simulation with 3D printing model showed excellent agreement with actually implanted LAAO size (r=0.927; bias=0.7±2.5), while LAAO sizing by 2D TEE measurements remained poor (r=0.544; bias 2.3±6.7).

Conclusions

LAAO size determination by using 3D printing model of LAA showed excellent accuracy. A prospective study to evaluate the clinical utility of this method should be done in future.
P1000Do patients with atrial fibrillation being at high-risk for stroke benefit from concomitant left atrial appendix closure during cardiac surgery
Authors: Kozmik T , Pisarenko J , Mainhard N , Weissenberger W , Mourad F , Shehada S , Balaj I , Wendt D , Tsagakis K , El-Gabry M , Jakob H , Neuhaeuser M , Thielmann M
Published: October 2019

Background

Left atrial appendix, as an essential source of systemic embolism and stroke in patients with atrial fibrillation, can be excluded during cardiac surgery, however the clinical benefit is as yet uncertain.

Methods

A total of 376 out of 3741 consecutive patients with atrial fibrillation presenting a high risk for stroke (CHA2DS2-VASc-Score ≥2 for men and ≥3 for women) who underwent heart surgery with cardiopulmonary bypass between 01/2012 and 12/2015 were analysed for mortality and stroke rate at 30 days, 12 and 24 months. Patients with concomitant LAA-closure alone (group1; n=107) were compared to patients with concomitant surgical ablation and LAA-closure (group2; n=85), and patients without surgical ablation and no LAA-closure (group3; n=184) as controls. To further adjust for pre- and intraoperative risk factors, a propensity score stratification analysis based on patients age, gender, EuroSCORE-2, CHA2DS2-VASc-Score and type of procedure was performed.

Results

Patients age was 72±8 years (mean±SD) and 33% were female. EuroSCORE-2 was 8.7±7.7%, 5.7±3.9%, and 5.4±8.4% and CHA2DS2-VASc-Score was 4.2±1.5, 3.9±1.4, and 4.1±1.4 on average for the respective groups. Mortality did not differ between groups at 30 days, 12 and 24 months. The incidence of stroke was 1.9% at 30 days, 4.8% at 12 and 6.7% at 24 months in group1. There was no stroke at 30 days and 12 months and 1.3% at 24 months in group2, and 1.8% at 30 days, 3.0% at 12 and 24 months in control group3. The overall mortality at 24 months was 27.1%, 20% and 24.6% respectively. After propensity score stratification, stroke rate showed significant benefit in group 2 (P=0.05) at 12 months and a hazard ratio of 0.17, 95% confidents limits 0.02–1.50, (P=0.08) at 24 months, whereas overall mortality did not significantly differ between the groups at 12 and 24 months follow-up.

Conclusions

In this propensity score stratification analysis, patients undergoing cardiac surgery with surgical ablation and concomitant LAA-closure had significant fewer strokes at 12 months follow-up compared to patients undergoing cardiac surgery with LAA-closure alone. Overall mortality did not significantly differ between the groups. Therefore, a concomitant LAA closure during heart surgery without additional surgical ablation does not show any clinical benefit in terms of reduced stroke rate or survival until 12 and 24 months follow-up.
P1007Efficacy and safety of atrial ablation procedures in patients with complete d-TGA and atrial switch at a Swiss tertiary center
Authors: Nozica N , Asatryan B , Noti F , Baldinger S H , Lam A , Haeberlin A , Servatius H S , Seiler J , Schwitz F , Tanner H , Wustmann K B , Delacretaz E , Schwerzmann M , Reichlin T , Roten L
Published: October 2019

Introduction

Patients with complete transposition of the great arteries (d-TGA) and atrial switch face a high lifetime risk of arrhythmias. Interventions in these patients are challenging because of their particular anatomy. Reports on ablation procedures in this patient population are scarce and missing for Switzerland.

Method

We retrospectively analyzed all ablation procedures performed in the above-mentioned population at a Swiss tertiary care center.

Results

Among 73 d-TGA pts. (71% male; N=37 Senning; N=36 Mustard) followed at our center, 17 ablations were performed in 11 pts. (15%; one ablation in 8 pts., two in 2 pts. and five in 1 patient). Median age at first ablation was 34 years (range 15–49 years). A total of 17 different intra-atrial reentry tachycardias (IART) and 3 AVNRT were targeted. Of the IART, 10 were cavotricuspid isthmus (CTI)-dependent and 7 were not. In two procedures (12%) only the systemic venous (SV) baffle was accessed for ablation. In 15 procedures (88%), ablation was performed within the pulmonary venous (PV) baffle. Access to the PV baffle was retrograde via the aorta in 6 cases (35%), via a baffle leak in 3 (18%) and via baffle puncture in 6 (35%). All procedures with retrograde approach to the PV baffle or with SV baffle only ablation were performed up to January 2012 and all remaining procedures afterwards. The 3 pts. requiring repeat procedures had retrograde or SV baffle approaches initially, and one additional ablation via baffle puncture was successful. The CTI was targeted in 10 pts. (91%) and ablation was finally successful in all with bidirectional block demonstrated in 8 pts. The coronary sinus was found to drain into the SV baffle in 5 pts. (46%) and useful for assessment of CTI block. The seven CTI-independent IART were scar-related micro-reentries. Ablation of all 3 AVNRTs was successful after one procedure without recurrence. Slow pathway ablation was performed in the SV baffle in two and in the PV baffle in one case (Figure). After a median follow-up of 7 months (range 2–186 months) 9 pts. are without recurrence and in 2 pts. rare self-limited arrhythmias still occur. No procedural complications occurred.

Conclusion

Arrhythmias in patients with complete d-TGA and atrial switch are mainly CTI-dependent IART or scar-related micro-reentries, and a few patients also have AVNRT. Ablation of these arrhythmias is safe and successful if PV baffle access is achieved via a baffle leak or baffle puncture.
P1010Electrophysiological characteristics of paroxysmal tachycardia in children with short PQ interval
Authors: Oleichuk E
Published: October 2019

Introduction

It is well known that children with short PQ interval can have different types paroxysmal tachycardia (PT). Combination of short PQ interval with PT is called Lown-Ganong-Levine (LGL) syndrome. We have hypothesized that in children with short PQ interval electrophysiological types of PT do not correlate with shortening of PQ interval.

Purpose

The aim of the study was to assess the PT types based on results of the electrophysiological studies and radiofrequencycatheter ablation (RFA), and to estimate the AV conduction parameters and their dynamic changes before and after the procedure. Materials and methods of research: 55 children with supraventricular tachycardia (SVT) and short PQ interval were examined. The examination included:ECG, 24-hour Holter monitor, transesophageal pacing study (TEPS), intracardiac electrophysiological study (EPS). 22 children underwent RFA procedure. During the period of the study 55 children had 111 TEPS and 28 EPS studies.

Results

21 (38,2%) children had orthodromic AV reentrant tachycardia with accessory pathway (AVRT), 27 (49,1%) had typical (slow-fast) AV nodal reentrant tachycardia (AVNRT), 2 (3,6%) had atypical AVNRT, 1 (1,8%) had combination of typical and atypical AVNRT, 1 (1,8%) had atrial ectopic tachycardia combined with atypical AVNRT, 4 (7,3%) had spontaneous atrial fibrillation or atrial flutter, 3 (5,4%) had combination with typical AVNRT and 1 child (1,8%) had AVRT. PQ interval measured 107,2 ms (83–120ms). 22 (40%) children underwent RFA-13 children with typical AVNRT, 9 with AVRT. In children with AVNRT tachycardia cycle length was 229–425 ms (309,8±67,6ms). Primary RFA was effective in 10 (76,9%) children. The AVNRT recurrence was found in 3 (13,6%) cases after 7,2±4,3 month from the time of procedure. After slow pathway ablation PQ interval length didn't change (107,1±9,1ms compared to 108,2±7,1ms; p=0,2). No change occurred with the maximal rate of 1:1 conduction through AV node (187,8±14,8 imp/min compared to187±12,5 imp/min; p=0,2). Effective refractory period of AV node (AVNERP) increased by a small amount (288,9±14ms, compared to 266±42,7ms; p=0,06). 9 (40,9%) children underwent RFA of the accessory pathway (AP). In all of the cases there were concealed AP with the left-sided localization. AVRT cycle length was 259–382 ms (304,2±41,2ms). After RFA of concealed AP maximal rate of 1:1 conduction through AV node increased by a small amount (220±26,4 imp/min compared to 191,2±23,6 imp/min) and AVNERP decreased (256,7±25,2ms compared to 268,6±38,9ms; p=0,09).After RFA of AP PQ interval length didn't change (110±5,9ms compared to 110±5ms; p=0,1).

Conclusion

In children with short PQ interval PT was associated with dual physiology of AV connection or with concealed AP. After the successful RFA in children with AVNRT and AVRT there was no PQ interval normalization, which remained short in all examinations. Thus, short PQ- interval is a co-existing phenomenon in children with AVNRT and AVRT.
P1014Videoassisted thoracoscopic surgery in children with arrhythmias
Authors: Polyakova E , Ildarova R , Kulbachinskaya E , Garipov R , Volkova Y , Grishin I , Termosesov S , Shkolnikova M
Published: October 2019

Videoassisted thoracoscopic (VATS) surgery is one of the surgical approaches for treatment of life threatening in patients with cardiac arrhythmias. Left Cardiac Sympathetic Denervation (LCSD) is an effective treatment in patients with life-threatening tachyarrhythmias, but extremely rarely used in children. Thoracoscopic pacemaker (PM) implantation in patients with bradyarrhythmias is less traumatic and is accompanied by a decrease in the frequency of postoperative complications, but is described only in adults.

Purpose

The aim of our work is to evaluate the safety and applicability of videoassisted thoracoscopic surgery in young patients with cardiac arrhythmias.

Methods

We included in the study 21 children (67% boys) with severe cardiac arrhythmias – catecholaminergic polymorphic ventricular tachycardia (CPVT) – 8 pts, long QT syndrome (LQTS) – 7 pts, atrioventricular block (AVB) – 5 pts, sick sinus syndrome (SSS) – 1 pt.

All pts had VATS surgery – LCSD (low pol of Th1-Th4) in 15 pts and epicardial implantation of PM in 6 pts from the database of the Russian Pediatric Arrhythmia Centre in 2016–2018. All pts with CPVT and LQTS were treated with BB and 8 pts had ICDs implanted.

Examination including personal and family history, ECG, 24-hour Holter monitoring, Treadmill exercise were made before surgery. All pts had structurally normal heart.

Results

The average age was 8.7±5.1 (from 2 to 17). The mean follow-up was 13.5±6.8 months (3 to 27 months). The mean operative time was 87.5 min (52 to 122 min), the blood loss was minimal, and all patients were able to move freely several hours after surgery. No pts experienced Horner's syndrome. No complications in the early and late postoperative period. Children with PM had VVIR or VVI with basic rate 70–75 imp/min and 45 imp/min in 1 pt. The percentage of children with cardiac events or syncope after VATS-S was significantly reduced from 62% to 5% (from 13 to 1).

Conclusions

VATS surgery is safe and associated with reduction of syncope or cardiac events in children with cardiac arrhythmias.
P1018Evolution of atrioventricular conduction disorders after TAVI
Authors: Irles D , Salerno F , Cassagneau R , Eschallier R , Maupain C , Cornet C , Mansourati J , Guedon L , Bouzeman A , Marijon E , Lellouche N , Lebon A , Guignier A , Schatz A , Leroux L
Published: October 2019

Background

The evolution of atrioventricular block (AVB) after Trans Aortic Valve Implantation (TAVI) is poorly understood, and indications of pacemaker (PM) implantation after TAVI not well defined. Modern PM algorithms can help studying the evolution of these AV conduction disorders after TAVI. SafeR® mode (Sorin® PM) allows to monitor precisely the AV conduction and to store AVB episodes in the PM memory as intracardiac electrograms, which can be re-read and validated afterwards.

Methods

From November 2015 and January 2017, all patients implanted in one of the 19 French enrolling centers with a Sorin® PM set in SafeR® mode after TAVI could be prospectively included in the study. All the PM interrogation files were centrally collected. The primary endpoint (PE) was the presence of at least one episode of high grade AVB (HG-AVB) beyond day 7 (D7) to one year after the TAVI. It could be validated either by the presence of a HG-AVB on EKG or telemetry, or by the confirmation of a HG-AVB in the PM memory files.

Results

273 patients were included in the study, the PE was assessable in 197 patients. PE was validated in 74.6% patients. In univariate analysis, the use of an oversized prothesis or balloon, and all early episodes of HG-AVB (all those occurring up to D7) influence the validation of the PE. Other AV conduction disorders have no influence on the PE (Table). In multivariate analysis, only HG-AVB occurring between D2 and D7 has a significant influence on the PE.

Factors influencing HG-AVB after TAVI Studied factor HG-AVB episode(s) during the one year follow up No HG-AVB episode during the one year follow up p value RBBB before TAVI (%) 41 34 0,346 Low implantation (>6mm) (%) 59 37 0,156 Use of Autoexpansive Valve (%) 62 62 0,990 Oversizing (%) 19 6 0,022 HG-AVB per TAVI (%) 56 30 0,001 HG-AVB D0-D1 (%) 53 24 0,001 HG-AVB D2-D7 (%) 68 34 0,001 New or wiser LBBB and improvement of PR interval after TAVI (%) 30 39 0,253 Influence of predefined factors on the Primary Endpoint.

Conclusion

The analysis of the SafeR® algorithm files in patients implanted with a PM after TAVI show a high incidence of HG-AVB during the one year follow up. In multivariate analysis, only HG-AVB occurring between D2 and D7 significantly influence the PE, confirming that AV conduction disorders occurring during the first 24 hours may spontaneously normalize.

Acknowledgement/Funding

Microport CRM
P1022Upstream therapy using preoperative renin-angiotensin system inhibitors in prevention of postoperative atrial fibrillation and adverse events: a collaborative pooled-analysis over 27,000 patients
Authors: Chen S , Schmidt B , Sommer P , Liu S , Krucoff M W , Kiuchi M G , Andrea B , Acou W J , Schratter A , Nagase T , Ling Z , Yin Y , Hindricks G , Puererfellner H , Chun K R J
Published: October 2019

Background

Renin-angiotensin-system inhibitors (RASIs) have been suggested as an upstream therapy for selected AF patients; however, the evidence in surgical setting is limited.

Objective

We aimed to evaluate the role of preoperative RASIs in prevention of postoperative atrial fibrillation (POAF) and adverse events for patients undergoing cardiac surgery.

Methods

In this collaborative pooled-analysis, both randomized and nonrandomized controlled trials comparing preoperative RASIs with no preoperative RASIs treatment on the incidence of POAF were identified. Sensitivity and subgroup analyses of RCTs were performed to test the stability of the overall-effect, and meta-regression to explore the potential risk of bias. The primary outcome was POAF, and the secondary outcomes includes rate of stroke, mortality and duration of hospitalization.

Results

Eleven trials involving 27885 patients (male 74%, median age 65yrs) were included. As compared to the control group, preoperative RASIs did not significantly reduce the risk of POAF (OR: 1.04, 95% CI: 0.91–1.19), stroke (OR: 0.86, 95% CI: 0.62–1.19), death (OR: 1.07, 95% CI: 0.85–1.35), composite adverse cardiac events (OR: 1.04, 95% CI: 0.91–1.18), and hospital stay (WMD: −0.04, 95% CI: −1.05 to 0.98). Pooled-analysis of randomized trials showed consistent results. The primary overall-effect was maintained in sensitivity and subgroup analyses. Meta-regression showed that male-gender was a significant risk-factor of POAF and use of Beta-blockers was associated with a significantly reduced risk in developing POAF.

Conclusion and relevance

This study demonstrates that preoperative RASIs do not offer additional benefit in reducing the risk of postoperative AF, stroke, death and hospitalization in the setting of cardiac surgery. The results provide no support for use of RASIs for the prevention of POAF and adverse events in patients undergoing cardiac surgery.
P1032Efficacy and safety of radiofrequency catheter ablation for atrial fibrillation in patients undergoing hemodaialysis
Authors: Hachisuka M , Hayashi H , Mimuro R , Maru Y , Fujimoto Y , Oka E , Hagiwara K , Tsuboi I , Yamamoto T , Yodogawa K , Iwasaki Y , Ogano M , Hayashi M , Shimizu W
Published: October 2019

Introduction

Although radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF) has become a standard therapy, the ablation outcomes in patients undergoing hemodialysis (HD) has not been fully elucidated. The present study aimed to evaluate the clinical outcomes of RFCA for AF in patients undergoing HD.

Methods

Twenty-three patients undergoing HD (17 men, age 65±8 years, 19 paroxysmal AF) who underwent RFCA for drug-refractory AF in two institutes were enrolled in the study and defined as HD group. The clinical parameters, recurrence free rate and frequency of periprocedural complications were compared to 46 randomly selected age, gender and left atrial diameter matched controls not requiring HD defined as non-HD group (34men, age 67±7 years, 38 paroxysmal AF).

Results

The patients in HD group had a significantly lower body mass index (21±3 vs. 25±3 P<0.01), higher prevalence of coronary artery disease (30% vs. 10% P=0.04), and higher prevalence of congestive heart failure (52% vs. 10% P<0.01) compared to patients in non-HD group. Echocardiography indicated lower left ventricular ejection fraction (57±17% vs. 65±9% P=0.02), higher E/e' (20±8 vs. 12±4 P<0.01), higher tricuspid regurgitation pressure gradient (30mmHg vs. 24mmHg P<0.01) and more impaired left ventricular diastolic function in HD group. All the subjects underwent bilateral pulmonary vein isolation plus additional linear lesion. The number of ablation procedure was similar between the two groups (1.43±0.5 vs. 1.46±0.6 P=0.88). During the follow-up period of 37±25 months after the last procedure, the arrhythmia free rate was similar between the two groups (86% vs. 84% log-rank P=0.82). Vascular access complication occurred in two patients in HD group, and pericardial effusion occurred in one patient in non-HD group, while no life-threatening complications were observed in either group. Cardiogenic cerebral infarction occurred in one patient in non-HD group. Discontinuation of oral anticoagulation after the ablation was more often seen in the HD group compared to non-HD group (91% vs. 60% P<0.01).

Conclusions

Although patients undergoing HD had more impaired left ventricular systolic and diastolic function, RFCA for AF in patients with HD was shown to be as effective and safe as in non-HD patients. RFCA may be an efficient approach to manage AF in patients undergoing HD.
P1035Factors associated with quality-of-life improvement after catheter ablation of atrial fibrillation: insights from the Kansai Plus Atrial Fibrillation (KPAF) registry
Authors: Kanda T , Masuda M , Shizuta S , Kobori A , Inoue K , Kaitani K , Kurotobi T , Morishima I , Nakazawa Y , Tsujimura T , Iida O , Asai M , Mano T
Published: October 2019

Background

Improving the quality of life (QoL) is one of the main purposes of catheter ablation (CA) of persistent atrial fibrillation (AF). Factors associated with QoL improvement after CA of AF patients have not been clarified. The Kansai Plus Atrial Fibrillation (KPAF) Registry is a multi-center registry enrolling more than 5,000 consecutive patients undergoing the first radiofrequency catheter ablation of AF.

Purpose

The aim of this study was to investigate the QoL change after AF ablation and its associated factors.

Methods

A total of 2030 patients in whom the QoL score was assessed before and one year after the ablation were enrolled from the KPAF registry (age 64±10 years, 75% male, paroxysmal 66%, CHADS2 score 1.1±1.1). The QoL was evaluated using the AF specific QoL evaluation method (AFQLQ), which scores the patient QoL within a range of 0–98 points.

Results

Overall, catheter ablation showed a significant increase in the AFQLQ score (68±19 vs. 86±13 points, P<0.01). AF recurrence was observed in 372 cases (18%) during a 1-year follow-up period. A multivariate analysis showed that AF recurrence, symptomatic AF, long AF duration, high preprocedural heart rate (>110 bpm) and small left atrial diameter were independent predictors of a QoL improvement defined as a >10% score increase.

Multivariate analysis

Conclusions

CA of AF significantly improved the QoL. AF recurrence was one of the strong factors associated with QoL improvement. Symptomatic AF, long AF duration, high preprocedural heart rate and small left atrial diameter were independent predictors of QoL improvement.
P1036Acute and long-term ablation results of extra pulmonary vein drivers detected by ultra high density mapping on top of PVI in persistent AF
Authors: Enache B , Latcu D G , Hasni K , Bun S S , Saoudi N
Published: October 2019

Background

Whether ultra-high density (UHD) contact mapping is useful in radiofrequency ablation of persistent atrial fibrillation (AF) is unknown.

Purpose

To sequentially map the left atrial (LA) activation during AF ablation (circumferential PVI and ablation of extra pulmonary vein drivers).

Methods

Time reference was an LA appendage (LAA) electrogram (EGM). Points were acquired with respiratory gating if reference, cycle length (10 ms tolerance) and electrode location were stable. For fragmented EGM the timing of the surrounding area was used. In case of extremely low voltage (<0.01 mV) or lack of local statistical coherence no colour-code was displayed (grey area). Circular propagation around single points was defined as organized rotating drivers (see figure). All pts had PVI followed by remapping and ablation of the centre of rotational regions and at sites with focal type propagation. DC or chemical cardioversion were not performed in the first 48 h.

Results

Out of 41 patients (pts) undergoing first time ablation with the above described protocol, 30 (66±8 y, mean current episode duration 8 months) were followed for a mean time of 14,7 months. At 48 hours post-procedure, 70% of pts were no longer in AF: 6 (20%) in sinus rhythm and 15 (50%) in atrial tachycardias. At 1 year after a single procedure, freedom from AF was 87% and freedom from AF and AT was 60%.

Conclusion

In persistent AF, sequential UHD activation mapping is useful in guiding and potentially improving long term results of ablation of extra pulmonary vein drivers after PVI.
1096Diastolic myocardial dysfunction by tissue doppler imaging predicts outcome following isolated coronary artery bypass grafting
Authors: Olsen F J , Lindberg S , Fritz-Hansen T , Pedersen S , Galatius S , Gislason G , Mogelvang R , Biering-Sorensen T
Published: October 2019

Background

Myocardial tissue velocities by tissue Doppler imaging (TDI) have proven superior predictors of outcome to left ventricular ejection fraction (LVEF) in ischemic heart disease, with early diastolic myocardial relaxation velocity (e') being an early sign of LV dysfunction in the ischemic cascade.

Purpose

We hypothesized that e' predicts outcome after coronary artery bypass grafting (CABG).

Methods

We included patients treated with isolated CABG (n=679). Before surgery, all patients had an echocardiogram performed with TDI to measure tissue velocities: systolic (s'), e' and late diastolic (a'). Endpoint was all-cause mortality retrieved from national registries. We performed Cox regressions and C-statistics. Net reclassification index was used to test improvement of EuroSCOREII.

Results

Of 679 patients, 79 (n=12%) died during follow-up (median: 3.8 years (IQR: 2.8; 5.0y). Follow-up was 100%. Mean age was 68 years, LVEF 50%, and 86% were male. All tissue velocities were univariable predictors of outcome (s': HR=1.46 [1.21; 1.78], p<0.001; e': HR=1.55 [1.33; 1.81], p<0.001; a': HR=1.19 [1.06; 1.33], p=0.004, per 1cm/s decrease for all). Overall, e' provided the highest C-statistics of all the tissue velocities (c-stat=0.69). In multivariable adjustments, e' remained an independent predictor after adjusting for clinical, biochemical and echocardiographic confounders (HR=1.24 [1.03; 1.49], p=0.022, per 1cm/s decrease). LVEF <40% modified the relationship between e' and outcome, so e' did not predict outcome in these patients (p for interaction = 0.013). However, e' was an independent predictor after multivariable adjustments in patients with LVEF >40% (HR=1.39 [1.11; 1.74], p=0.005, per 1cm/s decrease). When split by the median (−4.95cm/s), patients in the lowest group had a 3-fold increased risk of death (HR=3.31 [1.98; 5.56], p<0.001) compared to patients in the highest group (figure).

The e' improved the net reclassification improvement index when added to EuroSCOREII, with a net reclassification of 39%.

Conclusion

After CABG, e' is a strong predictor of all-cause mortality and improves the predictive value of the established prediction model, the EuroSCOREII. We identified a possible effect modifier in LVEF, such that e' was a strong predictor in patients with LVEF >40% and not when LVEF is below 40%.
1170Tafamidis versus liver transplantation as first-line therapy for hereditary transthyretin amyloidosis
Authors: Socie P , Benmalek A B , Lallemand A L , Cauquil C C , Rouzet F R , Le Guludec G L , Samuel D S , Adams D A , Slama M S , Algalarrondo V A
Published: October 2019

Introduction

By stabilizing transthyretin tetramer, tafamidis delays neurological progression in mutated Transthyretin amyloidosis (mATTR) and has replaced liver transplantation (LT) as the first-line therapy in European patients with stage I mATTR. To date, no study compared these two therapeutic strategies.

Material and methods

Stage I mATTR patients treated either with tafamidis or with LT were compared using a propensity score. The primary endpoint was the all-cause mortality. Secondary endpoints were the neurological progression (assessed by a worsening in the PND score) and the cardiac progression of mATTR (defined by a cardiovascular death or the onset or the worsening of symptomatic heart failure).

Results

The files of 345 patients with proven mATTR were analyzed and 144 patients entered the final analysis (72 patients in each group, median age 54 years, 60% carrying the V30M mutation). Patients treated by tafamidis had a better survival than patients with LT (HR: 0.93; 95% CI: 0.17–0.91; P=0.029). Conversely, the worsening-free survival of the neurological status was significantly shorter for patients that received tafamidis than for LT patients (HR: 6.08; 95% CI: 2.97–12.45; P<0.0001). A similar non-significant trend was documented regarding the progression of the cardiac status (HR: 1.99; 95CI: 0.91–4.34; P=0.084).

Conclusions

In mATTR, first-line therapy with tafamidis was associated with a better survival than LT. Conversely, LT provided better neurological stabilization than tafamidis. These results confirm that LT remains a major treatment in mATTR. In patients treated with tafamidis, close follow up of the treatment efficacy is mandatory.
1178Unsuspected role of the cardiac PKA type I in excitation-contraction coupling and in heart failure development
Authors: Gandon-Renard M , Bedioune I , Karam S , Varin A , Lechene P , Bichali S , Leroy J , Algalarrondo V , Stratakis C , Mercadier J J , Benitah J P , Gomez A M , Fischmeister R , Vandecasteele G
Published: October 2019

The cAMP-dependent protein kinase (PKA) consists of two regulatory (R) and two catalytic (C) subunits and comprises two subtypes, PKAI and PKAII, defined by the nature of their regulatory subunits, RIα and RIIα respectively. Whereas PKAII is thought to play a key role in β-adrenergic (β-AR) regulation of cardiac contractility, the function of PKAI is unclear. To address this question, we generated mice with cardiomyocyte-specific and conditional invalidation of the RIα subunit of PKA. Tamoxifen injection in 8 weeks-old mice resulted in a >70% decrease in RIα protein without modification of other PKA subunits, which was associated with ∼2-fold increased basal PKA activity in RIα-KO mice (p<0.05, N=6/group). This translated into enhanced cardiac contraction and relaxation, as observed in vivo by increased fractional shortening and E-wave velocity (p<0.05, N=10/group) and ex vivo by increased LV pressure and maximal rate of contraction and relaxation (p<0.05, N=9/group). L-type Ca2+ current density was increased in ventricular myocytes from RIα-KO, and β-AR stimulation was decreased by ∼50% (p<0.05, n=38 cells for WT, and, n=40 for RIα-KO). Consistently, Ca2+ transients amplitude and relaxation kinetics were increased, along with increased occurrence of Ca2+ sparks and waves (p<0.05, n=44 cells for WT, and, n=50 for RIα KO). Phosphorylation of Ca2+ channels (CaV1.2), PLB, RyR2 and cMyBP-C at PKA sites was increased >2-fold (p<0.05, N=6/group) in RIα KO without modification of total protein expression. With age, these mice developed a congestive heart failure (HF) phenotype with massive hypertrophy and fibrosis which eventually led to death in 50% of RIα-KO mice at 50 weeks (versus 0% in WT, p<0.01). These results reveal a previously unsuspected role of PKA type I in cardiac excitation-contraction coupling and HF.
1206Doxapram is a promising new antiarrhythmic drug for an atrial-specific therapy of atrial fibrillation
Authors: Schmidt C , Wiedmann F , Beyersdorf C , Zhao Z , El-Battrawy I , Kraft M , Lang S , Szabo G , Karck M , Zhou X , Borggrefe M , Thomas D , Haefeli W E , Decher N , Katus H
Published: October 2019

Background

TASK-1 (K2P3.1) is an atrial-specific two-pore domain potassium channel that is significantly upregulated in atrial fibrillation (AF) patients resulting in shortened atrial action potential duration (APD). Inhibition of TASK-1 in human atrial cardiomyocytes reverses AF-related APD shortening to values observed in patients with sinus rhythm (SR). By in silico-modelling and experimental characterization of drug binding sites, doxapram was identified as specific inhibitor of TASK-1.

Purpose

In this study, we investigated the antiarrhythmic efficacy of doxapram in a porcine model of AF to convert and suppress AF.

Methods

We established a new porcine model of persistent AF without induced tachymyopathy. AF was induced in domestic pigs by intermittent atrial burst stimulation using implanted pacemakers. During AF episodes, burst stimulation was inhibited by an integrated pacemaker biofeedback algorithm. AV-node ablation was performed to prevent AF-associated heart failure. All pigs underwent catheter-based electrophysiological investigations prior to and after 14 days doxapram treatment. Pigs in the treatment group received intravenous applications of doxapram twice per day. Rhythm status was continuously recorded by intracardiac long-term ECG monitors. The application of doxapram for cardioversion and long term suppression of AF in pigs with persistent AF was evaluated. Subsequent to the doxapram treatment, porcine cardiomyocytes were isolated from right and left atria and electrophysiologically investigated by patch-clamp and multi-electrode experiments. Atrial electrical remodeling was characterized by analyses of ion channel expression at mRNA and protein levels.

Results

TASK-1 mRNA, protein and transmembrane current were significantly increased in AF pigs compared to SR controls, resulting in shortened atrial APDs. In doxapram-treated AF pigs the AF burden was significantly reduced. After 14 days treatment with doxapram, TASK-1 currents and atrial APDs recorded in porcine cardiomyocytes were reduced and similar to values of SR animals. Doxapram could be successfully applied for cardioversion in pigs with persistent AF. On average, cardioversion was observed 3 minutes after doxapram application.

Conclusion

Doxapram significantly suppressed AF episodes and normalized cellular electrophysiological characteristics in a porcine model of AF through inhibition of the TASK-1 ion channel. Furthermore, doxapram rapidly converted AF into SR in pigs. Therefore, doxapram might serve as a new antiarrhythmic drug to treat AF in patients.
1268A comparison between the diagnostic performance of quantitative flow ratio and non-invasive imaging modalities for diagnosing myocardial ischemia defined by FFR, a PACIFIC-trial interim analysis
Authors: Van Diemen P A A , Driessen R S , Kooistra R A , Stuijfzand W J , Raijmakers P G , Schumacher S P , Bom M J , Everaars H , Min J K , Leipsic J A , Knuuti J , Underwood S R , Van Rossum A C , Danad I , Knaapen P
Published: October 2019

Background

Quantitative flow ratio (QFR) uses fast computational algorithms based on 3-dimensional quantitative coronary angiography and estimation of contrast flow velocity during invasive coronary angiography (ICA) to obtain QFR values equivalent to fractional flow reserve (FFR).

Objective

To compare the diagnostic performance of QFR with coronary computed tomography angiography (CCTA), single-photon emission tomography (SPECT), and positron emission tomography (PET) for diagnosing myocardial ischemia defined by FFR.

Method

QFR computation was attempted in 109 patients (286 vessels without a subtotal/total lesion) of the 208 patients included in the PACIFIC-trial. Patients underwent 256-slice CCTA, Tetrofosmin SPECT, and [15O]H2O PET prior to ICA in conjunction with 3 vessel FFR measurements. ICA images were obtained without the use of a dedicated QFR acquistion protocol. QFR was calculated using a fixed empiric hyperemic flow velocity (fQFR) as well as using a patient specific flow velocity based on contrast passage through the coronary (cQFR). All analysis were performed on a per vessel level.

Results

Fixed QFR computation succeeded in 152 (53%) vessels while cQFR analysis was successful in 140 (49%) vessels. A good correlation between FFR and fQFR/cQFR was observed (R=0.774, p<0.001/R=0.790, p<0.001). The diagnostic performance in terms of sensitivity, specificity, negative predictive value, positive predictive value, and accuracy is presented in table 1. In total, 133 vessels with matched FFR, fQFR, cQFR, CCTA, SPECT, and PET results were available for the comparative C-statistic analysis, figure 1. The diagnostic performance of fQFR and cQFR was comparable (p=0.451) and superior to CCTA (p=0.004/p=0.003), SPECT (p<0.001/p<0.001), and PET (p=0.008/p=0.006), figure 1. CCTA, and PET performed alike (p=0.568) and outperformed SPECT (p=0.023, p=0.002).

Table 1 % (95% Confidence Interval) fQFR n=152 cQFR (n=140) CCTA (n=152) SPECT (n=150) PET (n=149) Sensitivity 76 (59–89) 71 (53–86) 70 (51–84) 30 (16–49) 76 (58–89) Specificity 94 (88–98) 93 (86–97) 73 (64–81) 96 (90–99) 80 (72–87) Negative Predictive Value 93 (88–96) 92 (86–95) 90 (84–94) 83 (79–86) 92 (86–96) Positive Predictive Value 79 (64–89) 74 (59–85) 42 (33–51) 67 (42–84) 52 (42–62) Accuracy 90 (84–94) 88 (81–93) 72 (65–79) 81 (74–87) 79 (72–85)

Figure 1.

Conclusion

Fixed QFR and cQFR correlate well with FFR with a high diagnostic accuracy as result. QFR outperformed CCTA, SPECT, and PET for the diagnosis of myocardial ischemia on a per vessel basis with the important footnote that fQFR and cQFR could only be computed in 53%, and 49% of the vessels.
1270Early systolic lengthening in patients with ST-segment elevation myocardial infarction: a novel predictor of cardiovascular events
Authors: Brainin P , Haahr-Pedersen S , Olsen F J , Fritz-Hansen T , Jespersen T , Gislason G H , Biering-Soerensen T
Published: October 2019

Background

Early systolic lengthening (ESL) may occur in ischemic myocardial segments with reduced contractile force. We sought to evaluate the prognostic potential of ESL in patients with ST-segment elevated myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI).

Methods

We prospectively enrolled 372 patients with STEMI who were treated with primary PCI. All patients underwent a speckle tracking echocardiographic examination with a median of 2 days (interquartile range 1, 3 days) after the PCI. We assessed a novel viability index, the ESL index, defined as: (100 x [peak positive systolic strain/peak negative global strain]), obtained as the average value from all 18 segments. We also calculated ESL duration from 18 segments, defined as time from onset of QRS complex on the electrocardiogram to time to peak of positive systolic strain.

Results

During a median follow-up time of 5.3 years (interquartile range 2.5, 6.0), 145 (39%) experienced major adverse cardiovascular events (MACEs), which was a composite of incident heart failure, new myocardial infarction and all-cause mortality. The ESL index and ESL duration were significantly increased in culprit lesion areas (6.7±6.2% vs. 5.0±4.1% and 43±33ms vs. 33±24ms, P<0.001 for both). In Cox proportional hazards models the ESL index (HR 1.27 per 1% increase, 95% CI 1.13–1.43, P<0.001, Fig A) and ESL duration (HR 1.49 per 1ms increase, 95% CI 1.15–1.92, P=0.002, Fig B) yielded prognostic information on MACE. Both associations remained significant after adjusting for clinical (age, sex, hypertension, heart rate), echocardiographic (LVMI, E/e', WMSI, LVEF, postsystolic index) and invasive (postprocedural TIMI flow, TnI) confounders. Additionally, tertiles of the ESL index and ESL duration yielded significant prognostic information on MACE (Fig C-D).

ESL index and ESL duration and MACE

Conclusions

Assessment of ESL following primary PCI in patients with STEMI yields independent and significant prognostic information on the future risk of cardiovascular events.
1271Short-term effects of exposure to ambient fine particulate matter on out-of-hospital cardiac arrest: a nationwide case-crossover study in Japan
Authors: Zhao B , Johnston F H , Salimi F , Negishi K
Published: October 2019

Introduction

The cardiovascular health consequences of ambient air pollution generally equal or exceed those due to pulmonary diseases and cancers. Particulate matter less than 2.5μm in aerodynamic diameter (PM2.5) has become a major focus of research on the short-term exposure to air pollution and cardiovascular disease. However, the evidence regarding the association between several air pollutants and out-of-hospital cardiac arrest (OHCA), has been inconsistent, which could be due to limited sample sizes (∼11,000). Thus, a larger study may assist in characterising possible associations.

Purpose

This study aimed to identify the associations between exposure to ambient air pollution and the incidence of OHCA in Japan.

Methods

A case-crossover design was used to determine the odds ratio (OR) of OHCA across Japan with daily exposure of PM2.5, carbon monoxide (CO), photochemical oxidants (Ox), and sulfur dioxide (SO2) on the day of the arrest or 1–3 days before it (lag 0–3). OHCA cases were identified through the All-Japan Utstein registry of the Fire and Disaster Management Agency from January 1, 2014 to December 31, 2015. All cause OHCAs were investigated by conditional logistic regression adjusted for daily temperature and relative humidity.

Results

A total of 249,372 OHCAs were included during study period. Each 10 μg/m3 increase in daily PM2.5 exposure over 4 days was associated with all cause OHCA risk (lag 0: OR 1.017, 95% confidence interval (CI) 1.010, 1.024; lag 1: OR 1.015, 95% CI 1.008, 1.022; lag 2: OR 1.018, 95% CI 1.011, 1.025; lag 3: OR 1.021, 95% CI 1.014, 1.028; lag 0–1: OR 1.022, 95% CI 1.014, 1.030). CO, Ox and SO2 also showed significant associations with OHCAs. In the multi-pollutant model, the effects of PM2.5 remained independent of CO, Ox and SO2 (Table).

Conclusion

Short-term exposure to PM2.5 was independently associated with an increased risk of OHCA.