bluuebunny/crossref_metadata_2025 huggingface dataset:
P1452Low fluoroscopy approach with a novel ablation technology in right side procedures: a large multicenter experience from the CHARISMA registry
Authors: Cauti F M , Piro A , Di Belardino N , Tola G , Anselmino M , Pecora D , Scaglione M , Rossi L , Pedretti S , Solimene F , Mantovan R , Di Cori A , Rossi P , Iaia L , Bianchi S
Published: June 2020

Funding Acknowledgements

NO FUNDING

Background

Electrophysiological studies and ablation procedures expose both physicians and patients to a significant amount of radiation. Nowadays, most of 3-D mapping systems allow for improved tracking of catheters with possible reduction in radiation exposure. No data exists on the ability to minimize fluoroscopy time and dose while using the Rhythmia mapping system.

Purpose

To report preliminary data on feasibility and safety of a low fluoroscopic approach using the Rhythmia mapping system in SVT procedures.

Methods

The CHARISMA study is a non-randomized, multicenter, prospective study in which consecutive patients indicated for arrhythmia were enrolled. For our purpose consecutive right-side procedures performed through a low fluoroscopy approach with the Rhythmia mapping system were analyzed. The mapping system was used to create the 3D geometry of chambers of interest and anatomic reference points and to visualize the catheters from the beginning to the end of the procedure. Fluoroscopy was used only if deemed necessary.

Results

204 unselected consecutive cases of SVT from 11 centers were included in the study (mean age = 55 ± 18 years, 53% male, 85 AVNRT, 75 AFL, 28 AP, 9 AT and 7 other right atrial procedures). In all the cases, diagnostic EP and ablation catheters were positioned using only the low fluoroscopic guided mapping approach. During the study, a total of 7157 s of fluoroscopy was needed in 204 patients (51 ± 137 s per procedure). One hundred fourty-one procedures (69%) were completed with less than 10 seconds of fluoroscopy, whereas in 169 (83%) of the cases the fluoroscopy time was lower than 60 seconds. Low fluoroscopy approach with less than 10 seconds was less frequently obtained in case of AFL (46, 61.3%) compared to AVNRT ablation (65, 76.5%, p = 0.041) whereas no differences were found comparing with AP (21, 75%, p = 0.248). The median reconstructed RA volume was 94[65-133] ml in a median mapping time of 11 [6-16] min. The median number of radiofrequency ablations to terminate each arrhythmia was 5 [3-12] (total RF delivery time of 293 [180-505] sec). A 100% rate of acute success was observed in our case series. No complications occurred.

Conclusions

In our preliminary experience, arrhythmias ablation through low fluoroscopy approach and the use of a novel ablation technology seems to be safe, feasible, and effective in common right atrial arrhythmias. Use of fluoroscopy can be nearly avoided in most cases, without any reduction of the safety and effectiveness profile.
P1440Left atrial appendage closure for stroke prevention in nonvalvular atrial fibrillation with Watchman device versus Amplatzer Cardiac Plug. Results of the multicenter Russian trial
Authors: Davtyan K V , Simonyan G , Kalemberg A A , Topchyan A H , Lebedev D S , Mozgovoy P V , Romanov A B , Shabanov V V , Merkulov E V , Pevzner D V , Boytsov S A , Drapkina O M
Published: June 2020

Background

The data are limited on comparative efficacy and safety of the left atrial appendage occlusion (LAAO) using the Watchman device (WD) and Amplatzer Cardiac Plug (ACP) for stroke prevention in nonvalvular atrial fibrillation (AF) patients.

Objective

To assess the safety and efficacy of the WD compared with ACP for stroke prevention and adverse events in patients with AF.

Methods

200 consecutive patients (median age 67.5yrs, 94 female, median CHA2DS2VASc score - 4, median HASBLED score 3) with nonvalvular AF and contraindications to oral anticoagulation therapy from 5 medical centers in Russia, who undergone LAAO implantation using WD (n = 108; WD group) and ACP (n = 92; ACP group) were enrolled into this study. The coprimary end point was the composite of TIA/stroke and procedure-related complications during follow up.  Secondary end points included successful LAA occluder implantation rate and incidence rates of significant leakage. Patients were followed at 45 days, 3, 6 and 12 months after enrollment. At each follow-up visit the data regarding clinical events and healthcare utilization were collected.

Results

During the follow-up TIA/stroke has occurred in 6.2% of patients in the WD group with no such events in ACP group (6.2% vs 0%, p = 0.012). The composite safety-efficacy survival rate in WD group was 91.7% versus 92.4% in ACP group (p = 0.85). The periprocedural major complications rate (pulmonary trunk perforation with fatal haemotamponade, nonfatal haemotamponade with pericardiocentesis, device embolisation) was significantly higher in ACP group compared with WD group (5.4% vs 0%, p = 0.005). There was no significant difference in overall events rate between groups (3.7% vs 7.6%, p = 0.2). Successful LAA occluder implantation was performed in all 92 (100%) patients with ACP and in 105 (97,2%) with WD (p = 0.053). The significant leakage (≥5mm) was 3.03% in WD group with no such events in ACP group (3.03% vs 0%, p = 0.059).

Conclusion

LAAO using ACP was associated with higher major procedure-related complications rate. Despite a higher TIA/stroke rate in WD group, the composite efficacy and safety survival rate of LAAO using the WD and ACP was comparable during 12 month follow up.
P337Homozygous polymorphism of gene transcription factor SP4 is associated with hereditary sick sinus syndrome
Authors: Chernova A , Nikulina S , Shulman V , Voevoda M , Maksimov V
Published: June 2020

PURPOSE

The human transcription factor SP4 has functional polymorphism on А80807Т. Our study aimed to confirm that gene transcription factor SP4 polymorphism affect hereditary sick sinus syndrome.

METHODS

Polymerase chain reaction-restriction fragment length polymorphism was used to screen for А80807Т. We genotyped polymorphism А80807Т of the transcription factor SP4 in 109 patients with hereditary sick sinus syndrome, 59 their healthy relatives and 196 control subjects. Structure of primers was as follows: 1) 5’-aaatgaggacaatgaaaagcaca-3’- direct (A)  2)  5’-gcctaagctgctactatttcagtg3’- reverse(A - com) 3)  5’-catttctcaattgcctgctataga-3’ – reverse (T) 4)  5’-actgttgccctttgttgcca-3’ – direct (T - common), 

RESULTS

Patients with the T80807Т genotype shaved associate with hereditary sick sinus syndrome  more frequently than in controls and those with А80807Т and А80807A (P < 0.05). Presence of a T80807Т genotype was associated with an increased odds of having hereditary sick sinus syndrome.

CONCLUSIONS

Our data suggest that patients with the T80807Т genotype of the gene transcription factor SP4 are at increased risk to develop hereditary sick sinus syndrome.
70Autonomic dysfunction in atrial fibrillation (AF) patients: absent vasomotor reflex to decreased cardiac venous return during af in comparison to sinus rhythm; implications for earlier rhythm control
Authors: Malik V , Mishima R , Elliott A , Emami M , Roberts-Thompson K , Mahajan R , Arnolda L F , Lau D H , Sanders P
Published: June 2020

Funding Acknowledgements

Dr Malik is supported by an Australian Postgraduate Award Scholarship from the University of Adelaide.

OnBehalf

Centre for Heart Rhythm Disorders, University of Adelaide & Royal Adelaide Hospital

Background

A bi-directional relationship exists between AF and the autonomic nervous system (ANS). Patients with AF studied in sinus rhythm (SR) have impaired vasomotor responses to decreased cardiac volume. Whether autonomic dysfunction worsens during AF itself, is unknown. 

Purpose

We examined haemodynamic responses to lower body negative pressure (LBNP) in patients with persistent AF compared to AF studied in SR. LBNP decreases cardiac volume, deactivates atrial stretch receptors and induces a reflex to maintain blood pressure by increasing systemic vascular resistance (SVR). 

Methods

21 consecutive patients with paroxysmal or persistent AF were studied; during AF (n = 8) or SR (n = 13). Anti-arrhythmic and anti-hypertensives were withheld for 5 half-lives. Patients underwent LBNP using a custom-made chamber sealing both lower limbs. Negative pressure at sham (-0 mmHg), low (-20 mmHg) and high level (-40 mmHg) was applied for 5 minutes each. Finger photo plethysmography was used for beat-beat-blood pressure. Computation of SVR during AF is not feasible with this method. Therefore, the right forearm was used to perform venous occlusion plethysmography (VOP); non-invasive, well validated with LBNP and impervious to AF: to estimate forearm blood flow (FBF) and SVR (inversely proportional). 

Results

Baseline characteristics and responses to LBNP are presented in Table 1. MAP was maintained, and HR rose slightly, in the SR group. MAP and HR decreased in the AF group. VOP demonstrates a reduction in FBF in the SR group (vasoconstriction); whereas the vasomotor response to LBNP was absent during AF. Figure 1 (Panels A-C). 

Conclusion

The presence of AF is associated with autonomic dysfunction from impaired cardiac volume regulation. This novel finding may contribute to the known risk of falls and syncope due to AF. Further studies are needed to evaluate whether abnormal cardiac reflexes are involved in atrial remodelling and AF progression.

Table 1 Baseline Characteristics During AF During SR P Value Age 65 ± 5 59 ± 3 0.4 AAD & Anti-HTN medications withheld (%) 75 85 0.6 Resting mean arterial pressure (MAP) 109 ± 9 93 ± 6 0.1 Resting heart rate (HR) 94 ± 6 60 ± 4 0.0001* Haemodynamic response to LBNP % Δ MAP due to LBNP -9 ± 5 +0.5 ± 3 0.2 % Δ HR due to LBNP -6 ± 3 +5 ± 3 0.03* % Δ FBF due to LBNP +75 ± 59 -27 ± 8 0.02* AAD Anti-arrhthmic. HTN: Hypertension. Mean +/- SEM.

Abstract Figure. Vasomotor response to LBNP: in AF vs SR
P1064Using Data Mining to Predict Bleeding Events caused by Novel Oral Anticoagulants
Authors: Chiou W R , Hsieh M C , Chuang H N , Huang C C , Chuang J Y , Lin P L , Lee Y H
Published: June 2020

Background

Novel oral anticoagulants (NOAC) is important in preventing thromboembolism in atrial fibrillation (AF) patients. Bleeding risk was evaluated by HAS-BLED score traditionally. Data mining is a relatively new discipline that has sprung up at the confluence of several other disciplines, driven primarily by the growth of large databases. 

Purpose

This study aimed to find a useful predictive model by data mining to assess the risk of rivaroxaban, an antithrombotic drug that causes bleeding in AF patients. The seven parameters of the HAS-BLED score were used to predict the effect of rivaroxaban on bleeding tendency in AF patients and may provide clinicians with appropriate treatments to avoid complications from bleeding events and reduce the incidence of health damage.

Methods

Through conducting a multicenter retrospective study, we identified patients with AF who were treated with rivaroxaban for more than 1 month between December 1, 2011 and November 30, 2016. After preprocessing, the established data were used for training and testing of data mining models. This study evaluated four models, including association rules, neural networks, Bayesian classification, and decision trees.

Result

Of the 872 enrolled cases, 432 were in any of the bleeding groups and 432 were in the non-bleeding randomized control group. After comparing the overall classification accuracy, omission error and over-prediction error, the decision tree proved to be the most accurate model for bleeding prediction. The overall classification accuracy is 77%, the omission error is 15%, the over-prediction error is 21.9%, and the AUC score is 0.84. The results show that the model has good discriminative ability and visibility of decision rules.

Conclusion

Among several data mining models, decision tree proved to be the most accurate model for bleeding prediction. The conclusion of this study can be used as a reference for supporting decision making before anticoagulation treatment and suggest future research to compare efficacy of bleeding prediction between HAS-BLED score and decision tree.

Data mining comparison Model Omission error Commission error Overall accuracy AUC score Ranking Decision tree 15.0% 21.90% 77.00% 0.84 1 Association rules 16.8% 27.20% 76.50% 0.81 2 Neural networks 12.0% 26.40% 78.20% 0.83 3 Bayesian classification 16.1% 27.50% 76.50% 0.83 4
1256Monitoring of TLE procedure using TEE does it influences for procedure efficacy ? The comparison of two large populations (1058 and 2068 patients)
Authors: Nowosielecka D , Tulecki L , Tomkow K , Kleinrok A , Jachec W , Polewczyk A , Kutarski A
Published: June 2020

Background

To improve safety of lead extraction monitoring by using continuous TEE was proposed and introduced recently (after the introduction of cardiac surgeon presence, optimal venue such as hybrid room, arterial line etc). However, until now it is not proved that it works in practice.

Objective

The goal of this study was to compare TLE effectiveness and safety between two large group with TLE performed with and without TEE monitoring.

Methods

During last 15 years 3126 TLE were performed; 5183 leads (1-6 leads, aver 1,65, with mean implant duration time 95,7 mth) were extracted using - as first line - non-powered mechanical tools.

Results

In spite of the fact that the group which was monitored with TEE was sicker (Carlson’s index, lower EF), had more TLE risk factors (implant duration) and TLE procedure was much more difficult (more technical problems) – the TLE effectiveness was better (more radiological, clinical and procedural success, less partial radiological success) and major complications was even slightly less frequent. Unexpected differences in mid-term mortality can be explained by different rate of infective indications or lead remnant influence.

Conclusions

Results seem to indicate favourable effects of utility TEE for TLE procedure monitoring.

Abstract Figure.
P925Cardiac autonomic dysfuntion in adult patient with uncorrected atrial septal defect : a role of pulmonary arterial hypertension
Authors: Jomansyah U , Maharani E , Dinarti L K , Anggrahini D W , Hartopo A B
Published: June 2020

Background

Atrial Septal Defect (ASD) is a congenital heart disease that often under-diagnosed in youth. Atrial septal defect has a poor clinical manifestation at Pulmonary Arterial Hypertension (PAH) condition. Cardiac autonomic dysfunction may occur in PAH due to over sympathetic activation. This condition in general population is associated with increase risk of sudden cardiac death. Despite the case, there are only limited studies which associated cardiac autonomic dysfunction and PAH in adult patient with uncorrected ASD.

Purpose

This study aims to compare cardiac autonomic dysfunction, using heart rate variability, in adult patient with uncorrected ASD between PAH and non-PAH group.

Methods

Adult (18+) patient with uncorrected ASD who listed in ASD registry in Indonesia, were selected in this analytical observational study. Patients in whom no other congenital defect and atrial fibrillation in electrocardiogram were eligible for inclusion. Diagnose of PAH was established when mean pulmonary arterial pressure value from right heart catheterization is ≥ 25 mmHg. Arrhythmias and heart rate variability, using Standard Deviation of Normal-Normal (SDNN), High Frequency (HF) and Low Frequency (LF) parameters, were collected from holter monitoring. These procedures were performed on the same day.

Results

We enrolled 55 adult patients with uncorrected ASD (mean age: 33.3 ± 10.3 years, 89.1% women), consist of 51 secundum ASD, 3 sinus venosus ASD and 1 primum and secundum ASD patient. They were divided into PAH group (28 patients) and non-PAH group (27 patients). Patients in PAH group had a higher incidence of paroxysmal atrial fibrillation and ventricular extrasystole compare to those in non-PAH group (28.5% vs. 14.8% and 75% vs. 70%). All parameters of heart rate variability was significantly reduced in PAH group compare to non-PAH group (SDNN : mean difference 14.5 ± 2.98 ms, CI 95%, P < 0.001; HF : median difference 99.5 ms2, P < 0.001; LF : median difference 129.6 ms2, P < 0.001).

Conclusion

A marked reduction in cardiac autonomic function occur in adult uncorrected ASD patient with PAH compare to patient with non-PAH, that might be the result of decreasing baroreceptor and increasing chemoreceptor function in PAH.
P1507Experience in chronical lead extraction with ablation catheter and snare via femoral route
Authors: Uslu A , Kup A , Demir S , Balaban I , Gulsen K , Karagoz A , Kepez A , Akgun T
Published: June 2020

Background

  Transvenous lead extraction may become a complicated process and special sheath systems used for extraction may not be available in the laboratory. Transvenous lead extraction from femoral vein by using ablation catheter and snare may be an alternative and cost-effective method to transvenous lead extraction with specialized lead extraction sheaths. The aim of the present study is to evaluate the factors that may be associated with the use of transfemoral technique during extraction of chronically implanted leads.

Methods

We retrospectively analyzed consecutive patients who underwent transvenous extraction of pacemaker, cardiac resynchronization therapy (CRT) and intracardiac defibrillator (ICD) leads in our institution in between 01.01.2016 and 01.01.2019. The indications for lead extraction were based on the European Heart Rhythm Association recommendations.  Manual traction was applied to all leads at the beginning of each case. If manual traction was not successful, a subclavian approach by using locking stylet (Liberator Universal Locking Stylet, Cook Medical)  or femoral approach was used. Femoral approach was performed using the flexible 13F long sheath and a second sheath for ablation catheter. Ablation catheter was wrapped around the lead and the tip of the ablation catheter was caught with gooseneck snare. Downward traction was applied on the body of the lead by using ablation catheter and gooseneck snare complex to release either end of the lead.

Results

A total of 160 leads in 94 patients were extracted during the time interval between 01.01.2016 and 01.01.2019. The indications for extraction were cardiac device related pocket erosion and infection  in 71 (75.6%) and lead failure in the 23 (24.4%) cases. Extracted system was ICD in 48 (51.1%), CRT in 9 (9.6%) and pacemaker in 37  (39.3%) cases. The median time from the preceding procedure was 62.5 (IQR:32.3- 95.3) months. Lead extraction was performed by manual traction in 35 (37.2%) patients, by locking stylet method in 7 (7.4%) and by femoral approach in 52 (55.3%) patients. Clinical success was achieved in  93 (98.9%) cases and all of the patients discharged uneventfully without a major complication as death, cardiac avulsion or tear requiring pericardiocentesis or emergent surgery. Procedural success with femoral approach was achieved in 51/52 (98%) patients (99 leads). Ordinal regression revealed  the time from the preceding procedure as the only parameter that was significantly associated with the usage of femoral approach (OR:1.065 ( 95% CI 1.039-1.100) p < 0.001).

Conclusion

Based on our experience, transfemoral approach by using ablation catheter and gooseneck snare seems to be an effective and safe method for chronically implanted lead extraction. It may be particularly be useful when manual traction is unsuccessful and special toolkids are not available for extraction.
P536Reverse remodeling after cardiac resynchronization therapy is associated with improvement of contractile asymmetry in the area of left ventricular lead position
Authors: Zaremba T , Tayal B , Thogersen A M , Riahi S , Sogaard P
Published: June 2020

Background

One third of patients receiving cardiac resynchronization therapy (CRT) do not respond to the treatment, possibly due to suboptimal lead position and persistent dyssynchronous left ventricular (LV) contraction.

Purpose

To assess the influence of LV lead position on improvement of contractile asymmetry and its significance for LV reverse remodeling after CRT.

Methods

Patients with heart failure and left bundle branch block undergoing CRT implantation were studied retrospectively. Assessment of mechanical delay within the LV was assessed using a recently developed index of contractile asymmetry (ICA). ICA was calculated as standard deviation of differences in systolic strain rate in the opposing LV walls derived from curved anatomical M-mode plots. LV was divided into 12 equally sized 30-degree sectors. Spline interpolation was used to estimate ICA in six opposing sector pairs permitting quantification of regional contractile asymmetry in the entire LV. Position of LV lead tip was assessed by thoracic computed tomography (CT). Response to CRT was defined as a reduction of LV end-systolic volume (ESV) ≥15% after 6 months.

Results

Study population (n= 26) consisted of 65.4% males, 68 ± 10 years, ischemic etiology in 42.3%, LV ejection fraction 24.1 ± 5.8%, QRS duration 171 ± 22 ms. CRT response was present in 18 (69.2%) patients. Pre-implantation ICA in the LV sector containing LV lead was 0.75 ± 0.24 s-1 in responders vs. 0.46 ± 0.16 s-1 in non-responders (p = 0.003). Reduction of ICA in the LV sector with LV lead was directly correlated with reduction of LV ESV after CRT (r = 0.46, p = 0.02) (Figure 1). ICA reduction in the LV sector with LV lead was -0.24 ± 0.28 s-1 in responders and -0.05 ± 0.16 s-1 in non-responders (p = 0.03). Meanwhile, reduction of ICA in the LV sectors located 60 degrees clockwise and 60 degrees counterclockwise away from the LV sector with LV lead (remote LV sectors) did not differ significantly between responders and non-responders: -0.12 ± 0.15 s-1 vs. -0.06 ± 0.1 s-1 (p = 0.28). Likewise, no significant correlation between reduction of ICA in remote LV sectors and LV ESV reduction was observed (p = 0.11).

Conclusion

Pre-implantation contractile asymmetry in the LV lead target area is associated with a positive response to CRT. Simultaneously, the degree of LV reverse remodeling after CRT seems to correlate with the magnitude of improvement of contractile asymmetry specifically in the region of LV lead location.

Abstract Figure 1
P481The genetic background of sudden cardiac deaths caused by single vessel coronary artery disease and myocardial hypertrophy with fibrosis
Authors: Vahatalo J H , Holmstrom L T A , Pylkas K , Porvari K , Pakanen L , Kaikkonen K S , Perkiomaki J S , Huikuri H V , Junttila M J
Published: June 2020

Funding Acknowledgements

Sigrid Juselius Foundation, Finnish Foundation for Cardiovascular Research, Aarne Koskelo Foundation, The Finnish Medical Foundation

Background

Coronary artery disease (CAD) is the most common underlying cause of sudden cardiac death (SCD). Cardiac hypertrophy with varying amount of myocardial fibrosis is a common risk factor for CAD related SCD especially in young SCD victims where severity of CAD seems not to entirely explain the cause of SCD.

Purpose

The aim was to study the genetic background of hypertrophy and fibrosis among young, ischemic SCD victims with single vessel CAD.

Methods

The study population was derived from the Fingesture study consisting of all autopsy-verified sudden cardiac deaths in Northern Finland between years 1998-2017 (n = 5,869). CAD was determined to be the cause of SCD in 4,392 victims (74.8%). We carried out targeted next-generation sequencing using a panel of 174 genes associated with myocardial structure and ion channel function in 95 ischemic-SCD victims (mean [standard error] age, 63.6 [1.06] years; 88.4% males) with single-vessel CAD and cardiac hypertrophy in the absence of previously diagnosed CAD, and whose DNA passed the quality control for further analysis. Assessment for pathogenicity of detected variants was based on American College of Medical Genetics consensus guidelines.

Results

A total of 43 variants were detected in 43 of the study subjects (45.3 %). Five variants in eight subjects (8.4%) were classified as pathogenic or likely pathogenic. We observed 38 variants of uncertain significance in 39 victims (40.6 %). Variants were detected in myocardial structure protein coding genes, associated with arrhythmogenic right ventricular cardiomyopathy (13 variants), dilated cardiomyopathy (16 variants), hypertrophic cardiomyopathy (6 variants) and left ventricular non-compaction cardiomyopathy (3 variants). Five variants were detected in RYR2 associated with both cardiomyopathies and catecholaminergic polymorphic ventricular tachycardias. Seven variants were detected in multiple unrelated subjects. None of the subjects presented characteristic autopsy findings related to cardiomyopathies.

Conclusions

Variants associated with cardiomyopathies were common findings among CAD related SCD victims with single vessel disease and myocardial hypertrophy found at autopsies, suggesting that these variants may modulate the risk for fatal arrhythmias and sudden death in ischemic disease.
P347Physician-led, weight loss advice prior to atrial fibrillation ablation, overall weight change and clinical outcomes
Authors: Lau Y , Mackey W , Connelly D
Published: June 2020

Background

Randomised trial, controlled study and international guidelines have advocated weight loss in AF patients with obesity as a means of attaining better AF burden control and maintenance of sinus rhythm. However, previous study required patients to undertake a highly structured weight management programme, detailed counselling, meal plans and behaviour modification.

Aim

To assess if weight-loss can be attained through a 5-minute, target-driven, physician-led counselling amongst overweight/obese patients referred AF ablation, without the need for intensive weight management programme. Subsequently to assess this can lead to better clinical outcomes (reduction in AF recurrence and readmission).

Methods

All patients referred for AF ablation in a tertiary centre over a 6-month period were included. Baseline weight and BMI at initial encounter plus  weight and BMI at day of AF ablation were recorded. Optional physician-led counselling was provided, with aim for target weight loss of <10% or reduction of 3 point in BMI.

Initial contact to AF ablation is 6 months.

Clinical outcomes such as symptomatic AF >3 months post AF ablation and readmission for symptomatic AF were recorded. Follow-up duration of 6 months post ablation.

Patients received counselling were designated Group 1, and those who did not were designated Group 2.

Outcomes

146 new AF referrals for ablation seen over the 6-month period. 105 (71.9%) are paroxysmal AF, 37 (25.3%) are persistent, 4 permanent AF.

Mean BMI 34.4 (+/- 5.1).  Out of which, 76% have BMI > 30 (Obese), 47.6% possess BMI >35 (Morbidly obese), with 1 patient with BMI exceeding 50.

21.9%  patients received physician-led counselling to lose weight. Basic demographics (age, gender), proportion of pAF and duration of AF, use of antiarrhythmic drugs were not statistically different between the two groups.

Among AF patients receiving weight-loss counselling (Group 1), they have higher mean weight and BMI, 108kg (+/- 14.3) and BMI 33.7 (+/-4.3), as compared to those who did not received counselling (Group 2), 87.5kg (+/- 16.2) and BMI 29.5 (+/-4.3).

At point of AF ablation, Group 1 has median weight loss of (-)4.5kg, mean reduction of BMI (-)2.0 points, while Group 2 has median weight gain of 3.6kg, increase of BMI 1.1 point. Overall statistically significant difference in weight change (p <0.001).

Composite clinical outcomes at 6 months post ablation comprising recurrence of AF and readmission for symptomatic AF were higher in Group 2 as compared to Group 1, 38% vs 13% (p = 0.03).

This small cohort study suggests that concise physician-led weight loss counselling (without dietician-led meal plan or extensive weight loss programme) provided to AF patients with increased BMI can lead to significant weight loss and lower BMI in the run-up to AF ablation. This is also associated with statistically significant reduction in recurrence of AF and hospital re-admission.
P1129Bipolar voltage cut-off validation in electroanatomical voltage mapping to identify scar and conduction channels in ventricular tachycardia ablation: need for new cut-off in NICM
Authors: Zaraket F , Sanchez Somonte P , Quinto L , Garre P , Alarcon F , Tolosana J M , Guasch E , Arbelo E , Doltra A , Ortiz J M , Prat S , Brugada J , Sitges M , Mont L , Roca Luque I
Published: June 2020

Background/Introduction

Substrate-guided techniques have changed the approach and results of ventricular tachycardia (VT) ablation and electroanatomical voltage mapping (EAVM) constitutes a diagnostic and therapeutic cornerstone in this field. In current practice normal myocardium is typically characterized by bipolar voltage > 1.5 mV, dense scar < 0.5 mV, and border zone (BZ) tissue by the range between 0.5 to 1.5 mV. Of note, evidence for these cut-off values has been derived in humans from small observational studies and in animals. Furthermore, some studies suggest that only the 60% of not transmural endocardial scars and the 35% of not endocardial scars are detected without any adjustment of these values. New voltage cut-off values are needed.

Purpose

The purpose of this study is to adjust voltage cut off in order to establish the threshold that more accurately define the pathological substrate in VT ablation. Additionally, predictors of usefulness of current thresholds are analyzed.

Methods

EAVM were created with CARTO3 System and Sensor-Force catheter (Navistar Smart-Touch and Pentaray). We delineated the conducting channels by analyzing the late potentials activation. Based on these channels we looked for the best cut-off values to detect these channels. We describe the baseline characteristics, the best cut-off values for border zone and scar core in our series and we analyzed the accuracy of the current established values to detect the arrhythmogenic VT substrate

Results

We investigated 51 patients (74,5% males; 41,2% ischemic cardiomyopathy, mean LVEF 38,6% +/-13,6) with sustained monomorphic VT submitted to ablation during 2016 and 2017. The range of the voltage adjustment was from 0,01-1 mV for core area and 0,2-6mV as maximum, with an average of 0,31-1,42mV. Using currently accepted bipolar voltage cut-off <0.5 mV the core scar was correctly identified in 80,4% of patients: 90,4% in ischemic and 73,3% in NICM. Regarding BZ, using classical cut off (0.5-1.5mV) only 56,9 % of the cases were well identified: interestingly, accuracy was worse in NICM (46,6%) than in ischemic patients (71,4%) (p = 0,07).

Conclusions EAVM is very important to detect scar and channels in VT ablation, but several elements can affect it and recently the traditional voltage values have been questioned. Our study suggests how the threshold as currently applied in daily practice could be acceptable to detect the core scar area, but it has to be reconsidered in NICM, especially regarding the border zone. An evident trend (p = 0,07) suggests a better accuracy of current values to define VT substrate in ischemic patients than in NICM.

Abstract Figure. Channel Identification
915ATP efficacy on terminating ventricular tachycardia by device type, indication, and ventricular median cycle length
Authors: Brown M , Kurita T , Sterns L D , Schloss E J , Auricchio A , Zhang Y , Li S , Meijer A , Lexcen D R
Published: June 2020

Funding Acknowledgements

Medtronic

OnBehalf

PainFree SST

Background

Anti-tachycardia Pacing (ATP) is an established therapy that terminates VT without the need for painful ICD shocks. Here we use the data from PainFree SST clinical trial to evaluate the ATP success rate by device type, indication and MCL. 

Methods

Spontaneous episodes that were detected by ICD or CRT-D devices in the VT, fast VT and VF zones were included in the analysis. Episodes successfully terminated by ATP were deemed as having ATP success. Using the GEE method, ATP success rate and its 95% CI were calculated for device types, indications and ventricular MCL. 

Results

Of the 2770 enrolled patients (79% male, average age 65 years), 1699 (61%) were implanted with an ICD and 1071 (39%) with a CRT-D system; 1917 (69%) were reported as primary prevention and 847 (31%) were secondary prevention patients. For all MVT episodes, the ATP success rate was similar between ICD and CRT-D devices (82.3% vs 80.3%, p = 0.74). Patients with secondary prevention had a higher ATP success rate compared to those with primary prevention but the difference was not statistically significant (84.4% vs 76.8%, p = 0.16). Regardless of device type and indication, ATP success rate was significantly higher in the slower VTs (MCL ≥ 320 ms) compared to the faster VTs (MCL ≥ 240 to < 320 ms) (89.2% vs 73.7%, p < 0.0001). 

Conclusion

We found that ATP had a greater than 80% rate of success for terminating ventricular tachycardias overall. Slower VTs was significantly associated with a higher ATP success rate regardless of device type and indication compared to faster VTs. For faster VTs with a MCL ≥ 240 to < 320 ms, the ATP success rate was still successful at terminating VT more than 70% of the time.

Table 1. ATP Success Rates - No. of Enrolled Subjects (% of total) No. of Episodes Analyzed for ATP Success (No. of Subjects) GEE-estimated ATP Success Rate (95% CI) P-value* Overall 2770 (100%) 2277 (376) 81.5% (78.4%, 84.2%) - Device Type - - - 0.7440 ICD 1699 (61.3%) 1484 (229) 82.3% (78.3%, 85.6%) - CRT-D 1071 (38.7%) 793 (147) 80.3% (75.0%, 84.6%) - Indication - - - 0.1609 Primary Prevention 1917 (69.2%) 631 (160) 76.8% (71.2%, 81.6%) - Secondary Prevention 847 (30.6%) 1615 (212) 84.4% (80.7%, 87.6%) - Median Cycle Length - - - <0.0001 (>/=) 240 ms and < 320 ms - 861 (257) 73.7% (69.2%, 77.7%) - (>/=) 320 ms - 1416 (209) 89.2% (85.7%, 91.9%) - * Per a GEE main effect model for all episodes where device type, indication and median cycle length were considered.
221Evaluating the ability of different substrate mapping techniques to identify scar-related ventricular tachycardia circuits using computational modelling
Authors: Campos F , Orini M , Whitaker J , O"neill M , Razavi R , Porter B , Hanson B , Aldo Rinaldi C , Gill J , Lambiase P D , Taggart P , Bishop M J
Published: June 2020

Funding Acknowledgements

National Institute for Health Research; British Heart Foundation; and The Wellcome Trust and Engineering and Physical Sciences Research Council.

Background

Accurate identification of targets for catheter ablation therapy of ventricular tachycardias (VTs) in the postinfarction heart remains a significant challenge. Identification of such targets often requires VT-induction to delineate the entry/exit points of the reentrant circuit sustaining the VT. However, inducibility may not be possible due to hemodynamic instability. In this scenario, substrate ablation strategies can still be performed to uncover the arrhythmogenic substrate during sinus or paced rhythm. However, substrate mapping may fail to accurately delineate the reentrant circuit resulting in VT recurrence after the procedure.

Purpose

To use computer simulations to compare the ability of different electroanatomical maps constructed following typical substrate ablation strategies to identify the VT exit site.

Methods

An image-based computational model of the porcine post-infarction left ventricle was constructed to simulate VT and paced rhythm. Electroanatomical maps were constructed based on the following features extracted from electrograms computed on the endocardial surface: activation time (AT), bipolar electrogram amplitude, signal fractionation and the reentry vulnerability index (RVI - a metric combining activation and repolarization timings to identify tissue susceptibility to reentry). Potential ablation targets during substrate mapping were compared for: highest 5% AT gradient; lowest 5% bipolar signal amplitudes; areas with fragmented signals (more than one peak); and lowest 5% RVI. The minimum distance, d, between the manually identified VT exit site and the targets was measured.

Results

The RVI performed better than the other metrics at detecting the VT exit site (see Figure). The minimum distance between sites of lowest RVI and the exit site was 3.2mm compared to 13.1mm and 15.9mm in traditional AT and voltage maps, respectively. As the scar was not transmural, parameters derived from all electrograms (including those located on dense scar regions) were used to construct the electroanatomical maps. This improved the performance of the RVI significantly, making it more specific than the other metrics as can be seen in the Figure.

Conclusions

Among all metrics investigated here, the RVI identified the vulnerable region closest to VT exit site. This finding suggests that activation-repolarization metrics may improve the detection of pro-arrhythmic regions without having to induce VT. Moreover, the RVI may be particularly well suited for detecting vulnerable regions within non-transmural scars.

Abstract Figure. VT and Substrate Mapping
1261Geographical variations in the incidence of CIED infection and infection prevention strategies: Update from the global WRAP-IT study
Authors: Kennergren C , Poole J E , Wilkoff B L , Mittal S , Corey G R , Mccomb J , Diemberger I , Wright D J , Philbert B T , Simmers T A , Boersma L V A , Debus B , Krueger J , Vandersteegen K , Tarakji K G
Published: June 2020

Funding Acknowledgements

Medtronic, Inc.

Introduction

Cardiac Implantable Electronic Device (CIED) infections lead to significant morbidity, mortality, and use of health care resources. There is variation in infection prevention strategies among centers, and it is not clear whether there is also variation in infection rates across different geographies. Recently, WRAP-IT, the largest global randomized trial to evaluate an infection reduction strategy, randomized 6,983 patients to receive an antibacterial envelope (treatment) vs. no envelope (control). The results demonstrated a significant reduction in major CIED infection with the TYRX antibiotic envelope (12-mo infection rate for envelope vs. control 0.7% and 1.2%, respectively; HR, 0.60; 95% [CI], 0.36 to 0.98; P = 0.04).  The purpose of this analysis is to assess geographical variations in patient characteristics, procedural routines, and infection rates.

Methods

The WRAP-IT study enrolled patients undergoing a CIED pocket revision, generator replacement, or system upgrade or an initial implantation of a cardiac resynchronization therapy defibrillator and randomized them to receive the envelope or not, in addition to mandated pre-procedure intravenous antibiotic prophylaxis. To assess geographical variations in infection rates, the control group (per protocol) baseline demographics and procedural characteristics were identified. Major infection was defined as CIED infections resulting in system extraction or revision, long-term antibiotic therapy with infection recurrence, or death.

Results

A total of 3429 control patients were evaluated and followed for a mean of 20.9 ± 8.3 months; 2530 patients from 123 centers in North America, 777 patients from 46 centers in Europe, and 122 patients from 11 centers in Asia/South America. The 24-month Kaplan-Meier major infection rates were 1.2% in North America (30 pts), 2.5% in Europe (16 pts), and 4.3% Asia/South America (5 pts) (see Figure). These geographical variations in the incidence of major CIED infections were significant (overall P = 0.008, univariate). There were differences in baseline patient characteristics, including age, sex, medication use, NYHA Class, and number of previous devices across geographies. Differences also included procedural characteristics, such as device type, use of pocket wash, skin preparation, pre-operative antibiotic drug use, and procedure time.

Conclusion

Major CIED infection rates vary significantly across geographies. The effect of patient demographics and procedural characteristics on these findings will be assessed and presented at EHRA. Insights into geographical variability of CIED infections is important to mitigate infection risk, reduce morbidity and cost.

Abstract Figure. Major CIED Infection Rate by Geography
P1174Impact of sex-differences in long-term outcomes with cardiac resynchronization therapy: are women different?
Authors: Moreno Weidmann Z L , Alonso-Martin C , Mendez-Zurita F , Rodriguez-Font E , Guerra-Ramos J , Campos-Garcia B , Brossa V , Vinolas-Prat X
Published: June 2020

Introduction

Women are frequently underrepresented in clinical trials for heart failure. Differences on cardiovascular background may imply differences on indications, device election and outcomes in patients receiving cardiac devices (CRT and ICD). We sought to compare sex-related differences in a real-life cohort.

Methods

We analyzed all subjects who underwent a cardiac resynchronization therapy (CRT) implantation (with or without ICD) between 2016 and 2019 in a single center, all of them followed by remote monitoring. Baseline characteristics and outcomes were compared according to gender. Response to resynchronization was defined as clinical improvement in NYHA class or an increase of > =10% in LVEF.

Results

A total of 430 devices (ICD or CRT) were implanted. 149 (35%) of them were CRTs: 116 (88%) CRT-D and 33 (22%) CRT-P. Of the whole cohort, 43 (29%) were women and the mean age was similar in both sex (70+/-9 years). Women had more likely non-ischemic cardiomyopathy (86% vs 49%, p < 0.01), higher proportion of NYHA class III-IV (26% vs 40%, p 0.04) and worse renal function (mean glomerular filtration 61ml/min vs 75ml/min, p 0.04), but tend to be less affected by atrial fibrillation (21% vs 40%, p 0.05). Left ventricular ejection fraction was similar at the moment of implantation among both sex (30+/-7%, p > 0.05) and no difference on optimal medical treatment was observed. Women trend to receive more frequently CRT-P than men (33% vs 18%, p 0.054). After a mean follow-up of 3 years, a four-fold higher response to CRT was observed in women (OR 4.0, 95% CI 2.0-10.7, p 0.002), after adjustment by the etiology of the myocardiopathy. No differences on all-cause mortality (6% in men vs 1% in women, p 0.2) or ventricular arrhythmias (10% in men vs 2% in women, p 0.3) were observed. 

Conclusions

in a real-life cohort, CRT implantation showed a sex-disparity: the proportion of women receiving a CRT was lower than in men, but a CRT without defibrillation was more frequently implanted in women, reflecting a higher prevalence of ischemic cardiomyopathy in men. The underlying myocardial substrate in women and a lower prevalence of AF may explain a more favorable response to CRT, despite more pronounced symptoms of heart failure at the moment of implantation.
P508Biventricular pacing versus His bundle pacing after atrioventricular node ablation in heart failure patients with permanent atrial fibrillation and narrow QRS
Authors: Zizek D , Antolic B , Zavrl-Dzananovic D , Klemen L , Jan M , Zupan Meznar A , Breskvar Kac U D , Stublar J , Zupan I , Sinkovec M
Published: June 2020

Background

Atrioventricular (AV) node ablation with biventricular (BiV) pacemaker implantation is a feasible rate control strategy for symptomatic permanent atrial fibrillation (AF) with rapid ventricular response and tachycardia-induced heart failure (HF). However, certain controversy exists since BiV pacing delivers non-physiological ventricular resynchronization and does not return left ventricular (LV) activation times to those seen in individuals with intrinsically narrow QRS. Permanent His bundle pacing (HBP) is a physiological alternative to conventional and BiV pacing. By capturing the native conduction system, depolarization of the ventricles through the His-Purkinje system induces normal synchronous ventricular activation.

Purpose

The aim of the study was to compare short-term outcomes between BiV pacing and HBP after AV node ablation in HF patients with symptomatic permanent AF and narrow QRS.

Methods

A total of 25 consecutive HF patients with permanent AF and narrow QRS (≤110 ms) who underwent AV node ablation in conjunction with BiV pacing or HBP in our centre were enrolled. Post-implant QRS duration, echocardiographic data, and New York Heart Association (NYHA) functional class were assessed in short-term follow-up.

Results

Among 25 HF patients (aged 68 ± 7 years, 52% female, QRS 96 ± 9 ms, LVEF 37 ± 7%, NYHA II-IV), 13 received BiV pacing and 12 HBP. Implant and ablation procedures were acutely successful in both groups. In BiV group 1 patient had a LV lead dislodgement and 1 patient in the HBP group had an acute HB lead threshold increase after AV node ablation. In HBP group post-implant QRS duration was shorter compared to BiV (103 ± 15 ms vs. 177 ± 13 ms, p < 0.001). At a median follow-up of 6 months, patients treated with HBP had greater increase in LV ejection fraction compared to BiV (44 ± 10 vs. 37 ± 6, p = 0.045). A trend toward greater reduction of LV volumes (EDV 119 ± 54 ml vs. 153 ± 33 ml, p = 0.07; ESV 75 ± 34 ml vs. 97 ± 26 ml, p = 0.09) and improvement of NYHA class (2.1 ± 0.7 vs. 2.7 ± 0.8, p = 0.08) was also observed in HBP group compared to BiV group.

Conclusion

In rate control refractory HF patients with permanent AF and narrow QRS atrioventricular node ablation in conjunction with HBP demonstrated superior electrical resynchronization and greater increase in LV ejection fraction compared to BiV pacing. Larger prospective studies are warranted to address clinical outcomes between both pace and ablate strategies.
Far from acceptable: youth-reported risk behaviour screening by primary care physicians
Authors: Eisner-Fellay Taslina , Akre Christina , Auderset Diane , Barrense-Dias Yara , Suris Joan-Carles
Published: June 2020

Background

Adolescence and early adulthood are periods of experimentation during which health detrimental behaviours might be acquired.

Objective

This study’s purpose is to evaluate physicians’ likelihood of addressing health risk behaviours with youths depending on the youths’ wishes, risk behaviours and personal characteristics.

Methods

Data were drawn from the third wave (2017–18) of the GenerationFRee longitudinal study carried out on a sample of 1970 youths aged 17–26 in Switzerland. Analysed risk behaviours were: eating disorders, substance use, emotional wellbeing, problematic Internet use and gambling. Bivariate and multivariate analyses were performed, results are presented as adjusted odds ratios (aORs).

Results

Physicians discussed most risk behaviours with less than half of the youths. The odds of addressing risk behaviours were seldom raised when the risk behaviour was present, or when the youth wished to discuss it. Emotional wellbeing was addressed with half as many males as females (aOR 0.47), and drugs were found to be addressed more frequently with youths reporting a low family socio-economic status (aOR 6.18). When a risk behaviour is addressed it is mostly alongside an extended screening.

Conclusions

This study confirmed the low levels of health risk behaviours screening, regardless of the youths’ wish to discuss the topic with their physician. Despite the low levels, physicians do tend to screen systematically, especially when discussing substance use. There is a need to improve physicians training in risk behaviour screening and counselling in order to increase this practice.