bluuebunny/crossref_metadata_2025 huggingface dataset:
P2761Assessment of perioperative mortality risk in patients with infective endocarditis undergoing cardiac surgery: performance of the EuroSCORE II, PALSUSE, STS risk score for IE and modified AEPEI score
Authors: Brizido C , Madeira S , Oliveira P , Silva C , Gama F F , Lopes P , Strong C , Marques M , Neves J P , Mendes M
Published: October 2019

Introduction and aim

Infective endocarditis (IE) is a complex and heterogeneous disease which might lead to cardiac surgery. For such cases, several perioperative risk predictive tools have emerged. We aimed to validate the recently developed PALSUSE, STS risk score for IE and modified AEPEI score and to compare their performances with the established EuroSCORE II.

Methods

We retrospectively accessed 128 patients from a single center registry who underwent heart surgery for active infective endocarditis between January 2007 and November 2014. Discrimination and calibration of models were assessed by receiver operating characteristic curve analysis and Hosmer-Lemeshow test.

Results

Perioperative mortality was 16.4% (n=21). The median EuroSCORE II, PALSUSE, STS risk score for IE and modified AEPEI score were 6.6% [IQR 3.5–18.2], 5 [IQR 3–7], 25 [IQR 16–32] and 1 [IQR 0–1.8], respectively. Discriminative power was numerically higher for EuroSCORE II (AUC of 0.83, 95% CI, 0.75–0.91) followed by STS risk score for IE (AUC of 0.75, 95% CI 0.64–0.86), PALSUSE (AUC of 0.74, 95% CI 0.64–0.86) and modified AEPEI (AUC of 0.68, 95% CI 0.57–0.788) – figure 1. The Hosmer-Lemeshow test showed good calibration for EuroSCORE II (p=0.08) and STS risk score for IE (p=0.03) but not for PALSUSE (p=0.65), modified AEPEI (p=0.12).

Figure 1

Conclusion

All scores adequately stratified peri-operative risk in active infective endocarditis, however EuroSCORE II in the overall comparison performed better in this population. Heterogeneity of performance of risk scores in different cohorts of infective endocarditis highlights the complexity of this disease.
P2766Increased right ventricular burden in patients with chronic thromboembolic disease
Authors: Jervan O , Gleditsch J , Rashid D N M , Ghanima W , Steine K
Published: October 2019

Introduction

Patients with chronic thromboembolic disease (CTED) have residual perfusion defects after pulmonary embolism (PE) but not increased pulmonary artery (PA) pressure. These patients suffer from functional limitation and have a higher risk of venous thromboembolism recurrence.

Purpose

In this study we wanted to explore if CTED patients had signs of increased PA pressure and right heart burden by echocardiography

Methods

Inclusion criteria were history of PE, age 18–75 years and PE diagnosed 6–72 months prior to inclusion. Patients with left ventricular systolic or diastolic heart failure, valvular disease, chronic pulmonary disease and chronic thromboembolic pulmonary hypertension were excluded. All patients underwent echocardiography with standard and novel methods and ventilation/perfusion (VQ)-scan. The echocardiographic examinations were blinded to the result of the VQ-scan. VQ-scan were analyzed according to the European Association of Nuclear Medicine-criteria, and deemed either positive or negative. Data are presented as mean ± SD or median ± IQR as appropriate. Independent sample t-test or Mann-Whitney U test was used for the primary statistical analysis. Multiple linear regression was used to adjust for age, BMI and systolic blood pressure.

Results

Table 1 VQ negative (n=58) VQ positive (n=20) p-value Adjusted Age (years) 59±8 67±6.5 0.71 Time since PE event (months) 37±19 33±17 0.42 Pulmonary artery acceleration time (ms) 145±22 119.5±26 <0.001 <0.001 Pulmonary artery diameter (mm) 21±3.3 25±3.6 <0.01 <0.01 TAPSE (mm) 25.7±3.6 24.9±4.0 0.45 RV (right ventricle) S' (cm/s) 12.7±2.3 12.8±2.7 0.78 RV isovolumic relaxation time (ms) 33±23.9 50±22 <0.01 <0.01 RV myocardial performance index 0.36±0.10 0.44±0.15 0.04 0.02 Tricuspid regurgitation maximum velocity (m/s) 2.3±0.3 2.7±0.4 <0.001 <0.001 LV (left ventricle) ejection fraction (%) 62.5±4.2 61.3±6.0 0.41 E/A 1.02±0.26 0.90±0.23 0.09 E/e' 6.8±2.0 6.5±2.2 0.75 E/A: ratio between transmitral pulsed doppler peak early (E) diastolic and atrial (A) velocity; E/e': ratio between E and peak early velocity (e') by tissue velocity.

Figure 1 (error bars - mean and 95% CI)

Conclusion

Patients with CTED after PE have increased PA pressure and impaired RV systolic and diastolic function compared to those without residual perfusion defects. These findings indicate that CTED patients should be more thoroughly followed up.
P2777Natural history and long-term prognosis of stroke types in urban and rural China: a 9-year prospective study of 0.5 million adults
Authors: Chen Y , Wright N , Clarke R , Kartsonaki C , Turnbull I , Guo Y , Zheng B , Li L , Chen Z
Published: October 2019

Background

Stroke is a major cause of premature death and disability worldwide. However, relatively little is known about the natural history and long-term prognosis following stroke in many low and middle income countries, including China.

Methods

The prospective China Kadoorie Biobank recruited 512,000 adults (59% women, mean age 51 years) from 10 (5 urban, 5 rural) areas in China during 2004–08. Information about death and hospitalisation for specific causes was collected by linkage with mortality registries and nationwide health insurance systems. During a 9-year follow-up, 45,732 incident cases of stroke (∼92% confirmed by neuroimaging) were recorded among individuals without prior vascular disease at baseline. The adjusted 28-day case-fatality rates and long-term cumulative risks of recurrent stroke, major vascular events, and mortality following first-ever stroke were estimated by stroke types.

Results

Of the 45,732 first-ever stroke cases reported, 80% (36,588) had IS, 17% (7440) had intracerebral haemorrhage (ICH), 2% (702) had subarachnoid haemorrhage (SAH), and only 1002 (1%) had an unspecified stroke type. The overall 28-day case-fatality following first stroke was 11%, but increased with age and was higher in those in rural than in urban areas (16% vs 6%) and in men than in women (13% vs 10%). The 28-day case-fatality was highest for ICH (47%), lowest for IS (3%) and intermediate for SAH (19%) and unspecified strokes (24%). Among those who survived beyond 28 days, 17% died (28% for ICH, 16% for IS) and 41% had a recurrent stroke (44% for ICH, 41% for IS) at 5 years. For those with first-ever IS, 91% of the subsequent recurrent strokes involved same pathological type, while for ICH, 41% of the recurrent strokes were IS.

Stroke prognosis

Conclusions

Among Chinese adults, the short- and long-term prognosis following first-ever stroke were poor, highlighting the urgent need to implement more effective treatment and secondary prevention strategies for stroke cases.

Acknowledgement/Funding

UK MRC, UK Wellcome Trust, British Heart Foundation, Cancer Research UK, The Chinese Ministry of Science and Technology, the Chinese National Science
P2789A new technique to restore shape and pattern of flow in hypoplastic aortic arch
Authors: Afifi A , Nagy M , Hosny H , Shehata N , Simry W , Raef Y , El Mozy W , Abou Gamrah M , Aguib H , Yacoub M
Published: October 2019

Background

There is no agreement about the best method for correcting hypoplastic aortic arch in infancy. Residual abnormalities in shape can cause late complications.

Patients and methods

We have developed and applied a new method of direct anastomosis of the descending to the ascending aorta to allow for restoration of shape, function and growth. 12 infants undergoing this technique at the age of 61±3months (range 6–28 months) underwent repeat CT 4–15 months after operation.

Pre- and post-operative arch width, height and height to width ratio were recorded for all cases. Computerized shape analysis using an in-house tool (developed in MATLAB) was used for processing the 3D segmented shapes of the aortic arch, and assessing changes in the cross-sectional area at different levels. Computational Fluid Dynamics (CFD) was used to simulate aortic flow propagation and pattern after surgery, using patient specific geometry and flow boundary conditions.

Results

The pre- and post-operative cross-sectional area along the centerline of the aorta and arch was almost normalized, Figure 1.

The pattern of flow during the cardiac cycle with a retrograde helix in the aortic arch, similar to normal, was observed in all cases with peak velocities of 1.1±0.2m/s.

Aortic Shape and flow after surgery

Conclusion

We here describe a new technique, which at least in the short term appears to normalize the size, shape and pattern of flow in the arch. Long term studies are required to establish the value of this technique.
P2792Preoperative levosimendan improves survival in patients with low cardiac output syndrome undergoing cardiac surgery: a meta-analysis of randomized controlled trials
Authors: Brockmeyer M , Lin Y , Karathanos A , Parco C , Krieger T , Heinen Y , Albert A , Kelm M , Schulze V , Wolff G
Published: October 2019

Background and purpose

Previous studies and meta-analyses of perioperative levosimendan to improve the outcomes of patients with low cardiac output syndrome (LCOS) undergoing cardiac surgery have given controversial results and the optimal time of infusion of levosimendan remains uncertain. We thus aimed to elucidate the risk/benefit ratio of preoperative levosimendan in a meta-analysis of randomized controlled trials (RCTs).

Methods

Online databases were searched for RCTs comparing preoperative levosimendan to placebo in patients with LCOS undergoing cardiac surgery until February 2019. Data from retrieved studies were abstracted and analyzed in a comprehensive meta-analysis. Primary outcome was all-cause mortality. Secondary outcomes included myocardial infarction, renal failure/replacement therapy, need for inotropic therapy, need for left ventricular assist devices, ventricular arrhythmia and arterial hypotension.

Results

As a result of the online database search, six eligible RCTs with 1,326 patients were included in the meta-analysis. Preoperative levosimendan showed a significant reduction in all-cause mortality (odds ratio (OR) 0.49, 95% confidence interval (CI) 0.29–0.83; p<0.01), renal failure/replacement therapy (OR 0.48, CI 0.29–0.80; p<0.01) and need for inotropic therapy (OR 0.24, CI 0.06–0.95; p=0.04) compared to placebo. There were no significant differences in levosimendan vs. placebo concerning the rates of myocardial infarction (OR 0.61, p=0.38), need for left ventricular assist devices (OR 0.38, p=0.1), ventricular arrhythmia (OR 0.7, p=0.33), and arterial hypotension (OR 1.28, p=0.07).

Conclusions

Preoperative administration of levosimendan may improve survival in patients with low cardiac output syndrome undergoing cardiac surgery. It reduces need for inotropic medical support and renal failure/replace-ment therapy compared to placebo.
P2800Impact of plaque vulnerability on vascular response after implantation of two types of biodegradable-polymer drug-eluting stent: coronary angioscopic study
Authors: Ichikawa M , Kijima Y
Published: October 2019

Background

Vascular response after drug-eluting stent (DES) implantation depends not only on stent design but also on vulnerability of target coronary lesions. In this study, non-obstructive coronary angioscopy (CAS) revealed vascular response after two types of biodegradable polymer (BP) DES implantation into patients with acute coronary syndrome (ACS) or stable angina pectoris (SAP).

Methods

Eighteen Nobori BP biolimus-eluting stents (BP-BES) were successfully implanted into 15 patients (9 ACS and 9 SAP lesions). Twenty-three Ultimaster BP sirolimus-eluting stents (BP-SES) were implanted into 16 patients (6 ACS and 17 SAP lesions). At one year after stenting, CAS semi-quantified degree of neointimal stent coverage (NSC) into 4 grades (0, no coverage; 1, thin coverage; 2, thick coverage; 3, embedded in thick neointima and invisible). When NSC through a stent was composed of plural grades, CAS determined dominant, maximum and minimum NSC grades. Heterogeneity index was defined as subtraction of minimum from maximum grade. CAS also semi-quantified degree of yellow plaques (YP) into 3 grades (0, light; 1, dense; 2, glittering yellow). CAS detected presence of in-stent mural thrombi (ISMT).

Results

At one year after BP-BES implantation: 1) There was no significant difference with regards to dominant NSC between ACS and SAP lesions (1.00±0.50 vs. 0.89±0.60); 2) Heterogeneity index was greater in ACS than in SAP (1.22±0.44 vs. 0.67±0.50, P=0.02); 3) YP grade was greater in ACS than in SAP (1.89±0.33 vs. 1.00±1.00, P=0.02); and 4) We found one ISMT in ACS lesions and two ISMT in SAP lesions. At one year after BP-SES implantation: 1) There was neither significant difference between ACS and SAP lesions with regards to dominant NSC (1.67±1.21 vs. 1.53±1.01), with regards to heterogeneity index (0.50±0.55 vs. 0.35±0.49), nor with regards to YP grade (1.33±1.51 vs. 0.88±0.99); and 2) We found ISMT neither in ACS nor in SAP lesions.

Conclusions

For BP-SES implantation, vascular response at ACS lesions was similar to SAP lesions. Even one year after BP-BES implantation, however, plaque vulnerability appeared to remain in ACS lesions.
P2833Safety and efficacy of oral anticoagulation discontinuation in high thromboembolic risk patients at long term follow-up after successful atrial fibrillation ablation
Authors: Cavalli G , China P , Marras E , Corrado A , Themistoclakis S
Published: October 2019

Background

Current guidelines recommend the use of oral anticoagulation (OAC) after successful ablation procedure of atrial fibrillation (AF), according to patient's thromboembolic risk score. However, several observational studies demonstrated similar thromboembolic events and lower incidence of major bleedings in patients who discontinued OAC after successful AF ablation compared with those on OAC. However, data on long-term follow-up after OAC discontinuation in high thromboembolic risk patients successfully treated with AF ablation are missing.

Purpose

To evaluate the incidence of stroke/TIA and bleeding events at long term follow-up after successful AF ablation in high thromboembolic risk patients who discontinued OAC therapy (Off OAC group) compared to those who continued it indefinitely (On OAC group).

Methods

Patients with CHA2DS2VASC score of 2 or more at time of the ablation procedure who discontinued OAC after successful catheter ablation for AF performed between 2001 and 2018 were included in this study. OAC was discontinued in patients without atrial tachyarrhytmias recurrences after intensive monitoring, left atrial dysfunction or pulmonary stenosis.

Results

503 patients (pts), were enrolled in the study (On OAC group: 241 pts; Off OAC group: 262 pts). After a median follow up of 6.3 years, occurred 12 and 14 stroke/TIA events in the On OAC and Off OAC group, respectively (p: 0.854). Bleeding events occurred more frequently in the On OAC group compared to Off OAC group (18 vs 8 events, p: 0.025). At multivariate analysis OAC therapy was independently associated with an increased risk of major bleeding (OR: 2.92, CI95%: 1.11–7.70, p: 0.03) whereas no difference in the risk of stroke were found (OR 0.89, CI95%: 0.37–2.16, p: 0.799).

Conclusion

Discontinuation of OAC after successful AF ablation in high thromboembolic risk patients seems to be a safe and effective strategy even in a long term follow up. Prospective randomized trials are needed to confirm these results
P2837Day-case complex left atrial ablation is safe and cost-effective: experience from a UK tertiary centre
Authors: Datla S , Weight N , Lange J , Berwick K , He H , Lachlan T , Foster W , Yusuf S , Dhanjal T , Panikker S , Hayat S , Osman F
Published: October 2019

Background

Day-case standard catheter ablation is becoming routine. However, patients having complex left atrial ablation for atrial fibrillation (AF) or left atrial tachycardia (LAT) often stay overnight. We have been performing day-case complex left atrial ablation since 2015.

Purpose

To evaluate the safety, efficacy and cost-effectiveness of day-case complex left atrial ablation compared with those who stayed overnight.

Methods

A retrospective analysis of all consecutive complex left atrial ablations performed in a UK tertiary cardiac centre between 2010–2018. Data were collected on baseline parameters, procedure details including mapping technique, ablation strategy, immediate efficacy, and acute complications.

Results

A total of 830 complex left atrial catheter ablations were performed; mean age±SD=60±12 years, 63% male. The majority were AF ablation (n=804, 96.9%), with the rest being LAT/left-atrial flutter. Of the AF cases, 545 were paroxysmal (≤7 days), 212 persistent (>7 days) and 47 long-standing (>1yr); 98% of cases were elective. Pulmonary vein isolation was performed in all; additional LA lines were done in 163, CTI ablation in 129 and CFAEs in 33. 3D-mapping (Carto/Precision)=44.7% (with contact sensing=38.0%), PVAC=18.7%, PVI cryo-balloon=36.6%. Of the cohort 331 (39.9%) were done as day-case. Acute success= 94.9%, acute complications=4.58% (femoral site complications, n=12; pericardial effusion, n=19 (9 needing drain); stroke/cerebral embolus, n=3; phrenic nerve palsy, n=5; first degree heart block, n=1). Comparison of day-case vs non day-case revealed no significant difference in number of complications (Table 1). An overnight stay at out hospital costs £350. During the period of study our institution saved £115.850 (∼140,000 euros).

Day-case vs non day-case ablation Parameters Day-case (n=331) Non day-case (n=499) p-value Mean age ± SD (years) 61.2±11.6 59.1±11.9 0.009 Males (n, %) 205 (61.9%) 321 (64.3%) 0.484 Normal heart (n, %) 243 (73.4%) 383 (76.8%) 0.276 Paroxysmal AF (n, %) 218 (65.9%) 327 (65.5%) 0.928 Fluoroscopy time (mins) 23.8±13.9 27.0±14.5 0.001 Procedure time (mins) 150±89.6 163±68.2 0.025 % with 3D-mapping 30.8% 56.9% <0.001 Acute complications (n, %) 12 (3.63%) 26 (5.21%) 0.285

Conclusions

Day-case complex left atrial cardiac ablation is safe and effective. It is associated with good clinical outcomes and leads to significant cost savings as an overnight stay is not needed.
P2842Sequential application of horizontal and vertical orientation on radiofrequency ablation lesions produced by thermocool smarttouch SF catheter
Authors: Morgaenko K , Noshin S , Stevenson W , Mehta N
Published: October 2019

Background

Ablation lesions represent a complex interaction between the ablation catheter configuration and tissue anatomy. An understanding of each variable can assist in determination of the optimal lesion set. One such variable is the catheter orientation. With an irrigated radiofrequency ablation catheter with 6 pores (6P) near the distal tip, lesion surface area and volumes are smaller in the horizontal catheter orientation compared to the vertical catheter orientation. This finding is explained by the 6P irrigation catheter design, where irrigation fluid is discharged from six ports around the circumference of the electrode. Introduced in 2015, the ThermoCool SmartTouch® SF catheter has a 56-pore (56P) distribution to provide high density low volume irrigation settings. Irrigation catheters create smaller lesions in horizontal orientation compared to vertical orientation, however this has not been studied for the 56P irrigated catheter.

Purpose

Evaluate the impact of catheter orientation with sequential application of 56P catheter.

Methods

Ablation lesions were created on additive-free chicken model in a saline bath heated to 37°C using the 56P catheter under standard flow rate (8cc/min) conditions. Ablation energy of 20W and 30W was delivered twice for 30 seconds with 3 minutes interval between applications. Contact force (CF) of 5, 10, 15, and 20g was applied with the following conditions: horizontal catheter orientation followed by horizontal (HH), vertical by vertical (VV), horizontal by vertical (HV), and vertical by horizontal catheter orientation (VH). Measurements were obtained by lesion dissection through the midpoint by 3 independent operators. Kruskal-Wallis test was used for comparison of lesion depth, surface area and volume.

Results

Ninety-six lesions were analyzed. No coagulum or steam pops were included in the analysis. The minimum and maximum lesion depth, surface area and volume were 1.5 & 6.0 mm, 14.1 & 117.7mm2, 47.1 & 471.0 mm3 respectively. There was no significant difference in the lesion depth, surface area or volume in HH, VV, HV or VH orientation at different CF with 20W and 30W. (Fig 1)

Figure 1

Conclusion

Unlike other irrigated catheters, catheter orientation with sequential application with different CF and power did not impact lesion depth, surface area and volume with 56P catheter. This finding could be considered useful in situations where the catheter orientation could be challenging owing to tissue anatomy to achieve adequate lesion size.

Acknowledgement/Funding

UVA Health System
P2844Novel temperature guided irrigated ablation catheter: reproducibility of procedural efficiencies and acute success to isolate the pulmonary veins from two multicenter, feasibility studies
Authors: Puererfellner H , De Potter T , Vijgen J , Grimaldi M , Natale A , Jensen H , Peichl P , Bulava A , Martinek M , Kristiansen S , Duytschaever M , Lukac P , Knecht S , Neuzil P , Kautzner J
Published: October 2019

Background/Introduction

The novel catheter with 6 thermocouples for real-time temperature monitoring during irrigated radiofrequency ablation was designed to potentially enhance safety and effectiveness of the Smart Touch Surround Flow (STSF) catheter by incorporating real-time temperature sensing. A supplementary, novel algorithm was developed to modulate power to maintain target temperature during high power/short duration ablation (90W, 4s).

Purpose

This sub-analysis was performed to examine consistency and reproducibility of the procedural efficiencies and acute success of the novel catheter with optimized temperature control and microelectrodes in treating paroxysmal atrial fibrillation (PAF) across multiple sites from two initial feasibility studies, in standard (QMODE) and high power/short duration (QMODE+) temperature-control ablation modes.

Methods

The QDOT-MICRO (QMODE, NCT02944968; N=42) and QDOT-FAST (QMODE+, NCT03459196; N=52) studies were both prospective, non-randomized multi-center, clinical investigations completed across 6 and 7 centers, respectively, in Europe. Procedural efficiencies and acute success (PVI via entrance block) was examined across sites within the study.

Results

In the QDOT-MICRO study, median procedure time (105–155 min), RF ablation time (27.7–39.5 min), and fluoroscopy times (2.2–8 min) during QMODE ablation were similar across the 6 sites. In QMODE+ ablation, median procedure time, RF ablation time, and fluoroscopy times all fall within (84–134 min), (4.8–9.7 min) and (1.1–9.6 min), respectively, across the 7 sites. Fluid delivery by the study catheter was low in both studies: QDOT-MICRO 547±278mL (mean ± SD); QDOT-FAST 382±299. mL (mean ± SD); which is 39.1 and 57.4% lower, respectively, than reported in the SMART SF trial. Esophageal temperature probe was used in the majority of patients (30/42 for QDOT MICRO and 51/52 for QDOT-FAST). Acute PVI was successful in 100% of patients in both studies with no deaths or unanticipated AEs.

Conclusion(s)

In both feasibility studies, procedural efficiencies were reproducible across study sites in both QMODE and QMODE+, with 100% acute success and good safety outcomes. Efficiencies are likely to improve with further experience. These results need to be confirmed in larger trials.

Acknowledgement/Funding

Both Studies are Company Sponsored Studies funded by Biosense Webster, Inc.
P2845Recurrent atrial flutter and incidence of atrial fibrillation ablation after first-time ablation for typical atrial flutter: a nation-wide Danish cohort study
Authors: Giehm-Reese M , Kronborg M B , Lukac P , Kristiansen S B , Nielsen J M , Johannessen A , Jacobsen P K , Djurhuus M S , Riahi S , Hansen P S , Nielsen J C
Published: October 2019

Introduction

Cavo tricuspid isthmus ablation (CTIA) is an effective first-line treatment for typical atrial flutter (AFL). However, many patients develop atrial fibrillation (AF) after successful CTIA. Knowledge about recurrent arrhythmia after CTIA mainly comes from small cohort studies with limited follow-up.

Purpose

To describe incidences of AFL re-ablation and AF-ablation after first-time CTIA in a nation-wide cohort.

Method

In the Danish National Ablation Registry we identified patients undergoing first-time CTIA during 2010–2016. Subsequent CTIA and AF-ablation procedures were identified until March 1st, 2018. We gathered information on patient comorbidities in the Danish National Patient Registry.

Results

We identified 2409 patients undergoing first-time CTIA. Median age was 66 (IQR 58–72) years, and 1952 (81%) were men. 78 (3%) had a history of AF. Acute procedural succes was achieved in 2288 (95%) patients. During mean follow-up of 4±1.7 years, 242 (10%) patients underwent CTI re-ablation and 326 (13.5%) ablation for AF. Baseline characteristics associated with CTI re-ablation included prolonged procedural time, unsuccessful first CTIA, age<75 years and CHA2DS2-VASc score<2. Hypertension, history of AF, age<65 years and CHA2DS2-VASc score<2 were associated with later AF-ablation (Table).

Predictive characteristics Characteristics associated with CTI re-ablation HR 95% CI p-value Procedural time 1.003 (1.001–1.006) 0.01 Unsuccesful first CTIA procedure 3.42 (2.10–5.55) <0.0001 Age <75 years 1.52 (1.03–2.26) 0.04 CHA2DS-VAS2c score <2 1.45 (1.11–1.90) 0.01 Characteristics associated with later AF-ablation   Hypertension 1.31 (1.02–1.69) 0.04   History of AF 1.70 (1.07–2.71) 0.03   Age <65 years 2.38 (1.89–3.01) <0.0001   CHA2DS-VAS2c score <2 1.77 (1.40–2.45) <0.0001 AF: Atrial fibrillation; HR: Hazard ratio. All HR's are adjusted for age, gender, hypertension, diabetes, heart failure, iscemic heart disease, valvular heart disease, chronic obstructive lung disease, chronic kidney disease and history of AF using Cox regression analysis.

Conclusion

In a nation-wide cohort undergoing CTIA for AFL, 10% of patients underwent CTI re-ablation and 13.5% were ablated for AF during mean follow-up of 4±1.7 years. Probability of undergoing a second ablation procedure was higher in younger patients with less comorbidity.
P2856Risk factors for the first and second inappropriate implantable cardioverter-defibrillator therapy: a subanalysis of the NIPPON storm study
Authors: Nishii N , Noda T N , Nitta T N , Aizawa Y A , Ohe T O , Kurita T K
Published: October 2019

Background

Implantable cardioverter-defibrillator (ICD) including cardiac resynchronization therapy with defibrillator (CRT-D) has become an established therapeutic option to reduce the risk of sudden cardiac death. However, there are risks for the first and second inappropriate ICD shock events, which have not been well clarified.

Objective

To clarify the risk factors for the first and second inappropriate ICD therapy events.

Methods

We conducted a post-hoc, secondary analysis of the data from a multicenter, prospective, observational study (the Nippon Storm Study), designed to clarify the risk factors for electrical storm. The analysis included the data of 1549 of the 1570 patients with ICD or CRT-D enrolled into the study. An inappropriate event was defined as any inappropriate ICD or CRT-D therapy delivered, including antitachycardia pacing (ATP) or ICD shock for sinus tachycardia, atrial fibrillation (AF)/ atrial flutter (AFL), regular supraventricular tachycardia, or for non-arrhythmic events

Results

Over a median follow-up of 28 months, 293 inappropriate ICD therapy events occurred in 153 of the 1549 patients (10.0%) in the study sample, with 106 inappropriate ICD shock events identified in 72 (4.6%) patients. Inappropriate therapy events were unlikely during sleep. On multivariate Cox regression analysis, the risk factors for the first inappropriate ICD therapy included, younger age (hazard ratio (HR), 0.986; 95% confidence interval (CI), 0.973–0.998; p=0.028), AF/AFL (AF/AFL; HR, 2.324; 95% CI, 1.372–3.939; p=0.002), ICD implantation (HR, 2.377; 95% CI, 1.332–4.244; p=0.004), and multiple versus single stimulation zone (HR, 1.852; 95% CI, 1.163–2.951, p=0.010). After the first inappropriate ICD therapy event, any interventions were performed, including a change in the ICD programming (n=122), initiation or change in medication (n=33) and catheter ablation (n=7), or a combination of interventions. The rate of the second inappropriate ICD therapy event after treatment of the first was 37.6% at one year. The patients who underwent an intervention after the first inappropriate ICD event showed a lower risk of the second event, compared to those without any intervention (1.0% versus 6.0% at one week, 4.2% versus 22.3% at one month, 27.3% versus 57.4% at one year, log-rank p<0.001). On multivariate Cox regression analysis, the risk factors for the second inappropriate ICD therapy was no-intervention after the first inappropriate ICD therapy (HR, 3.521; 95% CI, 1.773–6.993; p=0.001).

Conclusions

The risk for the first inappropriate ICD therapy increased for younger patients, use of ICD versus CRT-D and a prior history of AF/AFL. Intervention after the first inappropriate ICD therapy could reduce the risk of the second inappropriate event.
P2860The effects of single nucleotide polymorphisms in Korean patients with early-onset lone atrial fibrillation after catheter ablation
Authors: Park Y M , Roh S Y , Lee D I , Shim J , Choi J.-I , Park S W , Kim Y.-H
Published: October 2019

Background

The status of SNPs among patients with extremely early-onset lone AF and the association with outcome of catheter ablation has not been evaluated before. This study evaluated the status of single nucleotide polymorphisms (SNPs) in Korean patients with early-onset (<40 years old) lone AF and effects on the outcome after catheter ablation.

Methods

A total of 89 consecutive patients (mean age 35.7±3.7 years, 81 males) with drug-refractory AF (paroxysmal 64.0%) who underwent catheter ablation were included. Sixteen SNPs including rs13376333, rs10465885, rs10033464, rs2200733, rs17042171, rs6843082, rs7193343, rs2106261, rs17570669, rs853445, rs11708996, rs6800541, rs251253, rs3807989, rs11047543 and rs3825214 were genotyped. Serial 48-day Holter electrocardiographic recordings were acquired to detect AF recurrences during long-term follow up.

Results

Wild type of rs7193343 [CC; 0/7 (0%) vs. CT; 22/40 (55.0%) vs. TT; 18/41 (43.9%), p=0.025] and rs11047543 [GG; 26/69 (37.7%) vs. GA; 13/18 (72.2%) vs. AA; 0/0, p=0.009] and homozygous variant of rs3825214 [AA; 16/31 (51.6%) vs. AG; 22/43 (51.2%) vs. GG; 2/13 (15.4%), p=0.05] were significantly associated with lower rate of late recurrence. When the patients were assigned to four groups according to the number of risk alleles (n=0–3), Kaplan-Meier survival analysis showed incremental prognostic value according to the number of variant alleles (p=0.002) (Figure 1).

Figure 1

Conclusions

Polymorphisms on rs7193343, rs3825214 and rs11047543 modulate the risk for AF recurrence after catheter ablation during long term follow up in Korean patients with early-onset lone AF.

Acknowledgement/Funding

Korean Society of Cardiology
P287015 year trend in ICD utilization according to the Italian national administrative database: an analysis of age groups
Authors: Zecchin M , Torre M , Ortis B , Proclemer A , Carrani E , Sampaolo L , Ricci R P , Boriani G
Published: October 2019

To achieve a complete coverage of all Implantable Cardioverter Defibrillator (ICD) performed in Italy between 2001 and 2015, data from the National Hospital Discharge Database (SDO: “Scheda di Dimissione Ospedaliera”) were analyzed. Frequencies and implant rate of ICD and Cardiac Resynchronization Therapy/Defibrillator (CRTD) according to the Italian population were computed. Data were analyzed for the following age classes: <50, 50–80, >80.

Results

Total number of ICD increased from 3141 in 2001 (implant rate 54/million inhabitants) to 23.540 in 2015 (387/million). From 2009 to 2015 CRT-D increased from 2916 in 2009 (49/million) to 8245 in 2015 (136/million), while the proportion of CRT/total ICD from 17% to 35%.

Mean age (from 67±12 in 2001 to 68±12 in 2015) and the proportion of males (from 80% to 79%) remained unchanged.

Ischemic heart disease was the most frequent diagnosis (55.6% in 2001, 45.4% in 2015).

ICD for secondary prevention have been reducing from 55.6% to 13.6% (ventricular tachycardia, VT) and from 18.1% to 5.9% (ventricular fibrillation, VF). The proportion of patients with heart failure (from 23.9% to 47.9%), hypertension (from 11.2% to 16.2%), diabetes mellitus (6.5% to 11.6%) and renal insufficiency (from 4.4% to 8%) increased.

The proportion of CRT/ICD remained constant (except for the 2009, where a possible underdiagnosis is very likely), between 43% and 39%.

In patients <50 years old the number of ICD increased from 367 (10/million) in 2001 to 1829 (52/million) in 2015; the most frequent diagnosis was idiopathic cardiomyopathy (30%), while ischemic heart disease was present in 20%. An increase of the proportion of patients with the diagnosis of heart failure (from 13.8% to 33.6%), hypertension (from 4.3% to 8.5%), diabetes mellitus (1.5% to 3.9%) and renal insufficiency (from 1.3% to 2.2%) was observed.

In patients >80 years old the number of ICD increased from 195 (82/million) in 2001 to 3902 (981/million) in 2015; ischemic heart disease was the most frequent diagnosis (53.8% in 2001, 43.5% in 2015). ICD for secondary prevention reduced from 50.3% to 14,8% (VT) and from 16.4% to 4.1% (VF), with an increase of the proportion of patients with heart failure (from 22.6% to 46.3%), hypertension (from 11.8% to 17.1%), diabetes mellitus (5.6% to 9.9%) and renal insufficiency (from 7.2% to 12.1%).

Conclusions

There was a steady increase of ICD and CRTD implantation during the last fifteen years, especially in those >80 years; the proportion of patients treated for secondary prevention dramatically reduced since early 2000; an increase of co-morbidities was observed.
P2871Attenuated clinical benefit after ICD replacement over long term follow-up in a contemporary large world population: insight to the DECODE registry
Authors: Zanon F , Menardi E , Ammendola E , De Filippo P , Manzo M , Stabile G , Potenza D R , Zaca' V , Bertini M , Lissoni F , Bandini A , Calzolari V , Zingarini G , Malacrida M , Biffi M
Published: October 2019

Background

Cardiac Implantable Electronic Device (CIED) surgery is threatened by serious complications both during the procedure and during follow-up. The factors associated to attenuated clinical benefit over long term follow-up are poorly understood.

Purpose

To evaluate type and extent of Adverse Events (AEs) and potential predictors of major AEs over 12 months after ICD/CRT-D replacement/upgrade in a contemporary Italian population.

Methods

Detect long-term complications after ICD replacement (DECODE) was a prospective, single-arm, multicenter cohort study aimed at estimating medium- to long-term complications in a large population of patients (pts) who underwent ICD/CRT-D replacement/upgrade from 2013 to 2015. The endpoint for this analysis is death from any cause, procedure-related infection, and surgical actions/hospitalizations necessary to treat the AEs.

Results

We included 983 consecutive pts (median age 71 years, 76% male, 55% ischemic, 47% CRT-D). During a mean follow-up duration of 353±49 days, 7% of the pts died. A total of 104 AEs occurred in 70 (7.1%) pts. 43 (4.4%) pts needed at least one surgical action to treat the AEs. A total of 23 (2.3%) pts had infective AEs (CIED related in 12 pts, due to other causes in 11). Mortality was unrelated to the occurrence of overall AEs, or of CIED-related AEs, or of surgical actions/hospitalizations needed to correct AEs. The endpoint was reached by 109 (11%) pts over 12-month follow-up (97 pts had a single event, and 12 pts had two events). The median time to the endpoint was 137 [50 - 254] days. On multivariate Cox regression analysis adjusted for baseline confounders, ischemic cardiomyopathy (HR = 1.86, 95% CI: 1.18 to 2.91; p=0.0076), hospitalization prior to the procedure (2.34, 1.35 to 4.05; 0.0025) and anticoagulation (1.91, 1.25 to 2.92; 0.0032) were associated with the endpoint during follow-up.

Conclusion

Evaluation of the patient's profile may assist in predicting vulnerability and should prompt reconsideration of the procedure by deferring at a more stable clinical status, and carefully individualized in the setting of upgrades and anticoagulation management

Acknowledgement/Funding

None
P2875Comparison between ejection fraction, global longitudinal strain, mechanical dispersion and delta contraction duration in predicting first and subsequent arrhythmic events in ICD patients
Authors: Guerra F , Malagoli A , Contadini D , Baiocco E , Menditto A , Bonelli P , Rossi L , Sticozzi C , Zanni A , Cai J , Maitra P , Villani G Q , Capucci A
Published: October 2019

Background

According to current guidelines, left ventricular ejection fraction (LVEF) is currently the most important parameter for primary prevention of sudden cardiac death in patients with structural heart disease. Unfortunately, LVEF has low sensitivity in detecting arrhythmic events and presents a significant intra- and inter-operator variability. For these reasons, alternative predictors in patients with structural heart disease are being sought. Among those, speckle-tracking derived parameters such as global longitudinal strain (GLS), mechanical dispersion (MD), and delta contraction duration (DCD) have been proposed as better alternatives.

Purpose

To assess speckle-tracking derived parameters as predictors of first and subsequent arrhythmic events in implantable cardioverter-defibrillator (ICD) patients with structural heart disease, and to compare their performance with LVEF.

Methods

Prospective, observational study enrolling all consecutive patients with structural heart disease admitted for an ICD implant. Patients not followed by a home-monitoring system were excluded. 2D speckle-tracking analysis was used to derive GLS, MD, and DCD of all patients at enrolment. Home monitoring was checked weekly in order to detect all ventricular arrhythmias (VA) and ICD therapies. A recurrent-event statistical approach (Prentice, Williams, and Peterson model) was applied in order to evaluate subsequent events after the first ones.

Results

Two-hundred-and-three patients were consecutively enrolled and followed-up for a median follow-up of 2.2 years. Kaplan-Meier curves showed an increased risk of ATP or shock (Log-rank p=0.003) and VAs (Log-rank p=0.001) associated with lower quartiles of GLS (Figure 1). An impaired GLS was independently associated with an increased risk for the first ICD therapy (HR 1.94; 95% CI 1.30–2.91; p=0.001), and for the first VA (HR 1.42; 95% CI 1.01–1.98; p=0.04). GLS impairment was not significantly associated with an increased risk of recurrent ICD therapies or VAs. LVEF, MD and DCD were not associated with an increased risk of first, second and third ICD therapy or VA.

Conclusions

Impaired GLS is associated with an increased risk of VAs and appropriate ICD therapies in a consecutive, “real-world”, unselected population of remote-monitored patients with structural heart disease, although it does not seem reliable in predicting further arrhythmic event after the first one. LVEF, MD, and DCD do not predict first or subsequent arrhythmic events in ICD patients with structural heart disease.

Acknowledgement/Funding

Marche Polytechnic University
Short-term e-cigarette vapour exposure causes vascular oxidative stress and dysfunction: evidence for a close connection to brain damage and a key role of the phagocytic NADPH oxidase (NOX-2)
Authors: Kuntic Marin , Oelze Matthias , Steven Sebastian , Kröller-Schön Swenja , Stamm Paul , Kalinovic Sanela , Frenis Katie , Vujacic-Mirski Ksenija , Bayo Jimenez Maria Teresa , Kvandova Miroslava , Filippou Konstantina , Al Zuabi Ahmad , Brückl Vivienne , Hahad Omar , Daub Steffen , Varveri Franco , Gori Tommaso , Huesmann Regina , Hoffmann Thorsten , Schmidt Frank P , Keaney John F , Daiber Andreas , Münzel Thomas
Published: October 2019

Aims

Electronic (e)-cigarettes have been marketed as a ‘healthy’ alternative to traditional combustible cigarettes and as an effective method of smoking cessation. There are, however, a paucity of data to support these claims. In fact, e-cigarettes are implicated in endothelial dysfunction and oxidative stress in the vasculature and the lungs. The mechanisms underlying these side effects remain unclear. Here, we investigated the effects of e-cigarette vapour on vascular function in smokers and experimental animals to determine the underlying mechanisms.

Methods and results

Acute e-cigarette smoking produced a marked impairment of endothelial function in chronic smokers determined by flow-mediated dilation. In mice, e-cigarette vapour without nicotine had more detrimental effects on endothelial function, markers of oxidative stress, inflammation, and lipid peroxidation than vapour containing nicotine. These effects of e-cigarette vapour were largely absent in mice lacking phagocytic NADPH oxidase (NOX-2) or upon treatment with the endothelin receptor blocker macitentan or the FOXO3 activator bepridil. We also established that the e-cigarette product acrolein, a reactive aldehyde, recapitulated many of the NOX-2-dependent effects of e-cigarette vapour using in vitro blood vessel incubation.

Conclusions

E-cigarette vapour exposure increases vascular, cerebral, and pulmonary oxidative stress via a NOX-2-dependent mechanism. Our study identifies the toxic aldehyde acrolein as a key mediator of the observed adverse vascular consequences. Thus, e-cigarettes have the potential to induce marked adverse cardiovascular, pulmonary, and cerebrovascular consequences. Since e-cigarette use is increasing, particularly amongst youth, our data suggest that aggressive steps are warranted to limit their health risks.
Mineralogical control on the magnetic anisotropy of lavas and ignimbrites: a case study in the Caviahue-Copahue field (Argentina)
Authors: Moncinhatto Thiago R , Haag Maurício B , Hartmann Gelvam A , Savian Jairo F , Poletti Wilbor , Sommer Carlos A , Caselli Alberto T , Trindade Ricardo I F
Published: October 2019

Anisotropy of magnetic susceptibility is a petrofabric tool used to estimate the alignment of minerals at the site-scale, the imbrication between the magnetic foliation and the emplacement surface being an indicator of flow direction. However, despite numerous studies examining the flow direction in pyroclastic deposits and lava flows, the effect of magnetic mineralogy and the domain state of ferromagnetic phases on the magnetic fabric remains poorly understood. This paper describes the magnetic mineralogy and its influence on the magnetic fabric of Plio-Pleistocene lava flows and ignimbrites of the Caviahue-Copahue Volcanic Complex in the Andean Southern Volcanic Zone, Argentina. Rock magnetism, anisotropy of magnetic susceptibility and anhysteretic remanent magnetization and petrographic observations were performed on 30 sites of the volcanic complex. Results revealed the extrusive and pyroclastic rocks present varied magnetic mineralogy, formed in different stages of the magmatic evolution. Magnetic mineralogy variations strongly affect the anisotropy of magnetic susceptibility data in volcanic rocks and associated ignimbrites, providing ‘scattered’ fabrics when late Ti-rich titanomagnetite phases dominate the fabric, and ‘inverse’ or ‘intermediate’ fabrics when single-domain grains are present. ‘Normal’ fabrics are typically found when early crystallized pure magnetite is present. Our results highlight the complexity in the interpretation of magnetic anisotropy data in volcanic rocks and ignimbrites.
Effect of the lateral topographic density distribution on interpretational properties of Bouguer gravity maps
Authors: Rathnayake Samurdhika , Tenzer Robert , Pitoňák Martin , Novák Pavel
Published: October 2019

Until recently, the information about the topographic density distribution has been limited to only certain regions and some countries, while missing in the global context. The UNB_TopoDens is the first model that provides the information about a lateral topographic density globally. The analysis of this model also reveals that the average topographic density for the entire continental landmass (excluding polar glaciers) is 2247 kg m−3. This density differs significantly from the value of 2670 kg m−3 that is typically adopted to represent the continental upper crustal density. In this study, we use the UNB_TopoDens density model to inspect how the topographic density variations affect interpretational properties of Bouguer gravity maps. Since this model provides also the information about density uncertainties of individual lithologies (main rock types), we estimate the corresponding errors in the Bouguer gravity data. Despite a new estimate of the average topographic density corresponds to relative changes of ∼16 per cent in values of the topographic gravity correction, these changes do not affect interpretational properties of Bouguer gravity maps. The anomalous topographic density distribution (taken with respect to the average density of 2247 kg m−3), however, modifies the Bouguer gravity pattern. We demonstrate that the gravitational contribution of anomalous topographic density is globally mostly within ± 25 mGal, but much large values are detected in Himalaya, Tibet, central Andes and along the East African Rift System. Our estimates also indicate that errors in the Bouguer gravity data attributed to topographic density uncertainties are mostly less than ± 15 mGal, but in mountainous regions could reach large values exceeding even ± 50 mGal. Unarguably, the UNB_TopoDens model provides an improved information about the global topographic density variations and their uncertainties. Nevertheless, much more in situ measurements of rock density samples together with detailed 3D geological models are still necessary to understand better the actual density distribution within the whole topography, particularly to mention a density change with depth.
Diophantine Property of Matrices and Attractors of Projective Iterated Function Systems in ℝℙ1
Authors: Solomyak Boris , Takahashi Yuki
Published: October 2019

We prove that almost every finite collection of matrices in $GL_d( \mathbb{R} )$ and $SL_d({\mathbb{R}})$ with positive entries is Diophantine. Next we restrict ourselves to the case $d=2$. A finite set of $SL_2({\mathbb{R}})$ matrices induces a (generalized) iterated function system on the projective line ${\mathbb{RP}}^1$. Assuming uniform hyperbolicity and the Diophantine property, we show that the dimension of the attractor equals the minimum of 1 and the critical exponent.