bluuebunny/crossref_metadata_2025_split huggingface dataset:
P969Predictors of survival after bifurcation stenting (practical insights from COSIBRIA registry)
Authors: Vassilev D , Nikolov P , Mileva N , Zlatancheva G , Dimitrov G , Ivanov V , Karamfiloff K , Panayotov P , Collet C , Gil R 
Published: October 2019

Abstract

Background
There is no much information about survival after coronary bifurcation stenting. We explored specifically predictors of death in all-comers registry database.

Methods
The COSIBRIA registry (COronary SIde Branch Residual IschemiA and COllateralization Assessment Study, Identifier: NCT01268228) collected all coronary bifurcation patients treated with intracoronary ECG (icECG) guidance or angiographically guided PCI. It was designed to explore relation between periprocedural ischemia assessed by means of icECG and post-procedural myonecrosis (troponin rise). Patients with STEMI, distal left main, cardiogenic shock or hemodynamic instability or BVS implantations were excluded. Unipolar icECGs were recorded before, during and after stent placement and at the end of procedure in side branch (SB) and main branch (MB). The coronary wire was placed in all distal vessels with diameter >1.5mm, to “map” the distal zones of ischemia. Provisional T-stenting, with proximal balloon optimization (POT) after stent implantation was default strategy. SB was stented in case of non-normalization of icECG ST-segment elevation after kissing-balloon dilatation or flow compromise and severe dissection (>type C) associated with symptoms. All patients were treated with 3rd and higher generation drug-eluting stents.

Results
731 patients were included in the analysis recruited from 01.08.2014 to 31.12.208 – 321 (44%) icECG guided. The mean age of patients was 67±10 years, 68% males, 38% smokers, 94% dyslipidemic, 41% diabetics, 26% had previous MI, 47% previous PCI, previous CABG 3%, renal failure 32%, cerebrovascular and peripheral artery disease – 15% and 10%. At median follow-up of 28 months (IQR 18–45 months), 110 patients died (15%): icECG-guided vs. angio guided (18.1% (58/321) vs. 12.7% (52/410), p=0.043, log-rank p=0.045). Side branches were stented in 27%. On univariate analysis significantly associated with mortality were: age, sex, COPD, renal failure, total cholesterol, atrial fibrillation, cerebrovascular disease, ejection fraction (EF), mitral regurgitation >1st degree, SB stenting, kissing balloon inflation, stent length, lesion location (LAD), SYNTAX score. On Cox-regression analysis an independent predictors of survival were: age (HR=1.033, CI: 1.011–1.055, p<0.001), male sex (HR=1.733, CI: 1.056–2.845, p=0.030), COPD (HR=0.586, CI: 0.349–0.985, p=0.044), EF (HR=0.972, CI: 0.953–0.992, p=0.006), MR>1 (HR=1.617, CI: 1.224–2.136, p=0.001), SB stenting (for non-stent implantation HR=0.497, CI: 0.300–0.824, p=0.007).

Conclusions
Even with modern treatment of coronary bifurcations the demographic factors and parameters of left ventricular function governs the patient survival. The only technical factor associated with survival was implantation of stent in SB, associated with worse survival. Intracoronary ECG guided PCI was not independently associated with survival.
P971Impact of treatment strategy on 1-year outcome for Left Main trifurcation lesions
Authors: Tani K , Mitomo S , Tanaka K , Tahara S , Nakamura S 
Published: October 2019

Abstract

Background/Introduction
Limited data exist regarding procedural strategy and clinical outcomes after percutaneous coronary intervention (PCI) for unprotected left main (LM) trifurcation lesion.

Purpose
The aim of this study is to evaluate 1-year clinical outcomes after LM trifurcation PCI comparing different strategies in kissing balloon inflation (KBI).

Methods
From 1, January, 2011 to 31, March, 2017, patients who underwent LM trifurcation PCI with second generation drug-eluting stent in our center were retrospectively analyzed. They were categorized into single-stent KBT group (KBT in left anterior descending artery [LAD] and left circumflex artery [LCX], or LAD and high lateral branch [HL]) and no-KBT group. Primary endpoint is restenosis in the lesions.

Results
Among 1301 patients who underwent LM PCI during the study period, 163 patients (12.5%) had a trifurcation lesion. Regarding the number of stents used for the lesions, 1, 2 and 3 stents were used in 75.4%, 22.0% and 2.5%, respectively. Median follow-up period of LM trifurcation patients was 265 days (interquartile range: 81–564). In the no-KBT group (64 patients), 19 patients experienced restenosis of HL and LCX (HL: 8 patients, LCX: 0 patient, and both: 11 patients). In the KBT-group, KBT for LAD and LCX was performed in 47 patients, and of them, 19 patients experienced restenosis of LM-LAD, HL and LCX (HL: 12 patients, LCX: 6 patients and all: 1 patient). On the other hand, in 9 patients with KBT for LAD and HL, there were no restenosis cases at 1-year follow-up. There was no statistically significant difference in restenosis rate between the no-KBI and KBT group (29.6% vs. 40.4%, p=0.69).
Restenosis rates in each segments

Conclusion
After LM trifurcation PCI, restenosis rate at 1-year follow-up was high, and no difference between no-KBT and KBT group overall. However, there was no restenosis case in patients with KBT for LAD and HL.
P978Core to block: a new ablation strategy for treating persistent atrial fibrillation
Authors: Shi R , Pope M T B , Boyalla V , Jones D G , Haldar S , Hussain W , Markides V , Betts T R , Wong T 
Published: October 2019

Abstract

Background
Ablation strategy targeting the core of atrial fibrillation (AF) rotors alone can lead to both stabilisation and destabilisation of rotational activity. Non-contact dipole density mapping system is designed to rapidly identify dynamic regional atrial activation patterns of interest (API) during AF.

Purpose
To assess the feasibility of an ablation strategy consisted of pulmonary vein isolation + targeting the core of APIs followed by linear ablation to the nearest non-conducting boundary to treat persistent AF.

Methods
The ablation strategy includes: 1. Antral pulmonary vein electrical isolation (APVI); 2. APIs (focal, localised rotational and localised irregular activation; Figure1) detection by dipole density mapping; 3. API core ablation followed by linear ablation to the nearest non-conduction barrier (APVI/mitral valve); 4. repeat step 2 and 3 in LA (RA, if necessary) until sinus rhythm is achieved.

Results
Consecutive 40 persistent AF patients (mean 62±12 years, 29 males, AF duration 10±4 months, LA diameter 42±9 mm) were included from 2 centres. An average of 2.0±0.7 APIs per patient were targeted post-APVI. Acute AF termination by ablation was achieved in 27/40 (68%) patients. The mean ablation time of APVI and “Core to block” was 33±12 mins and 31±22 mins, respectively. No major complication occurred. During a mean follow-up of 12±5 months, 32/40 patients (80%) maintained sinus rhythm.

Conclusion
APVI + “Core to block” guided by the dipole density mapping is feasible for treating persistent AF. A larger randomised study is needed to test the effectiveness of this ablation strategy.

Acknowledgement/Funding
None
P991Predicting arrhythmic risk in dilated cardiomyopathy: a systematic review & meta-analysis of clinical parameters
Authors: Sammani A , Kayvanpour E , Bosman L P , Sedaghat-Hamedani F , Proctor T , Jensen K , Katus H A , Te Riele A S J M , Meder B , Asselbergs F W 
Published: October 2019

Abstract

Background
Patients with non-ischemic dilated cardiomyopathy (NIDCM) are at increased risk of ventricular arrhythmias and sudden cardiac death (SCD). However, identifying patients at high risk for life-threatening ventricular arrhythmia (LTVA) who may benefit from an implantable cardioverter defibrillator (ICD) remains challenging.

Methods
We searched MEDLINE and EMBASE for prognostic studies describing predictors of LTVA (defined as sustained ventricular tachycardia (VT), haemodynamically unstable VT, ventricular fibrillation, (aborted) SCD or appropriate ICD intervention) in patients with NIDCM. We excluded articles with composite heart failure and arrhythmic endpoints but lacking (subgroup) analysis for LTVA. Study quality and risk of bias was assessed using the QUIPS-tool, and articles with high risk of bias in ≥2 areas were excluded from analysis. Univariable hazard ratios of reported predictors were pooled from the remaining studies in a meta-analysis using a random-effects model and presented with 95% confidence interval (CI).

Results
Out of 1996 unique citations, 51 studies were included comprising 9798 patients with 1493 arrhythmic events. 28 studies were pooled for meta-analysis (mean age 55±4.1 years, 72% male) with a mean follow-up of 3.7±1.9 years. Crude event rate was 4.3% (95% CI 4.02–4.57) per year. From our meta-analysis, hypertension (HR 1.95; CI [1.26–3.00]), history of out of hospital cardiac arrest or sustained VT (HR 4.15; CI [1.32–13.02]), T-wave alternans (HR 6.50; CI [2.46–17.14]), LVEDV per 10ml/m2 increase (HR 1.10; CI [1.10–1.10]), LVESV per 10ml/m2 increase (HR 1.10; CI [1.00–1.22]) and delayed gadolinium enhancement (HR 5.55; CI [4.02–7.67]) were significantly associated with LTVA (figure). The quality of evidence was moderate and there was significant heterogeneity (median i2 57%; IQR 76%) among studies. Additionally from data that could not be pooled, decreased LVEF, history of nsVT and decreased heart rate variability were significantly associated with LTVA.
Summary of meta-analysis results

Conclusion
The risk of LTVA in NIDCM is 4.3% per year and is considerably higher in patients with hypertension, history of LTVA, decreased LVEF, high LVEDV, high LVESV, T-wave alternans, history of nsVT, decreased heart rate variability and delayed gadolinium enhancement. These results may help determine appropriate candidates for ICD implantation. The high heterogeneity in reported results indicate the need for future multicentre studies to further improve risk stratification in NIDCM.

Acknowledgement/Funding
ERA-CVD JTC2016: DETECTIN-HF, 680969 & Dutch Heart Foundation (2016T096)
P992Incidence, predictors, and success of ventricular tachycardia catheter ablation in arrhythmogenic right ventricular cardiomyopathy (ARVC): A long-term cohort study from the Nordic ARVC registry
Authors: Christiansen M K , Haugaa K , Svensson A , Gilljam T , Madsen T , Hansen J , Holst A , Bundgaard H , Edvardsen T , Svendsen J H , Platonov P , Jensen H K 
Published: October 2019

Abstract

Background
Catheter ablation may reduce ventricular tachycardia (VT) burden in arrhythmogenic right ventricular cardiomyopathy (ARVC) patients. However, little is known about factors predicting need for ablation and various outcomes have been reported.

Purpose
We sought to investigate predictors and use of VT ablation and to evaluate the post-procedural outcome in ARVC patients.

Methods
We studied 435 patients from the Nordic ARVC registry including 220 probands with definite ARVC according to the 2010 task force criteria and 215 mutation-carrying relatives identified through cascade screening. Patients were followed until first-time VT ablation, death, heart transplantation, or January 1st 2018. Additionally, patients undergoing VT ablation were further followed from the time of ablation for recurrent ventricular arrhythmias.

Results
Cumulative use of VT ablation was 4% (95% CI 3%-6%) and 11% (95% CI 8%-15%) after 1 and 10 years. All procedures were performed in probands in whom the cumulative use was 8% (95% CI 5%-12%) and 20% (95% CI 15%-26%). In adjusted analyses restricted to probands, only young age predicted need for ablation. In patients undergoing ablation, risk of recurrent arrhythmias was 59% (95% CI 44%-71%) and 74% (95% CI 59%-84%) 1 and 5 years after the procedure. Despite high recurrence rates, the burden of ventricular arrhythmias was reduced after ablation (p=0.0042). Young age, use of several antiarrhythmic drugs and inducibility to VT immediately after ablation were associated with an unfavorable outcome.

Conclusions
Twenty percent of ARVC probands developed a clinical indication for VT ablation within 10 years after diagnosis whereas mutation-carrying relatives were without such need. Although the burden of ventricular arrhythmias decreased after ablation, risk of recurrence was substantial.
P996Early experience of transnasal micro-transesophageal echocardiography to guide left atrium appendage closure under conscious sedation
Authors: Couture E , Darmon A , Stein G , Platonov I , Brennt V , Horvilleur J , Chevalier B , Garot P 
Published: October 2019

Abstract

Introduction
Percutaneous left atrial appendage closure (LAAC) is typically performed utilizing transesophageal echocardiography (TEE) and fluoroscopy under general anesthesia (GA) or intracardiac echocardiography (ICE) under conscious sedation. Transnasal microtransesophageal echocardiography (micro-TEE) is a recently described technique to guide structural heart interventions eliminating the need for GA, which is beneficial for all, especially older patients. In this series, we report our initial experience with this novel technique to guide LAAC.

Methods and results
Between June 2018 and January 2019, we performed 30 consecutives LAAC (mean age 80,2 years old) with the Amplatzer AMULET in whom we considered using transnasal micro-TEE under conscious sedation instead of TEE under GA. All patients had a CT prior to the procedure to assess anatomy suitability and to rule out thrombus as well as a follow-up CT performed at 3 months post-LAAC to confirm complete sealing. Three patients had TEE instead of micro-TEE for various reasons (patient preference, cognitive impairment, INR >2). We observed one cross-over to TEE+GA because of a failed esophageal intubation under conscious sedation. Device implantation success rate was 100%. Imaging quality was quoted either good or excellent in 25 of the 26 patients with the remaining being quoted as suboptimal. Patient tolerance was either good or excellent in 24 of the 26 cases. There were five epistaxis noticed, one requiring nasal packing. No device embolization, no significant peri-device leak, no tamponade occurred in any patient during this period. At 3 months, there was no prosthesis thrombosis observed and 23% (6/26) had partial opacification of the LAA behind the prosthesis.

Conclusion
In this series, transnasal micro-TEE was feasible, safe, well tolerated and provided sufficient imaging quality to guide LAAC with the Amplatzer AMULET under conscious sedation. The cheaper cost and the wider field of view of micro-TEE over ICE are potential advantages that could impact the organization of LAAC programs especially when these interventions are planned in the elderly in whom GA carries a significant risk.
P998Left atrial appendage closure device thrombosis is associated with systemic embolization
Authors: Hala P , Lekesova V , Mraz T , Prokopova M , Petru J , Sediva L , Janotka M , Chovanec M , Molnarova K , Neuzil P 
Published: October 2019

Abstract

Introduction
Atrial fibrillation, in one of its forms, is the most frequent sustained tachyarrhythmia and increases the risk of stroke more than 5 times. Cardioembolic stroke and systemic embolism (CS/SE) represents the most severe complication of this arrhythmia. Approximately 92% of intracardiac thrombosis originates from the left atrial appendage (LAA) and, although its mechanical occlusion is proved method to prevent cardioembolism, thrombosis of all types of LAA occlusion devices and their associations with CS/SE were observed.
The purpose of this study is to evaluate the rate of LAA occlusion device thrombosis, its predictors and the risk for cardioembolism.

Methods
We analyzed a group of 359 patients (65% male, mean age 72 years) with high risk for thromboembolism (mean CHADSVASc = 4.0) after LAA catheter occlusion using any of 9 different occluder types since 2005. During clinical follow-up 819 patientyears were collected and an intracardiac thrombus was found on 22 devices. Total of 17 patients suffered CS/SE.

Results
Thrombosis was found in 11 men and 11 women, mean age 76 years, average CHADSVASc = 4.5 and HASBLED = 2.0. The thrombus was discovered on average 4.0 months after the LAA occlusion. In that time patients were receiving dual antiplatelet therapy (11x), acetysalicic acid (4x), or interrupted anticoagulation (6x). In 3 cases the thrombosis was associated with CS/SE which represented risk of 6.6% per year. In patients with no thrombosis annual risk of CS/SE was only 1.7% (P<0.001).
Figure 1

Conclusion
In our single center register thrombosis was found in total of 6.3% patients after LAA device implantation. In these patients, risk of CS/SE is 3.9-fold higher compared to patients without thrombus formation. Elderly patients and patients with more risk factors in general were affected more frequently.
P1026Risk factors for the occurrence of stroke after atrial fibrillation ablation
Authors: Lim H E , Ahn J , Han S J , Shim J , Kim Y H , Choi E K , Oh S , Shin S Y , Lip G Y H 
Published: October 2019

Abstract

Background
Risk factors for the occurrence of embolic stroke (ES) after atrial fibrillation (AF) ablation have not been fully elucidated. Our aim was to assess incidence of ES during long-term follow-up following AF ablation and to identify predicting factors associated with post-ablation ES.

Methods
We enrolled patients who experienced ES after AF ablation and body mass index-matched controls from AF ablation registries. Epicardial adipose tissue (EAT) was assessed using multislice computed tomography prior to ablation.

Results
A total of 3,464 patients who underwent AF ablation were recruited. During a mean follow-up of 47.2 months, ES occurred in 47 patients (1.36%) with a mean CHA2DS2-VAS score of 2.15 and overall incidence of ES was 0.34 per 100 patients/year. Compared with control group (n=190), ES group had more higher prior thromboembolic event and AF recurrence rates, larger LA size, lower creatinine clearance rate (CCr), and greater total and periatrial EAT volumes although no differences in AF type, CHA2DS2-VASc score, ablation extent, and anti-thrombotics use were found. On multivariate regression analysis, a prior history of thromboembolism, CCr, and periatrial EAT volume were independently associated with ES occurrence after AF ablation.
Cox regression analysis Risk factor Univariate Multivariate HR (95% CI) p value HR (95% CI) p value Age 1.017 (0.984–1.051) 0.31 Prior thromboembolism 2.488 (1.134–5.460) 0.023 2.916 (1.178–7.219) 0.021 CHA2DS2-VASc score 1.139 (0.899–1.445) 0.282 CCr 0.984 (0.970–0.999) 0.038 0.982 (0.996–0.998) 0.029 LA diameter (mm) 1.070 (1.012–1.130) 0.017 1.072 (0.999–1.150) 0.054 EAT_total (ml) 1.020 (1.010–1.029) <0.001 1.008 (0.993–1.023) 0.297 EAT_periatrial (ml) 1.085 (1.045–1.126) <0.001 1.065 (1.005–1.128) 0.032 PVI + additional ablation 0.846 (0.460–1.557) 0.592 No anticoagulant use 0.651 (0.346–1.226) 0.184 Recurrence 2.011 (1.007–4.013) 0.048 1.240 (0.551–2.793) 0.603 CCr, creatinine clearance rate; EAT, epicardial adipose tissue; LA, left atrium; PVI, pulmonary vein isolation.
K-M curve for stroke-free survival

Conclusions
Incidence of ES after AF ablation was lower than expected rate based on CHA2DS2-VASc score even though anticoagulants use was limited. Periatrial EAT volume, a prior thromboembolism event, and CCr were independent factors in predicting ES irrespective of AF recurrence and CHA2DS2-VASc score in patients who underwent AF ablation.
P1029Catheter ablation outcome and heart failure hospitalization in atrial fibrillation patients: insights from the Kansai plus atrial fibrillation (KPAF) registry
Authors: Tanaka N , Inoue K , Kobori A , Kaitani K , Morimoto T , Morishima I , Yamaji H , Nakazawa Y , Kusano K , Tanaka K , Hirao Y , Iwakura K , Fujii K , Kimura T , Shizuta S 
Published: October 2019

Abstract

Background
Heart failure (HF) is the leading cause of death in patients with atrial fibrillation (AF). Radiofrequency catheter ablation (RFCA) for AF is effective to maintain sinus rhythm.

Purpose
We sought to clarify whether AF ablation outcome influenced incidence of HF hospitalization after the procedures.

Methods
We conducted a large-scale, prospective, multicenter, observational study. A total of 5010 consecutive patients who underwent an initial RFCA for AF in 26 centers were enrolled (average age, 64±10 years; non-paroxysmal AF, 35.6%). The median follow-up duration was 2.9 years.

Results
The 3-year cumulative incidence of AF recurrence after a single procedure was 40.2%. The 3-year incidence of hospitalization for HF was observed in 92 patients (1.8%) and was significantly higher in patients with AF recurrence than those without it (3.3% vs 0.84%, log-rank p<0.001). After adjustment by advanced age,(≥65 years), reduced left ventricular ejection fraction (≤50%), low estimated glomerular filtration rate (≤60ml/min), and history of HF, all of which were statistically associated with a risk of HF hospitalization (p<0.1, respectively), AF recurrence after the index RFCA was an independent predictor of HF hospitalization (hazard ratio [HR]; 3.17, 95% confidence interval [CI]; 2.06–5.04, p<0.001).Even after multiple procedures (1425 re-ablation sessions in 1274 patients [25.4%]), AF recurrence after the last procedure was an independent predictor of HF hospitalization (HR; 2.83, 95% CI; 1.89–4.24, p<0.001).

Conclusions
Among AF patients receiving RFCA, those with AF recurrence were at greater risk of heart failure hospitalization than were patients without AF recurrence. These differences should be noted when treating AF patients in actual clinical practice.

Acknowledgement/Funding
This study was supported by the Research Institute for Production Development in Kyoto, Japan.
P1033Impact of workflow modifications in atrial fibrillation ablation for reducing the incidence of silent cerebral lesions with a new multi-electrode radiofrequency balloon catheter
Authors: Grimaldi M , Tondo C , Riva S , Neuzil P , Ghaly N , Bishara M , Schilling R , Reddy V 
Published: October 2019

Abstract

Background
Silent cerebral lesions (SCL) often occur after invasive cardiac procedures. Reported SCL incidence with AF ablation varies (incidence, up to 50%), depending on technology used, procedural workflow, and detection method.

Objective
To evaluate the impact of ablation workflow modifications on SCL incidence following pulmonary vein isolation radiofrequency (RF) ablation with a novel multi-electrode RF balloon catheter in patients with symptomatic paroxysmal AF (PAF).

Methods
In the RADIANCE feasibility study of the balloon catheter, all enrolled patients who underwent ablation were screened for SCL using pre- and post-procedural diffusion-weighted MRI. Several modifications were made to the ablation workflow in a subsequent European registration study (SHINE) of the same catheter: eliminating dual transseptal access, using an over-the-wire mini lasso, continuously irrigating all side ports, bolus dosing with heparin before transseptal puncture, maintaining activated clotting time (ACT) at 350–400 sec, and setting a maximum temperature limit of 55°C (previously, 60–65°C). Interim data are presented for SHINE (data cutoff, 22 Oct 2018).

Results
In the neurological assessment evaluable (NAE) populations of RADIANCE (n=38) and SHINE (n=30), respectively, mean ages were 60.8±10.04 and 59.7±7.83 years, and 57.9% and 70.0% were male. One patient in each study had a history of TIAs. SCL incidences were 23.7% (10 lesions in 9 patients) in RADIANCE and 7.1% (2 lesions in 2 patients) in SHINE (excluding 1 SCL that occurred in a patient who failed to meet inclusion criteria [age>75] and 1 SCL that occurred after data cut-off). SHINE NAE enrollment has since completed with no further SCL occurrences. Overall, mean ACTs were 344.3±24.55 sec in RADIANCE and 381.6±73.31 sec in SHINE (p=0.01); in patients with SCL, mean ACTs were 349.3±25.65 and 417.8±87.33 sec, respectively.

Conclusion(s)
Modifications to the workflow led to a decrease in the SCL incidence for PAF ablation using the novel RF balloon catheter.

Acknowledgement/Funding
These studies were sponsored by Biosense Webster, Inc.