bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1171Optimal fusion vs. biventricular pacing in cardiac resynchronization therapy: long-term results of 540 consecutive patients
Authors: Radu D A , Iorgulescu C N , Bogdan S N , Deaconu A I , Nastasa A , Badiul A , Cojocaru C , Vatasescu R G 
Published: June 2020

Abstract

Background
Right ventricular (RV) stimulation induces supplemental dyssynchrony in case of left bundle branch block (LBBB) patients. Isolated left ventricular (LV) pacing has been proven superior to biventricular pacing (BiV) in terms of acute hemodynamic response.

Purpose
We sought to determine whether an optimised isolated LV pacing algorithm called "optimal fusion" (OFu) produces better and sustainable effects when compared to BiV in the long term.

Methods
540/760 (reasonable data collection) consecutive patients implanted with CRT in CEHB were analysed. The follow-up included 7 hospital visits for each patient (between baseline and 3 years). Demographics, risk factors, usual serum levels, pre-procedural planning factors, clinical, ECG, TTE and biochemical markers were recorded. Statistical analysis was performed using software. Data were reported as either p-values from crosstabs (discrete) or mean differences, p-values and confidence intervals from t-tests (continuous). A p-value of .05 was chosen for statistical significance (SS).

Results
The overall group consisted of 51% OFu (275) and the rest BiV patients. Subjects in OFu were younger (-4.379 ys; &lt;.001; (-7.028;-1.729)), more often females (40.9 vs. 24.9%; &lt;.002), more obese (40.1 vs. 29.6%; &lt;0.40) and had more structural disease other than ischaemic scar burden (10.8 vs. 2.7%; &lt;.005). Procedures in OFu were mainly "de novo" (93 vs. 73.4%; &lt;.000), more often CRT-Ds (58.2 vs. 42.9%; &lt;.005) and more frequently in sinus rhythm (99.4 vs. 62.3%; &lt;.000) and with typical LBBB (77.2 vs. 45%; &lt;.000). Baseline PR interval was shorter in OFu (-32.20 msec; &lt;.033; (-61.58;-2.58)). Notably, OFu patients started from a lower EF (-3.29%; &lt;.001; (-5.156;-1.441)), had more dyssynchrony as evaluated by Pitzalis’ index (34.32 msec; &lt;.017; (6.132;62.522)) and poorer initial mechanical performance by dP/dt (-104.83 mm Hg/sec; &lt;.012; (-185.301;-24.366)). There was no SS difference in clinical parameters at 3 years. Mean EF was higher in OFu (38.59 vs. 34.82%; NS; (4.183;-4.755)) while both EDVs (170.40 vs. 161.40 ml; NS; (-82.40;100.40)) and ESVs (115.36 vs. 102.67 ml; NS; (-82.65;108.03)) were lower. When looking at absolute Δs, OFu performed much better in the long term: EF (+15.81 vs. +8.86%; NS; (-17.06877;3.17710)), EDV (-46.07 vs. – 10.1 ml; NS; (-19.88;102.60)) and ESV (-55.91 vs. -17.46 ml; NS; (-39.88;124.71)). The cumulated super-responder/responder (SR/R) percentage at 1 year was much higher in OFu (83.43 vs. 57.75; &lt;.040).

Conclusions
The benefit of OFu is definitely sustainable in the long term. Structural response is constantly superior with OFu when compared to BiV although the current data set did not yield SS when comparing absolute means. However, parameter Δs are clearly in favor of OFu which produced a SS higher cumulated rate of SR/Rs over 3 years of follow-up.
P1092Syncope in the emergency department: can 24-hour holter monitoring be of any help?
Authors: Lopes J , Saleiro C , Campos D , Sousa J , Puga L , Gomes R , Ribeiro J , Silva J , Goncalves L 
Published: June 2020

Abstract
Background
Syncope is a very common reason for presenting to the emergency department (ED). The existence of a telemetry unit is crucial but it is not the reality in some hospitals. In order to avoid unnecessary ward admission, 24-hour Holter (24HH) monitoring could be useful to help with the diagnosis (when the arrhythmic etiology is suspected and the symptoms are frequent enough) and also be important to safely discharge a patient.
Purpose
The purpose of this study is to evaluate the diagnostic performance of 24HH monitoring, during a syncope episode in the ER, and to compare the readmission rates between patients with normal and abnormal not diagnostic 24HH monitoring.
Methods
A cohort study of consecutive patients (P) who were monitored with 24HH in one hospital in the ED, between January 2015 and December 2017, were included. All the 24HH results were seen by a senior cardiologist and divided in three groups: A - normal, B - abnormal Holter study unlikely to explain syncope and C- Holter study considered to be diagnostic.
Groups A and B were compared using chi-square independence test to evaluate association between the result of the 24HH and readmission rates at 30 days and 1 year, as well as mortality and device implantation at 1 year. Multivariate logistic regression was used to look for other confounders.
Results
A total of 111 P were included in this study. Mean age was 75 ± 14 years old, with 55.6% male patients.
A previous emergency episode with syncope was present in 56.9% of P. The mortality at one-year follow-up was 11.9%. The 24HH was considered diagnostic in 25.2% of P (28 P), with 18.9% of all the P with necessity of pacemaker (PM) implantation. In the patients with a non-diagnostic 24HH, 6,4% implanted a loop recorder before discharge.
Group B patients had a higher 30-day readmission rate to the ED when compared with group A (OR = 4.050 CI 95 [1.13 – 14.497], p = 0.033), but no difference in one-year readmission rate (p= 0.065). There was no difference in one-year mortality between the two groups (p= 0.731) or in one-year implantation of pacemaker (p= 0.431).
Conclusion
The use of 24HH in the ED could be a valuable tool in the diagnosis of rhythm disorders that cause syncope. An abnormal non diagnostic result can still be a predictor of 30-day readmission to the ED with similar complaints.
P1433Prevalence and location of residual leaks following percutaneous left atrial appendage occlusion: the importance of 3D transesophageal echocardiography
Authors: Lopes J , Teixeira R , Campos D , Saleiro C , Sousa J , Puga L , Ribeiro J , Silva J , Goncalves L 
Published: June 2020

Abstract

Background
The left atrial appendage (LAA) shape and size are very variable, and incomplete appendage closure or persistent leaks around the device are common following device placement. Limited studies reported the rate of peri-device leaks (PDL) after percutaneous left atrial appendage closure, and the impact of 3D transesophageal echocardiography (3D-TEE) on the detection of those leaks.
Aim
To describe the rate and location of leaks 1 month after percutaneous closure of the LAA, with and without the use of 3D-TEE.

Methods
A cohort study of consecutive patients (P) who were submitted to a percutaneous LAA closure with success in one interventional cardiology centre, between May 2010 and October 2018, were included. Clinical and echocardiography data were recorded and analysed. Two groups were created: Group A (GA) included patients until August 2015 submitted to 2D TEE on follow up (N= 48) versus Group B (GB), which was composed of patients submitted to 3D-TEE after August 2015 (N= 76).

Results
A total of 124 P had an in-hospital admission for LAA closure, with control TEE 1 month after the procedure. Mean age was 73 ± 7 years old, with 62.9% male patients. The procedure was guided by TEE (52%) or intra cardiac echocardiography (ICE) (48%).Transeptal puncture was preferred (95% of the procedures). The most used device was Amulet (62%) vs ACP (23%) and Watchman (15%).
In the follow up TEE, 20% of patients had only 1 leak and 2% had 2 leaks. Of the detected leaks,31% were considered minor (&lt; 1 mm), 35% moderate (1-3 mm) and 34% major (&gt; 3 mm). Patients with leaks had a larger LAA diameter (22 ± 4 mm vs. 17 ± 3 mm, P = 0.01).
Of the detected leaks, 50% were located in the superior portion of the device, 23% were located in the inferior portion, 8% in the posterior portion and 8% in the lateral portion.
In GA the rate of leaks was 14% vs 24.5% in GB, with differences also when specified the size of the leak – minor (GA 2% vs GB 8.8%), moderate (GA 8% vs GB 8.1%) and major (GA 4% vs GB 7.6%).

Conclusion
The use of 3D echocardiography, 1 month after successful percutaneous LAA closure, augmented the rate of detection of device leaks. It remains to be studied the clinical impact of this finding.
P513Electrocardiographic and clinical predictors for permanent pacemaker requirement after transcatheter aortic valve implantation: a 10-year single center experience
Authors: Errigo D , Golzio P G , D"ascenzo F , Ragaglia E , Salizzoni S , Peyracchia M , Bruno F , Baldi E , Castagno D , Budano C , D"amico M , Giustetto C , De Ferrari G M 
Published: June 2020

Abstract

Funding Acknowledgements
None of the author have conflict of interest to disclose.

Background
As transcatheter aortic-valve implantation (TAVI) procedures have increased, the need of a permanent pacemaker (PPM) is a complication to be taken into account.

Objective
The aim of this study is to identify clinical, electrocardiographic (ECG) and procedural predictors for PPM requirement after TAVI.

Methods
The present is a single centre, retrospective study. All consecutive patients with severe symptomatic aortic stenosis who underwent TAVI had continuous ECG monitoring. Pre and post TAVI 12-leads ECG were analysed. We arbitrarily divided the patients into early and late PPM implantation (beyond the 3rd day after TAVI). The primary endpoint of the study was to identify electrocardiographic predictors of PPM implantation after TAVI, and the secondary endpoint was to identify other clinical or procedure-related predictive factors.

Results
Of 431 patients who underwent TAVI, 77 (18%) required a PPM, and 30 (7%) had late PPM implantations. Pre-operative RBBB implies more than five-fold increase of the risk of PPM implantation after TAVI (OR 5,43, CI 2.11 - 13.99, P = 0.000), whereas the history of syncope is associated with a two-fold increase of the risk (OR 2.00, CI 1.01 - 3.96, P = 0.044), and maintains its predictive value also in the late PPM subgroup (OR 2.76, CI 1.11 – 6.82, P = 0.028).

Conclusions
It is hard to predict the need of a PPM in the individual patients, but careful evaluation of pre-operative 12-lead ECG looking for pre-existing RBBB and an history of syncope, can individuate the group of patients with an increased risk of PPM requirement.
P1361Impact of radiation/chemotherapy for breast cancer on the electroanatomic features in patients receiving catheter ablation for left atrial arrhythmia
Authors: Schenker N , Hashiguchi N , Maurer T , Lemes C , Rottner L , Reissmann B , Rillig A , Kuck K H , Ouyang F , Mathew S 
Published: June 2020

Abstract

Background
Atrial fibrillation (AF) is a common cardiac arrhythmia and catheter ablation a viable treatment option for patients with AF. Extensive left atrial (LA) scars, frequently seen in patients with persistent AF, can limit its efficacy. Radiation for breast cancer treatment is known to have serious long-term effects (e.g. fibrosis) on the targeted tissue. At the same time, chemotherapy often leads to organ dysfunction. We sought to examine the effects of radiation and chemotherapy on the electroanatomic features of the LA in patients who received catheter ablation for left atrial arrhythmias with prior breast cancer treatment.

Methods and Results
We compared 38 patients (mean age 68.4 ± 7.1 years) who underwent catheter ablation for LA arrhythmia and had a previous diagnosis of breast cancer with 38 patients (mean age 65.4 ± 7.3 years) without breast cancer who formed our control group. LA scar area, as well as its distribution was measured during the electrophysiology (EP) study and graded according to the Utah classification.
The existence of LA scarring did not differ significantly between both groups (71.1% vs. 76.3%, p = 0.602). LA scar area (excluding PVs) was 107.5cm2 ± 19.0cm2 in the breast cancer group compared to 110.1cm2 ± 18.5cm2 in the control group (p = 0.536). The distribution of the scar area revealed no significant difference between both groups, however an involvement of the anterior wall was common (65.8% vs. 73.7%; p = 0.454). We further investigated whether the location of breast cancer had an impact on the LA scar development of the patients in our study cohort. Here, we found no significant difference in the amount of LA scarring when comparing patients with left-sided breast cancer to patients with right-sided breast cancer (66.7% vs. 73.9%). In a sub-analysis patients with breast cancer and persistent AF showed a non-significant trend towards greater LA scar areas (17.4cm2 vs. 6.8cm2) in comparison to patients of the control group with similar LA volumes.
The patient’s age (&gt;65 years) was the only independent predictor for greater LA scarring we could identify. Neither former radiotherapy, nor chemotherapy showed a positive correlation with greater LA scarring.

Conclusion
There is no change in the distribution as well as an increase of the extent of LA scars after thoracic irradiation and/or chemotherapy. A trend towards greater LA scar areas was seen in patients with breast cancer and persistent AF. The patient’s age was identified as an independent predictor for LA scar development.
1242The flexibility, ease of using, and leaving curve of a standardized ablation index workflow for catheter ablation of paroxysmal atrial fibrillation
Authors: Gupta D , Vijgen J , De Potter T , Scherr D , Van Herendael H , Knecht S , Kobza R , Berte B , Sandgaard N , Albenque J , Szeplaki G , Stevenhagen Y , Taghji P , Wright M , Duytschaever M 
Published: June 2020

Abstract

Background/Introduction
The ‘CLOSE’ protocol, incorporating standardized ablation index (AI) targets in conjunction with defined inter-tag distance (ITD) has been shown to improve the acute and long-term success of pulmonary vein isolation (PVI) when treating paroxysmal atrial fibrillation (PAF). The reproducibility and learning curve for this protocol has not been studied.

Purpose
To assess the acute and long-term efficacy of CLOSE PVI across multiple operators (n = 37) in the 17-centre European study ‘VISTAX’.

Methods
329 patients with PAF (61.8% male, 61.3 ± 10.1 years) underwent PVI according to the CLOSE protocol, with target AI values for each lesion of ≥400 on the posterior wall and ≥550 on the anterior wall, and target ITD of ≤6mm. Each 3-dimensional electroanatomic map was evaluated at a core lab where adherence to each of these criteria was assessed. 281/329 patients (85.1%) fulfilled all standardized workflow requirements and were adjudicated as having their PVI per-protocol (PP). First pass PVI and acute effectiveness (adenosine-proof first pass PVI at 30-minute challenge) were recorded. Clinical effectiveness was assessed as freedom from atrial arrhythmia recurrence through 12 months recorded via transtelephonic monitoring (weekly and symptomatically), in addition to holter and electrocardiogram monitoring during 3,6,12 month follow up visits. Learning curve analysis was evaluated on all investigators.

Results
First pass PVI rates were similar in the overall (86%) and PP cohorts (85%), as was acute effectiveness (82% in both cohorts). Freedom from atrial arrhythmia at 12 months too was identical for both cohorts (79%). Total procedure time and total ablation time decreased by an average 8 minutes and 10 minutes respectively after the first procedure and then showed further steady decreases over the number of ablations performed by the investigator (Figure). The procedural efficiencies and clinical success were reproducible across different centers. No significant deviations were found from individual sites.

Conclusion
The standardized CLOSE workflow is reproducible across centres, and is ‘forgiving’ without impacting on high efficacy of almost 80%. The learning curve is short, suggesting that the excellent clinical results can be replicated widely and easily.
Abstract Figure. Learning Curves- Procedure & Ablation
P956Improved quality of life and symptomatic atrial fibrillation reduction in patients treated with a standardized ablation index workflow
Authors: Gupta D , Vijgen J , De Potter T , Scherr D , Van Herendael H , Knecht S , Kobza R , Berte B , Sandgaard N , Albenque J , Szeplaki G , Stevenhagen Y , Taghji P , Wright M , Duytschaever M 
Published: June 2020

Abstract

Background/Introduction
The use of a standardized ‘CLOSE’ ablation workflow for pulmonary vein isolation (PVI), with defined inter-tag distance (ITD) with targeted ablation index (AI) values, has been shown in single centre reports to result in good outcomes. The effect of this approach on patients’ quality of life (QoL) has not been studied.

Purpose
To evaluate the effects of paroxysmal atrial fibrillation (PAF) ablation by the CLOSE workflow on QoL and symptomatic AF reduction in the multicenter VISTAX study.

Methods
329 patients with PAF (61.5% male, 61.3 ± 10.1 year) were treated at 17 European centres by point-by-point radiofrequency ablation using the CLOSE protocol to achieve PVI. An ITD ≤6mm and AI values of ≥400 on the posterior wall and ≥550 on the anterior wall were targeted. The AI value on the posterior wall was lowered as per investigator discretion in case of safety concerns. Patients were monitored for atrial arrhythmia recurrences via weekly and symptom-activated transtelephonic monitoring (TTM), for 12 months post procedure. Patients completed an Atrial Fibrillation Effect on Quality-of-life (AFEQT) questionnaire at their baseline and 12-month follow up visits.

Results
Majority (83.3% [274/329]) of patients experienced freedom from symptomatic atrial recurrence through 12 months. Of the 70 documented recurrences, 34 (49%) were documented by trans-telephonic monitoring only. All domains captured on the AFEQT questionnaire showed improvement with the overall score improving by 25.7, which exceeded the threshold of clinically meaningful improvement (±5) (Table). Patient reported most improvements in PAF control and symptoms relieved. The overall AFEQT score improvement was seen both in patients with or without documented atrial arrhythmia recurrence, with improvement by 21.5 and 26.8, respectively.

Conclusion
PAF ablation using a standardized CLOSE workflow resulted in consistent improvements in QoL. The improved QoL was observed regardless of atrial arrhythmia recurrence likely reflecting the low residual arrhythmia burden in patients with documented recurrence identified only on TTM.
AFEQT Scores Through 12 Months AFEQT Domain Baseline 12 Months Change from Baseline* Daily Activities 59.2 85.3 26.0 Treatment Concerns 62.2 88.1 26.0 Controlling PAF 50.2 87.8 37.5 Symptoms 63.7 89.0 25.1 Symptoms Relieved 52.0 88.4 36.3 Overall AFEQT Score 61.3 87.2 25.7 *only includes patients who completed both baseline and 12 month AFEQT questionnaire
P1415Wide antral circumferential pulmonary vein isolation ablation using a novel balloon cryoablation catheter
Authors: Martin A P , Fowler M , Lever N 
Published: June 2020

Abstract

Background
Pulmonary vein isolation using cryotherapy is an established treatment for the management of patients with paroxysmal atrial fibrillation. Ablation using the commercially available balloon cryocatheter has been shown to create wide antral pulmonary vein isolation. A novel balloon cryocatheter (BCC) has been designed to maintain uniform pressure and size during ablation, potentially improving contact with the antral anatomy. The extent of ablation created using the novel BCC has not previously been established.

Purpose
To determine the anatomical extent of pulmonary vein isolation using electroanatomical mapping when performing catheter ablation for paroxysmal atrial fibrillation using the novel BCC.

Methods
Nine consecutive patients underwent pre-procedure computed tomography angiography of the left atrium to quantify the chamber dimensions. An electroanatomical map was created using the cryoablation system mapping catheter and a high definition mapping system. A bipolar voltage map was obtained following ablation to determine the extent of pulmonary vein isolation ablation. A volumetric technique was used to quantify the extent of vein and posterior wall electrical isolation in addition to traditional techniques for proving entrance and exit block.

Results
All patients had paroxysmal atrial fibrillation, mean age 56 years, 7 (78%) male. Electrical isolation was achieved for 100% of the pulmonary veins; mean total procedure time was 109 min (+/- 26 SD), and fluoroscopy time 14.9 min (+/- 2.4 SD). The median treatment applications per vein was one (range one - four), and median treatment duration 180 sec (range 180 -240). Left atrial volume 32 mL/m2 (+/- 7 SD), and mean left atrial posterior wall area 22 cm2 (+/- 4 SD). Data was available for quantitative assessment of the extent of ablation for eight patients. No lesions (0 of 32) were ostial in nature. The antral surface area of ablation was not statistically different between the left and right sided pulmonary veins (p 0.63), which were 5.9 (1.6 SD) and 5.4 (2.1 SD) cm2 respectively. In total 50% of the posterior left atrial wall was ablated.

Conclusion
Pulmonary vein isolation using a novel BCC provides a wide and antral lesion set. There is significant debulking of the posterior wall of the left atrium.
Abstract Figure.
P1162Atrial fibrillation and Cardiac resynchronization therapy - is this combination truly bad?
Authors: Graca Rodrigues T E , Nunes-Ferreira A , Cunha N , Santos R , Aguiar-Ricardo I , Rigueira J , Silverio Antonio P , Pereira S C , Morais P , Bernardes A , Pinto F J , Sousa J , Marques P 
Published: June 2020

Abstract

Introduction

Cardiac resynchronization therapy (CRT) significantly reduces mortality and hospitalizations in patients with heart failure and reduced ejection fraction (EF). Atrial fibrillation (AF) is a very common comorbidity in these patients, however, CRT benefit in AF patients has been controversial.

Purpose

To compare the prognostic impact of CRT in patients (pts) with and without AF.

Methods
Prospective, single-center study that included pts undergoing CRT implantsince 2015. Clinical and echocardiographicevaluation were made before CRT implant and between 6-12 months post-implant. Pts with EF elevation ≥10% or LV end-systolic volume (ESV) reduction ≥15% were classified as responders. Patients with EF elevation ≥ 20% or ESV reduction ≥30% were classified as super-responders. All the parameters were compared between patients with and without AF.Prognostic impact of CRT was evaluated by comparing total mortality using the Cox regression and Kaplan-Meier methods.

Results
From 2015-2019, 566 CRTs were implanted (26.1% female, 72 ± 10.2 years old, follow-up duration 18.9 ± 15.8 months). From these patients, 166 patients (31%) had AF (73.5% males, mean age 72.2 ± 10.2 years, 37.3% ischemic, LVEF &lt; 30% in 65.5%). The cardiovascular risk factors and comorbidities were similar in both populations (with and without AF), except for chronic kidney disease which was more frequent in AF pts(28% vs 17%, p = 0.012).
The prevalence of complications and surgical revision were similar in both groups.
The CRT response rate was similar in both groups (50% in AF group vs 59.6%, p = NS) as was the super-response rate (22.4% in FA pts vs 31.5%, p = NS).
The 4-year survival rate of patients with AF was similar to non-AF (83.7% vs 84.3%).

Conclusion

Despite the controversy about the efficacy of CRT in AF pts, in our population the long-term survival and CRT response rates were comparable between patients with and without AF.
Abstract Figure.