bluuebunny/crossref_metadata_2025_split huggingface dataset:
1325Zero-fluoroscopy cryoablation for treatment of atrioventricular nodal reentry tachycardia in adult and pediatric patients
Authors: Prolic Kalinsek T , Zizek D , Stublar J , Kuhelj D , Jan M 
Published: June 2020

Abstract

Funding Acknowledgements
None
Introduction
Cryoablation is considered a safe but somewhat less effective alternative to radiofrequency ablation (RF) for treatment of atrioventricular nodal reentry tachycardia (AVNRT). Additionally, it is traditionally performed with the aid of X-ray fluoroscopy as the principal imaging method causing radiation exposure, which is especially undesired in the pediatric population.

Purpose
The aim of our study was to assess feasibility, safety and success rate of nonfluoroscopic cryoablation for treatment of AVNRT.

Methods
Forty-eight consecutive patients with a diagnosed AVNRT (aged 40 ± 22 years, 29 (60%) female, 19 (40%) male) were included in the study. Among the study population, 14 (29%) were pediatric patients aged 11.5 ± 4.1 years. Cryoablation was used at the discretion of the operator. Only three dimensional electroanatomic mapping system and intracardiac electrograms were used to guide catheter movement and positioning. X-ray fluoroscopy was not used. The initial approach in all procedures was cryomapping in the region of the slow pathway during ongoing AVNRT, with a switch to cryoablation when termination of tachycardia within 20 seconds of reaching -30°C was achieved. When cryomapping was not possible due to catheter instability, cryoablation was used during ongoing AVNRT for up to 10 seconds at -70°C or lower. When AVNRT was not readily inducible, termination of slow pathway conduction was targeted with cryomapping during programmed stimulation with atrial extrastimuli. Procedural endpoint was noninducibility of AVNRT. Recorded residual slow pathway conduction was not considered a failure.

Results
Mean procedural duration was 79 ± 34 minutes. On average, 4 ± 2 cryoablations, with a 240 seconds of cryoablation time per each application. Cryoablation was used as a first choice in 45 (45/48, 93.7%) patients. In the remaining 3 patients (3/48, 6.3%) RF ablation failed as the first choice due to transient AV conduction disturbance and cryoablation had to be used to reach the endpoint. Cryoablation was unsuccessful only in 3 cases (6.6%) where RF ablation was needed to achieve procedural endpoint. Targeting termination of AVNRT during cryomapping or cryoablation was possible in 25 patients (25/48, 52%). In 14 patients AVNRT was not inducible and termination of the slow pathway conduction was targeted instead. In 9 patients inadvertent catheter tip contact mechanically terminated AVNRT or slow pathway conduction; site of mechanical termination was then targeted with cryoablation. After mean follow-up of 349 ± 201 days 47 patients were free of recurrence (47/48, 98%). There were no procedural complications.

Conclusions
In our study population with adult and pediatric patients, zero-fluoroscopy cryoablation of AVNRT proved feasible, safe and resulted in high success rates. Cryomapping or cryoablation for AVNRT termination was possible in approximately half of the procedures.
P1381Improved outcome in ablation of ventricular tachycardia in patients with structural heart disease under general anaesthetic
Authors: Fazmin I T , Zhang R Y , Porto A , Divulwewa K , Di Nubila B , Mausa M F , Reddy A , Agarwal S , Begley D , Fynn S , Heck P , Virdee M , Mellor G , Grace A , Martin C A 
Published: June 2020

Abstract

Background
Catheter ablation is an important adjunct to device implantation for secondary prevention of ventricular tachycardia (VT). However, several factors may influence the success of ablations in terms of long-term freedom from VT recurrence. A thus far little examined factor is the use of general anaesthetic (GA) versus conscious sedation during the procedure, which has been shown to improve outcomes in persistent atrial fibrillation (AF) ablation.

Methods
Patients with structural heart disease VT undergoing ablations from January 2015 to March 2019 were retrospectively followed up at a single centre. End points were recurrent VT or device therapy (shock or anti-tachycardia pacing) at one year. Hazard ratios (HR) were generated using a multivariate Cox-regression proportional hazards model including variables of age at ablation, sex, amiodarone use at time of ablation, scar age, left ventricular ejection fraction, use of GA, and diagnosis of: diabetes mellitus (DM), hypertension (HTN), renal impairment or AF.

Results
79 patients (74 male, mean age 68.2+/- 10.3 years) were included. A substrate-based strategy of late potential ablation was employed. 69 had ischaemic and 10 had non-ischaemic cardiomyopathy. Mean scar age was 13.8 +/- 9.8 years; EF was 40-50% in 27 patients, 30-40% in 26 and &lt; 30% in 26. 37 patients had implantable cardioverter defibrillators and 30 had cardiac resynchronisation therapy (CRT) defibrillator devices, 1 had a CRT- pacemaker device and 4 had dual chamber pacemakers. Comorbidities were: DM (16), HTN (31), renal impairment (13), AF (31). 62 patients (79.5%) were on amiodarone at the time of ablation. Mean procedure duration was 234.8 +/- 44.5 min and mean radiofrequency energy application time was 2247 +/- 862 s. 61 were first procedures and 18 were repeat procedures. One patient suffered a complication of groin haematoma. 62 patients (78.5%) underwent VT ablation under GA and 17 (21.5%) under sedation of midazolam and fentanyl. Patient characteristics did not differ between groups. Significant factors which increased freedom from VT recurrence or device therapy were HTN (88.9% vs 59.4%, HR 0.72, 95% confidence interval (CI): 0.007-0.75, p= 0.028), amiodarone treatment (50.0% vs 76.3%, HR 0.036, 95% CI: 0.003-0.404, p = 0.036) and ablation under GA rather than sedation (50.0% vs 75.0%, HR 0.055, 95% CI: 0.006-0.495, p = 0.01) (Fig 1).

Conclusions
In patients with structural heart disease undergoing VT ablation, outcomes are improved with the use of GA over conscious sedation.
Abstract Figure 1
P1006Cryo-balloon ablation in elderly; Outcome and prediction of recurrence
Authors: Berkowitsch A , Weipert K , Hutter J , Zaltsberg S , Kahle P , Hain A , Neumann T , Kuniss M 
Published: June 2020

Abstract

Background
It is well known that prevalence of atrial fibrillation correlates with age, however the data on ablation of atrial fibrillation in elderly patients is poor. Aim of this study was analysis of outcome and prediction of recurrence after cryo-balloon ablation (CBA) in elderly patients based on available data in our registry.

Methods
The history of AF was assessed at admission. Additionally, all patients received echocardiographic examination and blood test. After a single trans-septal access and PV angiography PVI was performed using a 28-mm CBA. Mapping of PV signals before, during, and after each cryo application was performed with a 3F lasso catheter. The procedural endpoint after PVI was defined as complete elimination of all fragmented signals at the PV antrum with verification of entrance and exit block. Primary endpoint was first documented recurrence of AF, atrial tachycardia or atrial flutter (&gt;30 sec.). All patients received a follow-up every 3 month within 1st year, once yearly thereafter and in case of symptoms. Seven days Holter ECG was recorded by every follow up.

Results
A total of 44 (39%) of enrolled patients were male, 48 (43%) suffered non- paroxysmal AF(nPAF), 93 (82%) had hypertension, CAD was diagnosed by 27 (24%), 28 (25%) had DM (Hb1AC &gt; 6), Stroke/TIA was observed in 11 (10%). Median Age in elderly was 76 (75-78) y, BMI 25.77 (23.51-28.69), time since 1st diagnosis 40 (6-50) month, LA area index 11.36 (9.77-13.20), TAPSE 23 (19-26), GFR 74 (66-83) mL/min, LVEF 60 (57-62). A total of 44 patients (39%) reached endpoint within follow up of 20 (12-38) months. Univariate association with outcome was found by follows parameter: Time from 1st diagnosis &gt; 3 y (HR = 3.22 (1.66-6.27), p=.001); LA area index (HR = 1.17 (1.03-1.32), p=.013); DM (HR = 1.89 (1.02-3.55), p=.042); nPAF (HR = 1.90 (1.04-3.47), p=.036). After multivariate analysis only time from 1st diagnosis &gt; 3 y, (HR= 3.17 (1.62-6.16), p=.001 and nPAF (HR = 1.84 (1.01-3.36)), p=.048 were revealed to be predictive. The area under probability score calculated for these predictors was .731 (.638-8.25), p=.001. Follows complications were observed: 2 (2%) - pericard tamponades, 4 (4%) phrenicus nerve injury. Conclusion. PVI with cryo-balloon is effective for elderly patients providing freedom of arrhythmic events in 61% of patients. Longer history of AF over 3 years since 1st diagnosis was main predictor for post ablation recurrence. In elderly patients with shorter history of AF efficiency and safety of CBA is comparable with general population.
45Improving the optimization of cardiac resynchronization therapy: Does multipoint left ventricular pacing shorten the paced-QRS duration compared to the fusion-optimized intervals method?
Authors: San Antonio R , Pujol-Lopez M , Jimenez-Arjona R , Doltra A , Alarcon F , Trotta O , Quinto L , Garre P , Sanchez M , Arbelo E , Roca-Luque I , Guasch E , Brugada J , Mont L , Tolosana J M 
Published: June 2020

Abstract

Funding Acknowledgements
Cardiac Pacing Scholarship from the Spanish Society of Cardiology (SEC)

Background
Electrocardiogram-based optimization of cardiac resynchronization therapy (CRT) using the fusion-optimized intervals (FOI) method has demonstrated to improve both acute hemodynamic response and left ventricle (LV) reverse remodeling compared to nominal programming of CRT. FOI optimizes the atrioventricular (AV) and ventriculo-ventricular (VV) intervals to achieve the shortest paced-QRS duration. The recent development of multipoint pacing (MPP) enables the activation of the LV from 2 locations, also shortening the QRS duration compared to conventional biventricular pacing.

Purpose
To determine if MPP reduces the paced-QRS duration compared to FOI optimization.

Methods
This prospective clinical study included 25 consecutive patients who successfully received a CRT with MPP pacing capability. All patients were in sinus rhythm and had an PR interval below 250 ms. The QRS duration was measured with a 12-lead digital electrocardiography (screen speed of 200 mm/s) at baseline and using 3 different configurations: MPP, FOI and a combined FOI-MPP strategy. In MPP, the intervals were (based on previous studies): 1) AV 130 ms, 2) Right ventricular (RV)-LV2 (Δ1) 5 ms, and 3) LV1-LV2 (Δ2) 5 ms. In FOI, AV and VV intervals were optimized to achieve fusion between intrinsic conduction and biventricular pacing. In FOI-MPP, the Δ2 was set at 5 ms, while AV and Δ1 intervals were optimized using the FOI method. The CRT device was programmed with the configuration that achieved a greater paced-QRS shortening. After 45 days, battery life was estimated.

Results
Mean age was 65 ± 10 years, 20 were men (80%) and baseline QRS duration was 177 ± 17 ms. The FOI method bested nominal MPP (QRS shortened by 58 ± 16 ms vs 43 ± 16 ms, respectively, p = 0.002). Adding MPP to the narrowest QRS by FOI did not result in further shortening (FOI: 58 ± 16 ms vs FOI-MPP: 59 ± 13 ms, p = 0.81). The final configuration was FOI method alone in most cases (n = 16, 64%) and FOI-MPP in all others (n = 9, 36%; figure). In total, 10 out of 25 patients (40%) were not candidates to MPP due to: 1) pacing thresholds exceeding 3.5 V/0.4 ms at the distal or proximal electrode (8, 32%), and 2) phrenic stimulation (2, 8%). Estimated battery longevity was longer in patients receiving FOI as compared to MPP (8.3 ± 2.1 years vs. 6.2 ± 2.2 years, p = 0.04).

Conclusion
In CRT, the FOI method is not improved by coupling with MPP. Up to 40% of patients are not candidates for MPP due to high thresholds or phrenic stimulation. The use of MPP in unselected patients would result in a decrease of battery longevity, without any additional benefit over FOI.
Abstract Figure.
P1462Incidence of ventricular arrhythmias in cardiac resynchronization therapy and implantable cardioverter-defibrillator patients
Authors: Roubicek T , Morava J , Stros J , Kucera P , Polasek R 
Published: June 2020

Abstract

Introduction
Implantation of a cardiac resynchronization therapy combined with cardioverter-defibrillator (CRT-D) is now common practice. Our study looked at the occurrence of the first adequate CRT-D therapy with respect to gender, treatment indication (primary or secondary prevention of sudden cardiac death) and the etiology of heart failure in long-term follow-up.

Methods
In the database of CRT-D patients implanted between 2005 and 2013 we analyzed the occurrence of treated episodes of ventricular arrhythmia (first shock or anti-tachycardic pacing).

Results
250 patients (22.8% females) with left bundle branch block or non-specific interventricular conduction delay were enrolled. 80% of patients were implanted in the primary and 20% in the secondary prevention of sudden cardiac death. During the follow-up of 5.5 ± 2.5 years, 46.4% of patients died for cardiac (25.6%) or non-cardiac (20.8%) reasons. CRT-D therapy occurred in 33.2% of patients (20.8% shock). In patients implanted in the primary prevention of sudden cardiac death the incidence of therapies was 25.5% vs. 64.0% in patients implanted in the secondary prevention of sudden cardiac death (P˂0.00001). The incidence of therapies between the group of patients with coronary artery disease and other causes of heart failure did not differ (33.3% vs. 32.9%, P = NS). Women were at a significantly lower risk of adequate shock (women 10.5% vs. men 23.8%, P = 0.01).

Conclusion
Adequate CRT-D therapy occurred in a quarter of patients implanted in the primary prevention of sudden cardiac death. In patients implanted in the secondary prevention of sudden cardiac death the incidence of therapies is significantly more frequent. The female gender predicts significantly lower incidence of adequate shock.
Abstract Figure. Adequate shock therapy
P983When should we measure biomarkers in patients with atrial fibrillation to predict recurrences?
Authors: Merino Merino A , Perez Rivera J A , Saez De La Maleta Ubeda R , Salgado Aranda R , Pascual Tejerina V , Martin Gonzalez J , Garcia Fernandez J , Al Kassam Martinez D 
Published: June 2020

Abstract

Funding Acknowledgements
No grants to declare

Background
Atrial fibrillation (AF) in the most frequent arrhythmia. Remodeling and fibrosis phenomena are implicated in its development. ProBNP, galectin-3, ST2, urate, C reactive protein, troponin and fibrinogen are some biomarkers (BM) involved in these processes.

Purpose
The aim of our study was to assess the implication of these BM in the recurrence of AF after an electrical cardioversion (ECV) and if the relation depends on the moment that they are measured.

Methods
We included 115 patients with persistent AF who underwent an ECV. We performed a 6-months (M) -follow-up. We assessed our patients in a clinical, analytical (a blood sample was extracted pre-ECV and at 6M) and electrocardiographic (with holter at 3M and an ECG at 6M). Any documentation of AF during the follow-up was defined as a recurrence. We assessed the relation between basal BM and recurrence by Kaplan-Meier method and the relation between BM at 6M and recurrence by tStudent with normal variables and U-Mann-Withney with no-normal ones. We performed a ROC curve with those BM that show statistical significance in order to define the best cut-off point to classify our patients. We also made a logistic regression analysis to assess the existence of independent association between BM and recurrence.

Results
71 patients had a recurrence (61.73%). These patients were older than those who did not, without any other significant clinical difference between both groups. None of the basal BM was related to recurrence during the follow-up. ProBNP and ST2 at 6M were significantly related to recurrence. ProBNP showed an area under the ROC curve of 0.774 (figure 1). The best cut-off point for proBNP was 300 pg/ml (sensibility (S) 72%, specificity (Sp) 72%) and for ST2 30.73 ng/ml (S 66% and Sp 58%). Only proBNP was independently related to recurrence (OR: 10.90; CI (3.87-30.75), P &lt; 0.001.

Conclusions
BM measured pre-ECV do not predict recurrences in the follow-up, so they should not be used with that purpose. Those patients that suffered recurrence had higher levels of proBNP (distension BM) and ST2 (remodeling BM) measured at 6M. These 2 processes might be the most important pathophysiological factors in the maintenance of AF. The repeated measurement of these BM could lead the most accurate management in these patients.

Abstract Figure.
P516Permanent his bundle pacing: conclusions from the one-year experience of a romanian center
Authors: Pestrea C G , Gherghina A , Ortan F 
Published: June 2020

Abstract

Background
Long term right ventricular pacing has been associated with an increased risk of heart failure development due to pacing induced cardiomyopathy. Therefore, alternatives of more physiological pacing have been evaluated. Amongst them, His bundle pacing (HBP) has emerged in the past two decades as the most physiological method of ventricular pacing due to synchronous activation of both ventricles through the intrinsic conduction system. Although there is an already consistent experience in the United States, China and western Europe regarding His bundle pacing, some countries in central and eastern Europe have little or no experience in this matter. We present the results of our one-year experience after implementing His bundle pacing in a tertiary cardiac pacing center in Romania.

Material and methods
Between July 2018 and October 2019, HBP using the current available dedicated delivery system was attempted in 50 patients with permanent cardiac pacing indications. Patient characteristics and procedural results were analyzed during implant and at 3 months, 6 months and 1 year follow-ups.

Results
The mean age of the patients was 70,14 ± 10,58 years and 58 % were male. The main indication for cardiac pacing was atrioventricular block (66%) and 96 % received a dual-chamber pacemaker. No ventricular back-up leads were used. The acute procedural success (selective or nonselective His bundle capture) was achieved in 40 patients (80%). The rest of the patients received either right ventricular or left bundle branch pacing. Selective His bundle pacing was seen in 15 out of 40 patients, with nonselective His bundle pacing in the rest. The acute His pacing threshold was 1.77 ± 1.06 V at 1 ms, the sensed R wave amplitude was 4.2 ± 2.27 mV and total fluoroscopy time was 15.95 ± 10.9 min. The paced QRS duration was very similar to the baseline QRS duration in patients without bundle branch block and significantly narrower in patients with bundle branch block morphology (126,6 ± 23 ms vs. 95,5 ± 21,65 ms, p &lt; 0,001). The presence of a native QRS complex with a bundle branch block morphology was associated with an increased risk of procedural failure, longer fluoroscopy times and higher capture thresholds. Also, pacing threshold (1,91 ± 1,23 vs. 1,62 ± 0,84 V/1ms , p = 0,4) and fluoroscopy times (21,15 ± 10,35 vs. 10,75 ± 8,85 min, p = 0,002) were lower in the second half of the procedures as the learning curve was achieved. There were no significant changes in pacing and sensing thresholds at 3 months, 6 months and 1 year follow-ups. There was only one case of lead dislodgement a week after the procedure that required reintervention.

Conclusion
His bundle pacing is feasible and easy to implement in an experienced device implantation center, with a high procedural success rate. Improvement of the procedural parameters is achieved while advancing the learning curve. Proper patient selection could influence the outcomes of the procedure.
842The effect of post TAVR pacemaker implantation on mid and long-term mortality
Authors: Hochsatdt A , Merdler I , Meridor Y , Schwartz A L , Steinvil A , Finkelstein A , Viskin S , Rosso R 
Published: June 2020

Abstract

Introduction
Transcatheter aortic valve replacement (TAVR) is standard of care for patients with symptomatic severe aortic stenosis at high risk for surgery. Atrioventricular conduction defects remain a frequent complication of the procedure, and permanent pacemaker (PPM) implantation has been associated with increased long-term mortality in some studies.

Purpose
We evaluated the influence of PPM on mid and long-term mortality in a very large cohort of patients undergoing TAVR.

Methods
All patients undergoing TAVR in one tertiary cardiac catheterization center were included. Patients were categorized into three groups: 1) patients with a PPM implantation prior to the procedure, 2) patients with post procedural PPM implantation and 3) patients without PPM. Univariate and multivariate comparisons was preformed for all-cause mortality for up to 6 years. Sub-analyses were preformed according to ventricular pacing burden on outcome.

Results
A cohort of 1,306 post TAVR patients were followed for a median period of 38 [IQR 20-58] months. Risk factors associated with need for post procedural PPM implantation were male gender, dialysis treatment, NYHA ≥3 and pre procedural RBBB (p &lt; 0.03 for all). Univariate mid-term (up to 12 months) and long-term (up to 72 months) mortality were similar for patients regardless of post procedural PPM (p = 0.361 and p = 0.287 accordingly), yet long term mortality was significantly higher in the pre-TAVR PPM group (OR 1.6, p &lt; 0.001). Multivariate analysis of mortality by PPM group and patients" clinical characteristics did not show any independent mid or long-term survival effects of PPM either prior to or after the procedure (p = 0.974 and p = 0.300 accordingly).
Sub-analysis of the cohort according to average right ventricular pacing percent, showed no significant mid-term or long-term mortality difference between patients having high (&gt;90%), moderate (40-90%), mild (mild 40-10%) and minimal (&lt;10%) pacing burden (p &gt; 0.320 for all comparisons). Analysis of patients with high pacing burden vs. non-paced patients showed similar mortality trends for both mid and long-term mortality (p = 0.537 and p = 0.127 accordingly).

Conclusion
This long-term cohort of consecutive patients undergoing TAVR showed that post procedure PPM was not associated with increased long-term mortality. This conclusion was not altered by ventricular pacing burden.
Abstract Figure. Survival curves for the three PPM groups