bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1136Is there a negative impact of permanent pacemaker implantation in long-term outcomes after transcatheter aortic valve implantation?
Authors: Carvalho Mendonca T J , Patricio L , Oliveira M , Rodrigues I , Portugal G , Ramos R , Cacela D , Cunha P S , Kahlbau H , Fragata I , Fragata J 
Published: June 2020

Abstract

Introduction
Transcatheter aortic valve implantation (TAVI) is an established treatment in patients (P) with aortic stenosis. Despite the continuous developments of this procedure, high-grade conduction disturbances requiring permanent pacemaker (PPM) implantation is still a major and common complication of TAVI. Furthermore, long-term chronic right ventricular pacing has been associated with negative effects on ventricular function and heart failure (HF).

Aim
to evaluate the long-term impact of PPM after TAVI focusing on mortality and HF hospitalization.

Methods
We retrospectively examined P who underwent TAVI with a self-expanding valve from 2009 to 2018 at our institution. All P had pre-procedural clinical evaluation, including ECG, cardiac computed tomographic angiography and transthoracic echocardiography. P with previous PPM were excluded.

Results
265P (57% male, mean age 81.4 years, 20% with left ventricular ejection fraction &lt;40%) were analysed. Mean STS score and mean Euroscore II were 6.33% and 7.07%, respectively. Mean transvalvular gradient was 52.78 mmHg and mean aortic valve area 0.67 cm2. Forty-seven P (17%) underwent PPM implantation during the first 30 days after TAVI. P requiring PPM had higher prevalence of diabetes mellitus, chronic renal disease, atrial fibrillation and right bundle branch block. During a mean follow-up of 20.3 months, post-TAVI PPM was associated with similar mortality rate (29.8% vs. 25.6%, HR 1.28, 95% CI 0.72-2.29, p = 0.42) and similar cardiovascular mortality (9.8% vs. 6.4%, HR 0.72, 95% CI 0.21-2.4, p = 0.59) compared to P without PPM. There were no significant differences in HF hospitalization (4.9% vs. 2.4%, p = 0.47). Kaplan-Meier curves of total mortality and cardiovascular mortality according to the need for PPM post-TAVI were similar.

Conclusions
In P submitted to TAVI, PPM implantation is a relatively common finding, not associated with higher risk of total mortality, cardiovascular mortality or HF hospitalization in a long-term follow-up.
P380Simultaneous endo-epicardial mapping of the human right atrium: unravelling 3-dimensional excitation
Authors: Kharbanda R , Knops P , Van Der Does J M E , Kik C , Taverne Y J H J , Roos-Serote M C , Heida A , Oei F B S , Bogers A J J C , De Groot N M S 
Published: June 2020

Abstract

Funding Acknowledgements
Prof. Dr. NMS de Groot is supported by funding grants from CVON-AFFIP (914728), NWO-Vidi (91717339), Biosense Webster USA (ICD 783454) and Medical Del
Abstract
Introduction & Purpose
Mapping studies demonstrated that endo-epicardial asynchrony (EEA) and conduction disorders, mainly longitudinal dissociation, play an important role in the pathophysiology of atrial fibrillation (AF). The aim of our study was therefore to investigate the correlation between features of conduction disorders assessed in the endo- and epicardial plane and the degree of EEA.
Methods
In 80 patients (63 male (79%), age 66 ± 9 years, 31 history of AF (39%)) undergoing cardiac surgery, simultaneous endo-epicardial mapping (256 electrodes, interelectrode distance:2mm) of the inferior, middle and superior right atrium (RA) was performed during SR. Areas of conduction block (CB) were defined as conduction delays of ≥12ms, EEA as activation time differences of opposite electrodes of ≥15ms and transmural CB as CB at similar endo-epicardial sites.
Results
Amount of CB was highest at the endocardium (endo median:1.9% [0-21.6] vs. epi median:1.1% [0-19.2], all locations p &lt; 0.025) and was more pronounced at the superior RA. Amount of conduction block at both the endo-epicardium combined was higher at the superior RA in patients with hypertension (p = 0.046). Likewise, prevalence of transmural CB and EEA,-up to 84ms-, significantly increased from inferior to superior RA (all p &lt; 0.001). Transmural CB at the inferior RA appeared to be associated with a higher incidence of post-operative AF (p = 0.03). Degree of EEA was also highest at superior RA (superior: 17.5ms [16-21.75] vs mid: 17ms [0-20] and inferior: 0ms [0-17], p &lt; 0.001). Prevalence of CB was correlated with prevalence EEA (r= 0.74-0.87; all locations p &lt; 0.001). In patients with hypertension (p = 0.009), diabetes (p = 0.015) and hypercholesterolemia (p = 0.015), EEA degree was higher at inferior RA. Significantly more CB (p = 0.007) and EEA (p = 0.037) were observed in patients with a history of persistent AF compared to patients without AF history.
Conclusions
This study provides important insights into the complex 3-dimensional endo-epicardial excitation and arrhythmogenesis. Knowledge of 3-dimensional excitation during SR is essential to understand the substrate underlying AF in order to improve (ablative) AF therapy.
671Assessment of irrigated-tip radiofrequency catheter ablation lesion characteristics using different irrigation fluids on ex-vivo bovine myocardium
Authors: Candemir B , Baskovski E , Esenboga K , Yorgun H , Aytemir K , Eralp T 
Published: June 2020

Abstract

Introduction
Certain arrythmias, particularly of ventricular origin, necessitate deep lesions in order to achieve clinical success. The introduction of irrigated-tip radiofrequency (RF) catheters has allowed creation of deeper lesions and has decreased char formation. Although normal saline has been used as a standard solution, recent observations have suggested less ionic solutions may increase lesion depth. In this in-vitro study we aimed to characterize lesions created by irrigated-tip RF catheters using standard normal saline(NS), half-normal saline (HNS), and HNS-%2.5Dextrose (HNS-DEX/2) combination solutions.

METHODS
Bovine myocardium was placed firstly in ringer-lactate bath. Using irrigated-tip RF catheter ablation lesions were created serially using 30, 40, 50, 60, 70Watts with NS, HNS and HNS-DEX/2 as irrigation solutions. Lesion depths, steam pops and impedance drops were measured. Subsequently the experiment was repeated in normal saline bath.

RESULTS
Both HNS-DEX/2 and HNS irrigation solutions increase lesion depths when compared to normal saline (Table 1, Figure 1). Steam pops were more common and earlier with HNS-DEX/2 and HNS.

DISCUSSION AND CONCLUSION
Our findings suggest that less ionic irrigation solutions lead to increased lesion depths using similar RF power. If confirmed in-vivo, HNS and, particularly, HNS-DEX/2 as irrigation solution may increase ablation success for intramural/deep myocardial arrhythmic foci. Additionally, studies to assess safety of this strategy are necessary as intuitively deeper lesions may lead to more complications.
Table 1 Irrigation Solution/Bath solution 30W/30ml(Lesion depth mm)(Impedance drop) 40W/30ml(Lesion depth mm)(Impedance drop) 50W/30ml(Lesion depth mm)(Impedance drop) 60W/30ml(Lesion depth mm)(Impedance drop) 70W/30ml(Lesion depth mm)(Impedance drop) HNS+%2.5D / Ringer Lactate 470-&gt;61 4.583-&gt;63 5.074-&gt;62SP+(32s) 6.080-&gt;66SP+(27s) 7.577-&gt;65SP+(26s) HNS/ Ringer Lactate 3.590-&gt;65 4.580-&gt;63SP+(34s) 5.073-&gt;59SP+(33s) 5.580-&gt;56SP+(28s) 6.583-&gt;64SP+(22s) NS/ Ringer Lactate 3.077-&gt;60 472-&gt;59 4.576-&gt;61 5.081-&gt;56 674-&gt;55 SP+(30s) HNS+%2.5D/Normal saline 3.573-&gt;67 598-&gt;63 5.573-&gt;58SP+(28s) 697-&gt;76SP+(26s) 7.570-&gt;58SP (25s) HNS/Normal saline 3.563-&gt;58 4.066-&gt;52 4.567-&gt;52 5.575-&gt;52 788-&gt;60SP+(28s) NS/Normal saline 2.566-&gt;58 3.063-&gt;52 4.073-&gt;58 5.077-&gt;55 5.568-&gt;44 Lesions created by irrigated tip radiofrequency catheter with bovine myocardium
Abstract Figure 1
P1422Low incidence of major procedure-related adverse events of cryoballoon ablation in real practice: an interim analysis of the Russian national prospective cryoablation registry
Authors: Lubimceva T , Topchyan A , Davtyan K , Poleschenko Y A , Artiykhina E , Tarasiyk E , Kosonogov A , Kryzhanovsky D , Korolev S , Kolunin G , Sagitov I , Nechepurenko A , Gasimova N , Mikhaylov E , Lebedev D 
Published: June 2020

Abstract

OnBehalf
On Behalf Of the National Cryoballoon Registry Investigators
Background
Cryoballoon ablation (CBA) is an effective strategy for atrial fibrillation (AF) management. The Russian Cryoballoon Atrial Fibrillation Ablation Registry (NCT03040037) is a prospective observational multicenter national registry that aims to provide real-world efficacy, safety and outcomes of this technology.
Methods
A specialized Web-based registry platform was developed for prospective data entry. The platform consists of 8 sections: AF ablation clinic experience and operator experience, patient characteristics, CBA procedure characteristics, periprocedural patient management (including drug therapy), 12-moths follow-up with scheduled and unscheduled visits, redo procedure characteristics, early and late procedure-related complications. Patient inclusion criteria were the following: indications for AF catheter ablation, planned CBA, a signed informed consent.
Results
To date thirty-one clinics have joined the Registry, and 830 patients (477 males, a mean age 65.4 ± 11.3 years) were included. The mean BMI was 33.2 ± 3.3 kg/m2. Paroxysmal AF was presented in 688 pts, persistent AF – 111 pts, long standing persistent AF – 31 pts. The main underlying diseases were hypertension (75%), coronary artery disease (11%), chronic heart failure (25%); less commonly - hypertrophic cardiomyopathy (1.4%) and dilated cardiomyopathy (0.7%). The mean LA diameter was 45.4 ± 10.2 mm, and LVEF was 65.4 ± 12.6%.

Periprocedural anticoagulant therapy included
uninterrupted NOACs (313 pts), bridge anticoagulation (327 pts), uninterrupted warfarin (45 pts), anticoagulation initated only after CBA (32 pts). The mean temperature of cryoablation was -44.6 ± 16.3 C. Transesophageal echo-guided CBA was performed in 92 cases , intracardiac echocardiography-guided - in 465 cases. There were 5 (0.6%) cases of hemopericardium, and pericardiocentesis was required in 1 (0.1%) case only. Periprocedural TIA was diagnosed in 1 (0.1%) patient with bridge anticoagulation, no stroke occurred. Transient phrenic nerve injury was detected in 18 (2.1%) patients, persistent palsy – in 1 (0.1%) patient. Two cases of esophageal injury were reported, no surgery was required and healing was reported in both patients. The data collection is ongoing.

Conclusion
We report early results of the ongoing national CBA Registry. There was a low number of major procedure-related adverse events in real clinical practice among centers with different AF ablation experience. Long-term follow up of the included patients will be reported in the future.
Abstract Figure. Antithrombotic therapy and CBA
P927Electrophysiological features in children with premature ventricular contractions
Authors: Alekseeva K , Kruchina T , Gordeev O , Ginzburg I , Novik G , Egorov D 
Published: June 2020

Abstract

Background
Premature ventricular contractions (PVCs) is the one of the most frequent arrhythmias in children. There is no clear understanding regarding the causes of PVCs in children without structural heart diseases. There is also little information about the state of the conduction system (CS) of the heart in children with PVCs. Purpose:The aims of the study were to estimate the electrophysiological properties of the sinus node (SN) and atrioventricular node (AVN) in children with PVCs, and to evaluate the effect of atropine test on the frequency and nature of the PVCs. Methods: 167 children(54(32,3%) girls and 113(67,7%) boys with PVCs without structural heart disease were examined. Mean age at the time of the first examination was 14,5 ± 5,3years (6-18 years). Examination included: ECG, 24-hour Holter monitor (HM), echocardiogram, treadmill test, transesophageal pacing study (TEPS), atropine test.Results:The duration of the PVCs was 3,3 ± 1,5years (6-14 years). The burden of the PVCs was 7-29% according to HM data. 5(3%) children had syncope. Frequent PVCs were recorded in 43(25,7%) patients, single PVC in 59 (35,3%), and the rest of children did not have PVCs during TEPS. SN recovery time (SNRT) was 1118,1 ± 292,4ms (541-2300ms) which exceeded the age-dependent limit in 23(13,7%) children. Corrected SNRT was 350,1 ± 171,1ms (41-1317ms), which exceeded the age-dependent limit in 15(8,9%) children. Max.rate of 1:1 conduction through AVN was 166,7 ± 39,1 imp/min (90-220 imp/min); in 16(9,6%) children it was less than 120 imp/min, while 8 (4,8%) children had enhanced AV nodal conduction (more than 200imp/min). The effective refractory period (ERP) of AVN was 325,1 ± 91,7ms (190-650ms), exceeding the age norm in 18(10,7%) children. 16(9,6%) children had a discontinuous AV nodal conduction. The frequency of stimulation which suppressed PVCs was 100-160imp/min. Atropine test was performed in 100(59,9%) children (0,1% sol. Atropini sulfatis 0,02 mg/kg IV). After administration of atropine the increase in heart rate constituted 7-131%, with an average of 57%. The SNRT was 665,5 ± 154,4 ms (406-1512ms), maximal rate of 1:1 conduction through AVN was 213,2 ± 31,9 imp/min (150-270 imp/min). Among patients who initially had PVCs during TEPS, after atropine test PVCs disappeared in 61(59,8%) children, in 16(15,7%) children there was a significant decrease, and 4(3,9%) patients had an increase in the number of PVCs and episodes of stable ventricular bigeminy, and in 1(0.9%) child there were short runs of ventricular tachycardia (up to 8 QRS complexes).Conclusions: In children with PVCs normal electrophysiological parameters of cardiac CS were noted in most cases. In 35% of children there was a hypervagotonic influence on SN or AVN, and in 75,5% cases there was a disappearance or decrease in PVCs after atropine test. This suggests that the preferential nature of PVCs in children without structural heart diseases is autonomic system dependent
P1468Four years follow-up of leadless pacing system single center real life experience compared to data of the prospective trial
Authors: Winter S , Ding Quang Nguyen D Q , Ghorbani P G , Fehske W F 
Published: June 2020

Abstract

Funding Acknowledgements
none

OnBehalf
Cologne Registry

Introduction
The Micra™ leadless intracardiac pacing system has been introduced and implemented into clinical routine more than three years ago. Feasibility, implantation safety and acute success have been proven in the setting of controlled studies. Additionally few real- life and post-implantation data exist. We aimed to report our single center follow-up (FU) data in comparison with the results of the prospective controlled Micra™- studie.

Methods
In 112 patients (69 men; age: 79 ± 10 y) successful Micra™ implantation was performed.Pacemaker interrogation was performed one to seven days after implantation and during FU (1; 3; 6, than every 6 month) up to 48 month. Data were assessed in a real-life setting and compared with existing data of the controlled prospectiv trial.

Results
The implantation was successful in all 112 attempts without procedure or device-related major complications. During Follow up there was one patient developing severe heart failure symptoms resulting in an implantation of a CRT-device and switching of the leadless pacemaker system.
The average acute thresholds, sensing and impedance after system release were: 0.63 ± 0.42V@0.24ms; 9,94 ± 3,61mV and 705 ± 166 Ohm. During follow up of up to 4 years neither, pacemaker failure, nor infections were reported. Measurements were reevaluated for long-term thresholds, sensing and impedance: 0.54 ± 0.16V @ 0.24 ms; 16,15 ±4,22 mV and 579 ± 133 Ohm. In the first three years no significant changes from acute to long-term measurements were detectable. In comparison to the data of the controlled trial the measurements of our real-life cohort was very similar.

Conclusion
In a real life setting the implantation of the leadless Micra™ system demonstrates high rate of implant success without major complications. Also shown were stable long-term system parameters in the clinical setting of up to two years of follow up. These data of every day clinical practice support the findings of the prospectiv trials.
P1003New onset atrial fibrillation after stenting of the right coronary artery in patients with ischemic disease of the heart
Authors: Payziev D , Azizov S I , Uzokov J K , Iskhakov S A 
Published: June 2020

Abstract

Background
Atrial fibrillation (AF) is a major heart rhythm disorder among population older age. Percutaneous coronary intervention (PCI) with stenting of the right coronary artery may increase the new onset AF. Aim of the study was to estimate the new onset AF after stenting of the right coronary artery (RCA) in patients with stable ischemic disease of the heart and its effect on short-term prognosis.

Methods
765 patients in whom performed PCI with stenting of the proximal and medial segment of RCA were enrolled in this study (aged 41-71 years; mean age 55.8 ± 12.0 years; male 51%). Short-term outcomes were analyzed in median 1.1-year follow-up due to the development of new onset AF.

Results
Among 765 patients, after PCI in RCA developed AF in 58 patients (7.5%) within follow-up. Among them, 40 patients (5.2%) with type 2 diabetes mellitus, 37 patients (4.8%) hypertension, 34 patients (4.4%) older than 60 years old, 30 patients (3.9%) myocardial infarction in history. Restoration of sinus rhythm (cardioversion rate) was in 86%. Majority of the patients in whom sinus rhythm was not recovered were older (11.0%) and diabetic mellitus (8.0%). The propensity-matched model showed that new onset AF was associated with an increased risk of bleeding during the procedure (OR 1.4; 95% confidence interval, 1.27-1.74) and heart failure (OR 1.27; 95% confidential interval, 1.16-1.45). Conclusion: New onset AF is common within short-term period after PCI in proximal and distal segments of the RCA and it was independently associated with post procedural complications and heart failure.
P1086Prevalence and predictors of left atrial thrombi in patients scheduled for electrical cardioversion of nonvalvular atrial fibrillation
Authors: Abud A , Santillan M , Perello L , Rosller C , Rossi L , Pantaley C , Garello E , Carlessi A 
Published: June 2020

Abstract

Background
Transesophageal echocardiography (TEE) showed the presence of thrombi in 12 to 26% of patients with atrial fibrillation (AF).

Purpose
To assess clinical and echocardiographic variables associated with thrombi in the left atrium (LA) prior to electrical cardioversion in patients with nonvalvular atrial fibrillation (AF).

Methods
Cross-sectional study including 188 patients. Clinical and echocardiographic variables were analyzed. Qualitative variables are expressed in percentages and quantitative variables in mean and standard deviations. Qualitative variables were analyzed by the Chi square method. A value of p &lt;0.05 was considered statistically significant.

Results
Mean age was 60.7 ± 12.3 and 75.5% males. The mean CHA2DS2-VASc and HAS-BLED scores were 2.43 ± 1.6 and 1.06 ± 1. The percentage of paroxysmal AF was 49.7%, nonparoxysmal 23.2% and atrial flutter 27%. Mean ejection fraction (EF) was 52.2 ± 13%. The prevalence of thrombus was 12.3%.
Female gender (p = 0.0275), heart failure (p = 0.0006), CHA2DS2-VASc score ≥2 (p = 0.0015), EF &lt;50% (p = 0.0089), moderate/severe spontaneous echocardiographic contrast (p = 0.000042) and LA appendage emptying velocity ≤20 cm/sec (p = 0.0000001) are associated to the presence of thrombi in the LA. No thrombi were detected in patients with CHA2DS2-VASc score of 0.
History of previous anticoagulation for over thirty days or creatinine clearance &lt;56 ml/min were not predictors of LA thrombi.

Conclusion
Female gender, heart failure, EF &lt;50% and CHA2DS2-VASc score ≥2, emptying velocity of less than 20 cm/sec and spontaneous echocardiographic contrast were univariate predictors of thrombi in the LA. CHA2DS2-VASc score of 0 is a strong predictor of absence of thrombi.
916The impact of anesthesia choice on subcutaneous implantable cardioverter defibrillator outcomes: acute and one year results from the post approval study
Authors: Aasbo J , Dinerman J , Mark G , Burke M C , El-Chami M , Belott P , Mackall J , Gold M 
Published: June 2020

Abstract

Funding Acknowledgements
This study was financially supported by Boston Scientific
The influence of anesthesia technique on the outcomes of subcutaneous implantable cardioverter defibrillator (SICD) implantation has not been prospectively evaluated.
The aim of the present analysis was to characterize the effect of anesthesia choice acutely and over a year follow-up in the large "real-world" cohort of the SICD Post Approval Study (SICD-PAS).
Patients received either general anesthesia (GA), conscious sedation (CS), or monitored anesthesia care (MAC) at the implanting physicians" discretion. Acute results and complications over one year were compared between GA, CS and MAC.
1,631 patients were studied. 64.3% received GA , 29.2% received CS and 6.6% received MAC. Procedure times were shortest for MAC versus GA and CS (Table 1). Cross-over from CS and MAC to GA occurred in 2.9% and 1.9% of procedures, respectively. The mean left ventricular ejection fraction (LVEF) was lower in the MAC cohort compared with GA and CS. GA patients were less often discharged the same day than CS and MAC. Patients who had GA were more likely to have had intra-operative DFT testing, while successful DFT testing at implant did not differ among groups (Table 1). At one year, freedom from total complications did not differ between groups (93.3% for GA, 92.9% for CS and 87.8% for MAC, p = 0.095) nor did freedom from inappropriate shocks (94% for GA, 94.2% for CS, 88.9% for MAC, p = 0.138) nor appropriate shocks (95.8% for GA, 95% for CS, 95% for MAC, p = 0.747).
All three anesthesia techniques had similar acute and one year outcomes but, despite having worse LVEF, patients who received MAC had shorter procedure times and infrequently required conversion to GA. GA was associated with higher rates of next day patient discharge. These results suggest that MAC may be preferred for the majority of patients. This observation should be confirmed with prospective trials.
Table 1:Characteristics and Outcomes Parameter Conscious Sedation General Anesthesia Monitored Anesthesia Care P value Gender[%(N/Total)] Male 68.1 (324/476) 69.3 (726/1048) 66.4 (71/107) 0.77 Age (years) mean ± SD 54 ± 15 53 ± 15 54 ± 13 0.61 Body Mass Index mean ± SD 30 ± 7 30 ± 8 29 ± 6 0.41 Creatinine (mg/dL) mean ± SD 2 ± 2 2 ± 4 2 ± 2 0.43 LVEF (%) mean ± SD 33 ± 15 32 ± 15 26 ± 9 &lt;0.001 Procedure Time (min) mean ± SD 85 ± 42 75 ± 33 65 ± 30 &lt;0.001 Same Day Discharge % 70.3% 64.3% 72.6% 0.03 DFT Attempted % 84% 89.1% 81.3% 0.004 Successful DFT % 98.7% 98.6% 98.8% 0.97