Assessment of atrial fibrillation catheter ablation outcomes in patients with hypertrophic cardiomyopathy

Funding Acknowledgements

Type of funding sources: None.

Background

Atrial fibrillation (AF) is a frequent manifestation of hypertrophic cardiomyopathy (HCM) and it is associated with increased risk for thromboembolic events and worsening of heart failure. AF is usually refractory to antiarrhythmic drugs in cases with HCM and catheter ablation may be useful in such patients.

Purpose

We aimed to evaluate outcomes of both cryoballoon and radiofrequency (RF) AF catheter ablation in patients with HCM.

Methods

All of the patients with HCM who underwent AF catheter ablation between January 2014 and January 2022 were screened and patients with available follow-up datas were included.

Results

A total of 44 patients were enrolled. Mean age was 54.2±12.6 years and 45.5% of the patients were female. RF ablation was performed in 23 cases and remaining patients underwent cryoablation. Median follow-up was 42.5 (4-94) months. Baseline characteristics were listed in Table-1. Only pulmonary vein isolation was performed in 25 (56.8 %) patients while additional ablation procedures including left atrial appendage isolation and linear ablation were required in other cases. Periprocedural complications occured in 6 cases. Atrial tachycardia recurrence developed in half of patients and mortality occured in 2 (4.5 %) cases during follow-up (Table-2).

Six months recurrence free survival (RFS) rate was 90.9% and 1 year RFS was 86.1% however RFS rate reduced to 58.2 after 3 years follow-up. Atrial tachycardia recurrence rates, complication and mortality rates were similar between the patients who underwent cryoablation and RF ablation. Changes in NYHA class and BNP levels were not significant during follow-up, however EHRA class was distinctly improved (II vs. I; p<0.001).

Conclusion

Although long term outcomes of AF catheter ablation is not satisfactory; it is effective in short term rhythm control with reasonable complication rates. Recurrence rates are similar between RF and cryoablation.

Comparison between cryoballoon and radiofrequency for atrial fibrillation ablation in patients with heart failure

Funding Acknowledgements

Type of funding sources: None.

Background

Radiofrequency (RF) and cryoballoon (CB) ablation are the most commonly performed methods for catheter ablation in patients with atrial fibrillation (AF). However, data regarding AF ablation in patients with reduced left ventricular ejection fraction (LVEF) is scarce.

Purpose

We aimed to compare the safety and efficacy of RF and CB AF ablation in heart failure (HF) patients with LVEF <50%.

Methods

HF patients whose LVEF < 50% were included in this retrospective study. Transthoracic echocardiography (TTE) was performed to evaluate LVEF by using Modified Simpson method before and after the procedure. Atrial tachyarrhythmia (ATa) recurrence was defined as detection of AF, atrial flutter, or atrial tachycardia (≥ 30 s) after a 3-month blanking period.

Results

Eighty-nine (n = 42 CB and n = 47 RF) HF patients were enrolled and baseline characteristics were listed in Table-1. There was no significant difference in AF recurrence rate between the groups [16 (38.1 %) in CB and 12 (25.5 %) in RF, respectively, P = 0.296] during the follow up of median 16.5 (10.25-24) and 11 (9-17) months (Figure-1). There was significant increase in LVEF (39.52 ± 7.77 vs. 46.30 ± 10.95, P < 0.001) and decrease in brain natriuretic peptide (BNP) [230 (10-1653.10) vs. 163 (10-1653.10), P = 0.003] levels after ablation. The changes in LVEF (P = 0.370) and BNP (P = 0.772) were similar between the CB and RF ablation groups.

Conclusion

Our findings demonstrated that AF ablation using either CB or RF was associated with an improvement in LVEF and neurohormonal profile in AF patients with reduced LVEF.

Effects of mitral annular calcification on the outcomes of transcatheter aortic valve implantation

Background

Transcatheter aortic valve implantation (TAVI) has become the standard of care treatment in patients with severe aortic stenosis who carry intermediate or high risk for surgical aortic valve replacement. Mitral annular calcification (MAC) is frequently seen in patients with aortic stenosis and it is associated with increased cardiovascular morbidity and mortality. It is reported that MAC is an independent predictor of all cause mortality after TAVI.

Aim

The aim of this study is to both evaluate the relationship between mitral annular calcification and TAVI related complications and mortality; and to define the predictors of both all cause mortality and permanent pacemaker implantation after TAVI.

Methods

All of the patients who underwent TAVI procedure due to severe aortic stenosis between 01.01.2020 and 01.06.2020 in our University Hospital were screened and patients fullfilling including criterias were enrolled. Patients' baseline demographic datas, laboratory, echocardiography and TAVI procedure related parameters were recorded. Outcomes are identified as follows; association between mitral annular calcification and TAVI related complications, establishment of the predictors of all cause mortality and permanent pacemaker implantation, definition of the in-hospital and all cause mortality rates.

Results

A total of 245 patients including 98 males (40%) and 147 females (60%) were enrolled in the study. The mean age of the population was 76,3±8,3 years. The mean left ventricular ejection fraction was % 54,8±11,4; aortic valve area was 0,74±0,14 cm2 and mean aortic transvalvular gradient was 47,0±14,3 mmHg. MAC was detected in 148 (% 60,4) patients (Table 1). In-hospital mortality was occurred in 14 (5,7%) cases. Permanent pacemaker implantation was performed in %17,8 (n=42) patients and all cause mortality was developed in 89 (36,3%) cases during the median 23,1 (11,6–44,3) months follow-up. Pericardial effusion (26,4% vs 12,4%; p=0,013) and contrast induced nephropathy (21,6% vs 7,2%; p=0,005) were developed more frequently in patients with MAC than without MAC (Table-2). Only the presence of MAC extending to left ventricular outflow tract was detected to be independent predictor of permanent pacemaker implantation requirement (HR: 3,32; p=0,002). All cause mortality predictors were established as; use of renin-angiotensin-aldosterone system blockers (HR: p=0,012), level of hemoglobin (HR: 0,79; p=0,006), severe mitral annular calcification (HR: 1,94; p=0,024) and atrial fibrillation development after TAVI (HR: 2,39; p=0,002). There was not any correlation between aortic valve area and MAC vloume (r=0,03; p=0,689), MAC Hounsfield Unit (r=−0,007; p=0,934) and MAC Agatston score (r=−0,08; p=0,290).

Discussion

MAC is associated with all cause mortality after TAVI and MAC extending to left ventricular outflow tract is an independent predictor of permanent pacemaker implantation requirement.

Funding Acknowledgement

Type of funding sources: None.

The relationship between comorbidities and physical activity and kinesiophobia of patients with heart rhythm disorders in Covid-19 pandemia

Background/Introduction

Covid-19 disease, which affects more than 128 million people worldwide, has caused changes in lifestyle and physical activity habits in patients with cardiovascular disease due to lockdown restrictions. During the pandemic period, patients with chronic diseases (also patients with comorbidities) cannot participate in physical activity and exercise programs due to social isolation.

Purpose

The aim of our study is to investigate the relationship between the comorbidities of heart rhythm disorder patients and their physical activity levels and kinesophobia in the Covid-19 pandemic.

Methods

105 individuals (54 healthy adults, 51 patients with heart rhythm disorders) were included in this study.

Physical Activity Level: Physical activity level was evaluated using the International Physical Activity Questionnaire-Short Form (IPAQ-SF).

Fear of Movement: Fear of movement was evaluated using the Tampa Scale of Kinesiophobia for Heart.

The Comorbid Conditions: The comorbid conditions of the patients were evaluated by the Charlson comorbidity index.

Results

Table 1. In patients with heart rhythm disorders, there was a negative, moderate correlation between the Charlson comorbidity index and the number of daily steps (r=−402, p=0.03), while a positive, moderate relationship with the Charlson comorbidity index and Tampa score (r=391, p=0.05) has been found.

Conclusion

While the Charlson comorbidity index value and Tampa Score were higher in patients with heart rhythm disorders than in the control group, the number of inactive patients among the subgroups of the IPAQ-SF scale was higher than the control group.

While heart rhythm disorders patients with more comorbidities are more prone to develop kinesiophobia, the number of daily steps decreases in the same direction.

Management of comorbidities of patients with heart rhythm disorders can be provided by physical activity counseling to these people.

Funding Acknowledgement

Type of funding sources: None.

P359Outcomes of radiofrequency catheter ablation of ischemic ventricular tachycardia in patients with electrical storm

Background

Electrical storm (ES) is defined as 3 or more episodes of sustained ventricular tachycardia (VT) within 24 hours and related with high mortality rates. Catheter ablation is an effective treatment option in patiens with ES. 

Purpose

 

We aimed to evaluate outcomes of VT catheter ablation in patients with ES.

Methods

 

All patients who underwent catheter ablation due to VT ablation between June 2014 and November 2018 were screened and outcomes of patients who admitted with ES were evaluated. 

Results

A total of 128 patients were included. 52 (40.6%) patients were admitted with ES. Mean age of the patients with ES was 68 ± 10,5 years and 48(92,3) patients were male. Median follow up was 22.5 (8-46)  months. Baseline characteristics were listed in Table- 1.Multivariate regression analysis revealed that hemoglobin level (HR:0.76, CI:0,61-0,94, p = 0.011 ) and antiarrhythmic drug use (HR:0.25, CI:0,10-0.62, p = 0.003) were predictors of ES development. Recurrence rates and number of re-do ablation procedures were significantly higher in patients with ES (Table-1). Cardiovascular and all cause mortality rates were also significantly higher in patients with ES (Table-1). 

Conclusion

Despite catheter ablation is an effective treatment in patients with ES; presence of ES is related with increased mortality and recurrence rates after ablation.

Table-1 Patients with ES Patients without ES p value Age, years 68 ± 10,5 63,8 ± 8,8 0,017* Gender, male, n (%) 48(92,3) 72(94,7) 0,853 Hypetension, n (%) 34(65,4) 59(77,6) 0,158 Diabetes, n (%) 17(32,7) 18(23,7) 0,314 Previous PCI 32(61,5) 51(67,1) 0,574 NYHA >II 17(32,7) 13(17,1) 0,044* LV EF, (%) 27,8 ± 8 29,1 ± 8,3 0,369 LV EDD, mm 64,6 ± 9,1 63,3 ± 8,2 0,431 Hemoglobin, g/dL 13,0 ± 2,1 14,1 ± 1,6 0,002* BNP level (pg/mL) 461(35-3161) 244(10-4517) 0,008* Recurrence 23(44,2) 21(27,6) 0,050* Re-do ablation 0,050* 8(10,5) 0,010* Cardiovascular mortality 16(34,8) 12(16,9) 0,045* All cause mortality 22(42,3) 17(22,4) 0,020* Baseline characteristics and outcomes of catheter ablation in patients with and without ES

P1373Assessment of atrial fibrillation cryoablation outcomes in patients with diabetes

Background

Diabetes is related with both AF occurence and increased thromboembolic risk. There is scarce data about the outcomes of AF catheter ablation in patients with diabetes.

Purpose

We aimed to evaluate outcomes of AF catheter ablation in patients with diabetes.

Methods

All patients underwent AF cryoablation between January 2013 and January 2018 were included .  

Results

A total of 493 patients were enrolled. Mean age was 59.6 ± 11.8 years and 253 (51.3 %) patients were female. Median follow up time was 28 (6-59) months. Recurrence occured in 61 (12.4%) patients. Diabetes was present in 78 (16%) cases. Mean HbA1c value of the diabetic patients was 6.79 ± 1.02 %. 50 (64.1 %) patients was under treatment with only oral antidiabetics while others were using insulin. Diabetic group was older (p < 0.001) and hypertension prevalance was significantly higher in diabetics(p < 0.001). Complication and recurrence rates were similar between the two groups (Table-1). Subgroup analysis revealed that there was not significant difference by AF recurrence between not only patients treated with OAD alone and treated with insulin but also patients with HbA1c value <7 and HbA1c value ≥7 (p = 0.064).

Conclusion

Recurrence and complication rates were similar between diabetic and non-diabetic patients. Despite neuropathy is a well known manifestation of diabetes; phrenic nerve damage rate is similar in diabetic patients with non-diabetic counterparts.

Table-1 Diabetic group (n = 78) Non-diabetic group (n = 415) p value Age, (years) 64.38 ±10.12 58.91 ±11.84 <0.001* Gender, female (%) 45 (57 %) 207 (49.8 %) 0.267 Follow up, (months) 29.5 (6-59) 28 (6-58) 0.987 Hypertension, n (%) 57 (73%) 191 (46 %) <0.001 StrokeTIA, n(%) 4 (5.1 %) 8 (1.9 %) 0.104 Coronary artery disease, n (%) 39 (50 %) 176 (42.4 %) 0.242 AF type, Paroxysmal, (%) 65.7 % 71% 0.367 LV EF, % 59.81 ± 8.44 61.82 ± 6.89 0.027* LV end diastolic diameter, cm 4.90 ± 0.49 4.82 ± 0.46 0.160 LA diameter, cm 3.88 ± 0.51 3.81± 0.58 0.361 Recurrence 8 (10.2 %) 53 (12.7 %) 0.708 Phrenic nerve damage, n (%) 0 (0 %) 17 (4.1 %) 0.088 Inguinal hematoma, n (%) 7 (8.9%) 44 (10.6 %) 0.647 Pseudoaneurysm, n(%) 1 ( 1.2%) 3 ( 0.7 %) 0.502 Comparison of diabetic and non-diabetic patients

P980Evaluation of the outcomes of radiofrequency catheter ablation in patients with ischemic ventricular tachycardia

Background

Ablation of ventricular tachycardia (VT) is an effective and safe treatment option in symptomatic patients under antiarrhythmic drugs or patients with frequent ICD therapies.

Purpose

We aimed to evaluate outcomes of VT catheter ablation in patients with ischemic VT.

Methods

All of the patients who underwent VT catheter ablation between June 2014 and November 2018 were included.

Results

128 patients (120 male, 8 female) were included and mean age was 65 ± 10 years. Mean ejection fraction was 28.6 ± 8.2 %. Baseline characteristics were listed in Table-1.  Mean follow-up was 22.3 ± 6.4  months. 52 (46.6 %) patients were admitted with electrical storm. Acute success rate was 96.6%. Complications including transient ischemic attack, deep venous thrombosis, pericardial effusion and inguinal hematoma were developed in 6 patients.  Recurrence of VT was occured in 44 (34.4 %) patients and the presence of PCI history and admission with electrical storm were predictors of recurrence. All cause mortality was occured in  39 patients and predictors of all cause mortality was detected as follows; diabetes, NYHA stage >2, lower levels of EF and higher BNP levels. Cardiovascular mortality was developed in 28 patients and predictors were defined as, lower levels of EF, higher BNP levels and number of shock after index ablation. VT recurrence was not found to be related with both cardiovascular and all cause mortality.

Conclusion

VT ablation is a safe and effective option in patients with ischemic VT who are symptomatic despite optimal medical treatment. Admission with electrical storm and history of PCI were predictors of VT recurrence after ablation. Higher levels of BNP, lower EF values are related with both all cause and cardiovascular mortality.

Table-1 Gender, male, (%) 120(93,8) Age(year) 65,5 ± 9,7 HT 93(72,7) DM 35(27,3) AF 41(32,0) NYHA class(pre-ablation) IIIIII IV 71(55,5)27(21,1)25(19,5) 5(3,9) Previous PCI 83(64,8) Previous Cardiac surgery CABG AVR MVR 72(56,3) 70(54,7 1(0,8) 4(3,1) LV EF (%)≤3031-40 ≥41 28,6 ± 8,290(70,3)28(21,9) 10(7,8) Electrical storm 52(40,6) LV EDD (mm) 63,8 ± 8,5 Baseline characteristics

P1862Phrenic nerve damage after atrial fibrillation ablation using second generation cryoballoon

Background

Cryoballoon (CB) ablation is a safe alternative to radiofrequency ablation in the treatment of atrial fibrillation (AF). However, phrenic nerve damage (PND) is a bothersome complication of the procedure.

Purpose

In this study, we aimed to establish the incidence of PND during CB and define the characteristics of affected patients.

Methods

In this retrospective analysis, all patients with AF that underwent CB ablation between 2013 and 2018 were included into the study. Characteristics and outcomes of patients complicated with PND were evaluated. PND was detected by palpation of diaphragma contractions or observation of reduced diaphragma motility by fluoroscopy during the procedure.

Results

Totally 653 patients were included in the study. PND was detected in 3.5% (23/653) of the patients. Median age of the patients with PNP was 56 (25–78) years and 10 patients (43.4%) were male. The most common ablation site related with PND was right superior pulmonary vein (RSPV) (18 patients, 78%). Transient PND was observed in 16 patients (69%) of the patients which resolved within 24 hours after the procedure. In the remaining 5 patients (21%) diaphragmatic contraction was recovered at the 6th month control visit. In 2 patients (10%), phrenic nerve paralysis was still present >1 year visit.

Table 1. Baseline characteristics of patients with PND Age (years), median (min–max) 56 (25–78) Gender, n (male %) 10 (43.4%) Hypertension, n (%) 9 (39.1%) LA (mm), (mean ± sd) 38.5±5.8 EF (%), (mean ± sd) 60.8±6.5 Structrual heart disease, n (%) 3 (0.13%) – HCMP 2 (0.087%) – DCMP 1 (0.043%) DCMP: Dilated cardiomyopathy; HCMP: Hypertrophic cardiomyopathy; EF: Ejection fraction; LA: Left atrium; PND: Phrenic nerve damage.

Conclusion

PND is not a rare complication of CB ablation despite all the preventive maneuvers during the procedure and technological developments. However, most of the PND recovered during the follow-up.