Baseline profile and results of atrial fibrillation ablation in patients with arrhythmia-induced cardiomyopathy

Background

Atrial fibrillation (AF) is known to trigger a reversible dilated cardiomyopathy referred as arrhythmia-induced CM (AiCM). However, it remains unclear why some patients are more prone to develop AiCM than others and there is scarce information about their clinical outcomes after AF ablation.

Purpose

We ought to find clinical and analytical predictors for the development of AiCM and recovery of LVEF in patients referred for AF ablation.

Methods

A prospective multicenter study of consecutive patients undergoing point-by-point radiofrequency (RF) catheter ablation between September 2016 and November 2021 was conducted. The low voltage areas and left atrial (LA) volume were analyzed offline on high density electroanatomical maps collected prior to RF ablation. Peripheral blood sample for biomarker analysis (Gal-3, FABP4 and sRAGE) were obtained at the time of the procedure.

Results

803 consecutive patients were included, median age was 61 and 240 (30,81%) were women. AF pattern was paroxysmal in 254 (32,60%) and persistent in 534 (68,55%; of whom, long-standing persistent in 113 (14,51%) patients). The median follow-up period was 23.83 months [IQR 9 to 36]. The multivariate analysis revealed LA area, width of QRS segment, persistent AF and chronic kidney disease (CKD) as independent predictors for AiCM. Recurrence-free survival was not different amog both cohorts (Figure 1).

The median increase in LVEF from baseline to the 6-month follow-up visit in patients with AiCM was 16% (CI 14.31–18.47) without changes in the non-AiCM group. The median LVEF previously to CA from patients in the AiCM group was 38% (IQR 30–45%) and after the procedure 57% (IQR 50–60%) [see figure 2].

Conclusions

AiCM is characterized to have a particularly complex pathophysiology not fully understood thus far. Pulmonary vein isolation in patients is safe and suitable for patients that suffered from tachycardiomyopathy. We found that persistent AF and chronic kidney disease play a key role in its development. Neither peripheral blood biomarkers nor left atrial samples showed relevant association with its occurrence.

Funding Acknowledgement

Type of funding sources: None.

Utility of Soluble ST2 biomarker to predict recurrence after electrical cardioversion in patients with atrial fibrillation

Background

Atrial fibrillation (AF) is the more frequent arrhythmia in clinical practice. The ST2S is a biomarker that has demonstrated to be predictor of cardiovascular outcomes in patients with heart failure but there is scarce information of his utility in patients with AF.

Purpose

Considering the characteristics of the ST2S we hypothesize this biomarker could correlate to recurrence in patients with AF and electrical cardioversion (ECV).

Methods

This was an observational and prospective clinical trial. We compared all patients with AF referred for ECV with a control group without AF, from September 1th 2016 to September 30 2019. Clinical, ECG, echocardiographic and ST2S levels were analyzed in both groups at basal, at 3 and 6 months of follow-up in such cases with AF. Patients with inflammatory or allergic diseases, moderate/severe ventricular dysfunction, structural cardiomyopathy, moderate/severe hepatic, renal or respiratory disease were excluded.

Results

We included a total of 94 patients with AF and 40 paired controls. Clinical variables are presented in Table 1. Fifty-eight (61.7%) patients with AF had recurrence at follow-up. There was a significant difference between the ST2S levels at baseline between AF patients (17163.8 pg/mL) and controls (11016.2 pg/mL) (p=0.001). ST2S biomarker levels at 3 and 6 months of follow-up decreased in those patients without AF recurrence as shown in Figure 1. Covariable models were performed and ST2S biomarker levels at 3 months were significant to predict recurrence at 6 months follow-up (Table 2). The calculated cut-point of the biomarker was of 15511.51 pg/ml with a c-value: 0.669.

Conclusions

In our experience ST2S was a useful biomarker to predict recurrence of AF after ECV. Considering the size of the study more studies should be performed to confirm this results.

Funding Acknowledgement

Type of funding sources: None.

Plasma miR-451a predicts atrial fibrillation recurrence after pulmonary vein ablation

Background/Introduction

Atrial fibrillation (AF) is the most common sustained arrhythmia diagnosed in European countries. Several studies have shown that catheter ablation is a more effective treatment than antiarrhythmic drugs and should be prioritised in symptomatic patients. However, AF recurrence after catheter ablation remains a challenge. MiRNAs have been identified, in recent years, as epigenetic modulators in numerous biological processes, including cardiac electric conduction. MiRNAs can be easily detected in the circulation, making them attractive as potential biomarkers for risk stratification in AF patients.

Purpose

Our purpose is to find a miRNA able to predict the AF recurrence after catheter ablation.

Methods

44 patients submitted to catheter ablation were consecutively recruited and classified based on recurrence after a follow up of 12 to 48 months. Peripheral and left atrium blood samples were collected before catheter ablation. Human Cardiovascular Disease miScript miRNA PCR Arrays were performed to analyse 84 miRNAs altered in cardiovascular disease. Significant miRNAs changes in ΔCt levels were assessed using Two-way ANOVA and post hoc Tukey tests. Simple logistic regression analysis was performed to analyse association to AF recurrence. KEGG pathway enrichment analysis was performed to identify the most enriched targets and pathways involved in AF recurrence.

Results

In our cohort, overall recurrence rate was 47.7%. qPCR expression analysis showed increased levels of miR-328-3p and decreased levels of miR-486-5p in recurrent patients, both in peripheral as well as left atrial blood. Our results also showed decreased levels of miR-let-7b-5p and miR-451a in recurrent patients, but selectively regulated in peripheral and atrial blood, respectively (Figure 1). Simple logistic regression analysis showed a significant association between blood atrial levels of miR-451a and AF recurrence (Figure 2A). KEGG pathway enrichment analysis showed that miR-451a could be involved in epigenetic regulation of myocardial electromechanic integrity (Figure 2B).

Conclusion

Expression analysis of atrial blood miR-451a levels, prior to catheter ablation, could be a good a risk stratifier of recurrence.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): IN607A2019/02. Xunta of Galicia. Grants for the consolidation and structuring of competitive research units in the universities of the Galician University System, in the public research organizations of Galicia and in other entities of the Galician R&D System 2019

Conventional single-chamber pacemakers versus transcatheter pacing systems at long-term follow-up

Background

Leadless pacemakers systems (LPM), have demonstrated safety and efficacy at mid-long term follow-up. There are still issues that cannot be completely avoided with conventional transvenous pacemaker (VVI) such as infectious or pocket related complications in which LPM are clearly superior.

Purpose

The aim of the study was to compare the clinical and device performance between LPM and VVI in a one-center long-term follow-up.

Methods

This was a prospective, observational, one-center study. We include all patients with a single chamber pacemaker implantation from June 1 2015 to March 1 2022 to complete a long-term follow-up. All clinical, electrical and echocardiographic characteristics, including electrical parameters, complications and mortality, were described.

Results

We included 245 patients with VVI pacemakers and 315 LPM. Mean age was 79.6±6.6 in LPM and 83.5±8.9 y/o in VVI pacemakers. All clinical, electrical and echocardiographic characteristics are described in Table 1. Electrical parameters of LPM were stable at long-term follow-up. There were a total of 7 complications in LPM and 17 in VVI pacemakers (p=0.006). There were no significant differences between major complications but there were in minor complications as shown in Table 2. There were no significant differences in mortality between both groups, but there was one death related to endocarditis in a VVI pacemaker patient during the follow-up (40,3±10 months).

Conclusions

In our study, there were no significant differences in terms of mortality and major complications between LMP and VVI at long-term follow-up. We consider our study supports the results in favor of the safety and effectiveness of LPM in the long-term.

Funding Acknowledgement

Type of funding sources: None.

Utility of open window mapping using high-density mapping approach in accessory pathways ablation

Introduction and purpose

We sought to described a new protocol of open window mapping (OW) utilizing high-density mapping in accessory pathways (AP) in CARTO® 3 system. This protocol automatically map conventional electrophysiology criteria for AP location, as shorter local EGM AV interval (extended early meets late tool), earliest local activation time (LAT)and annotation at unipolar signal (wavefront annotation).

Methods

This was a single center, prospective and observational trial of 21 consecutive patients who underwent an AP catheter ablation.

Results

We included 16 men and 5 women, with a mean age of 32.6±17.9 years. The characteristics of AP, including mapping and ablation were described in Table 1. Twelve AP were of left location and 9 in right location. Mapping was performed in anterograde conduction in 17 patients (80.9%), retrograde in 9 patients (42.9%) and orthodromic tachycardia in 7 patients (33.3%). Mean mapping points were 3205±2034, with 29.2 min±12.5 min of mapping. All 21 patients had a successful ablation after OW mapping and mean radiofrequency time until complete AP elimination was 2.76 s.

We present an example of a Left lateral AP OW mapping in antegrade and retrograde conduction in Figure 1, which shows EEML mapping tool, targeting shorter interval EGM AV or VA and color adjust to determine earliest LAT in chamber of exit.

Conclusions

In our experience, automatically mapping of conventional electrophysiology criteria for AP diagnostic is feasible to localize AP insertion, suggesting an increasing in effectiveness of procedure, and reducing mapping time, ablation time and X-ray exposure time. More studies should be performed to corroborate these conclusions.

Funding Acknowledgement

Type of funding sources: None.

Safety of leadless pacemaker implantation in very eldery patients in a one-center study

Funding Acknowledgements

Type of funding sources: None.

Introduction

Leadless pacemakers (LPM) have demonstrated safety in patients with multiple commorbidities. Very elderly patients have multiple commorbidities and are more prone to develop complications in pacemaker implants.

Purpose

We present our experience with LPM in a subgroup of very elderly patients.

Methods

We present a prospective clinical trial that including all consecutive LPM implantation from June 1 2015 to December 25 2021. We divide the patients in two groups according to age: older or younger than 85 y/o. Clinical and electrical, characteristics, as well as related complications and electrical parameters were compared between the two groups according to age.

Results

A total of 300 LPM were implanted and divided in two groups: 231 patients of less than 85 y/o and 69 patients ≥85 y/o. Clinical and electrical characteristics were described in table 1. Mean follow-up was of 36 months. There were 7 complications, all during the implantation procedure and there were no significant differences in complications between both groups . Electrical performance had no differences between the patients and was stable at long-term follow-up. (Figure 2)

Conclusions

There were no significant differences in complications or electrical performance between both groups and LPM were safe at long-term follow-up in very elderly patients with multiple commorbidities.

Feasibility of open window mapping approach in accessory pathways ablation

Funding Acknowledgements

Type of funding sources: None.

Introduction and Objectives

We described a new protocol of open window mapping (OW) in accessory pathways (AP) in CARTO® 3 system. This protocol automatically mapping conventional electrophysiology criteria of AP diagnostic, as shorter local EGM AV interval (extended early meets late tool), earliest local activation time (LAT) and annotation at unipolar signal (wavefront annotation).

Methods

Single center, prospective and observational study of 17 consecutive patients underwent AP catheter ablation.

Results

Mapping was performed in anterograde conduction in 13 patients (76.5%), retrograde in 5 patients(29,4%) and orthodromic tachycardia in 2 patients (11,7%). Mean of numbers of points were 3092±2246, with 30min ± 13min of mapping. Ablation was effective in 17 patients( 100%) and RF time until complete AP elimination was 2.6s. Image 1 show representation of EEML tool, targeting shorter interval EGM AV or VA and color adjust to determine earliest LAT.

Image 1 show representation of EEML tool, targeting shorter interval EGM AV or VA and color adjust to determine earliest LAT.

Conclusions

In our experience, automatically mapping of conventional electrophysiology criteria for AP diagnostic is able to localize AP insertion, suggesting an increasing in effectiveness of procedure, a reducing in mapping time, ablation time and X-ray exposure time.

Leadless pacemaker patients following cardiac valve intervention in a long-term follow-up

Introduction

Leadless pacemakers (LPM) have demonstrated adequate electrical performance and safety in patients with multiple commorbidities such as heart valve replacements at short-term follow-up.

Purpose

We present our experience in patients with LPM and heart valve replacements at long-term follow-up.

Methods

This was a prospective observational study including all consecutive LPM implantation from June 1 2005 to March 15 2021. Clinical, electrical, echocardiographic characteristics, related complications and electrical parameters were compared in 2 different groups with and with-out valve surgical procedure.

Results

A total of 255 LPM were implanted. Clinical, electrical and echocardiographic characteristics are described in table 1. Mean follow-up was of 24 months. There were no significant differences in electrical performance or related complications in between both groups (Figure 1).

Conclusions

Electrical performance and complications were no significantly different between both groups with and without heart valve replacements.

Funding Acknowledgement

Type of funding sources: None.

Leadless pacemaker implant with concomitant atrioventricular node ablation: experience in a single center study with longterm followup

Introduction

Feasibility of concomitant leadless-pacemaker (LP) implantation plus atrioventricular node ablation (AVNA) is unknown. Moreover, safety issues in the long run are also undetermined. It seems theoretically attractive since it could avoid one additional procedure and catheter could be introduced through the same sheath employed for the LP. On the contrary, risk of dislocation/electrical variations could represent a shortcoming.

Objective

We aim to report 1) feasibility of concomitant AVNA after a LP implantation and 2) long-term outcomes.

Methods

Single center, prospective and observational study of 256 consecutive patients with an indication for single-chamber pacemaker placement. The implantation procedure was carried out using a femoral approach and conventional technique. Successful implantation was accomplished in 255/256 patients referred for leadless implantation. In one patient, a complete obstruction of the inferior vena cava was documented, and a conventional unicameral pacemaker was implanted.

Results

33 out of 255 patients underwent immediate AV ablation. Mean age was 75.2±8.3 years. Were predominantly females: 25 (75.7%) and indication was fast conduction atrial fibrillation (n=25), atypical flutter or atrial tachycardia (n=8). Mean acute “R wave” was 11.3mV, threshold of 0.55Vx0.24ms and impedance of 833Ω. Uneventful AV node ablation was performed in all of them immediately after LP implantation. Additional mean fluoroscopic time was 3.0 minutes.

There were no vascular or arrhythmic complications after the implantation. After a mean follow-up of 27.9±12 months, all patients remained alive without notable event, and electrical parameters remained unchanged (Figure 1). Actuarial survival was shown in Figure 2.

Conclusions

Conconmitant AVN ablation after LP implantation seems feasible without remarkable complications in the long run. In our experience, this approach appears more comfortable for the patients and less time-consuming than conventional pacemaker implantation with sequential AV node ablation. There were no device macrodislodgements or unexpected device malfunctions in the follow-up period.

Funding Acknowledgement

Type of funding sources: None. Electrical performanceSurvival

Leadless pacemaker implantation after transcatheter aortic valve implantation, should we go simple?

Funding Acknowledgements

Type of funding sources: None.

Introduction

Transcatheter aortic valve implantation (TAVI) is a valvular replacement that has been developed as an alternative in patients with high and intermediate risk. One of the more frequent complications are new on-set conduction abnormalities.

Purpose

The purpose of the study was to evaluate the performance of leadless pacemakers (LPM) after TAVI and compare it with conventional pacemaker implantations (VVI- PM).

Methods

This was a prospective observational study that included all consecutive patients in which a TAVI and a PM was implanted during the same hospitalization (January 1 2015 to December 31 2020). Clinical, echocardiographic, ECG at implant characteristics, and related complications were described.

Results

 From a total of 126 patients (21.3%) with PM implantation: 2 required cardiac resynchronization system, 73 DDD-PM, 29 VVI-PM, 22 LPM. Clinical and echocardiographic characteristics are described in table 1. Main follow-up was of 12 months and 22 patients (79.7%) developed AF. Electrical parameters were stable in conventional and LPM. Total mortality was of 33 patients (26.2%), there was one case of infectious endocarditis in a DDD-PM, and there were no complications in LPM patients.

Conclusions. New on-set of conductions abnormalities are one of the main related complications in TAVI patients. In our study, patients with LPM had a safe performance with low complications rate. Table 1 DDD-PM (73) VVI-PM(29) LPM(22) p Age 84.2 83,1 79,4 0.1753 Men 35 (47.9%) 19 (65,5%) 12 (54,5%) 0.108746 Hypertension 67 (91.8%) 23 (79,3%) 10 (45,4%) 0.077846 Diabetes Mellitus 19 (26%) 12 (41,4%) 7 (31,8%) 0.128362 COPD 13 (17.8%) 7 (24.1%) 4 (18.2%) 0.073172 Renal insufficiency 15 (20.5%) 9 (31%) 10 (45,4%) 0.260054 AF 13 (17.8%) 27 (93.1%) 21 (95.4%) < 0.00001 Ischemic cardiomiopathy 24 (32.9%) 16 (55.2%) 7 (31.8%) 0.063504 LVEF 57.5 56 59 0.298312 Sinus Rhythm at implant 72 (98.6%) 2 (6.9%) 1 (4.5%) < 0.00001 RBBB Pre-TAVI 22 (30.1%) 3 (10.3%) 7 (31.8%) 0.06561 AF at follow-up 11 (15.1%) 28 (96.6%) 22 (100%) < 0.00001 Mortality 14 (19.2%) 14 (48.3%) 5 (22.7%) 0.002973 Complications 4 (5.5%) 1 (3.4%) 0 0.668225 Clinical, electrical and echocardiographic characteristics.

Leadless pacemaker implant with concomitant atrioventricular node ablation: a single center study with longterm followup

Funding Acknowledgements

Type of funding sources: None.

Introduction

Feasibility of concomitant leadless-pacemaker(LP) implantation plus atrioventricular node ablation(AVNA) is unknown. Moreover, safety issues in the long run are also undetermined. It seems theoretically attractive since it could avoid one additional procedure and catheter could be introduced through the same sheath employed for the LP. On the contrary, risk of dislocation/electrical variations could represent a shortcoming .

Objective

We aim to report 1) feasibility of concomitant AVNA after a LP implantation and 2) long-term outcomes. 

Methods

Single center, prospective and observational study of 243 consecutive patients with an indication for single-chamber pacemaker placement. The implantation procedure was carried out using a femoral approach and conventional technique. Successful implantation was accomplished in 242/243 patients referred for leadless implantation. In one patient, a complete obstruction of the inferior vena cava was documented, and a conventional unicameral pacemaker was implanted.

Results

33 out of  242 patients underwent immediate AV ablation. Mean age was 75.2 ± 8.3 years. Were predominantly females: 25(75.7%) and indication was fast conduction atrial fibrillation(n = 25), atypical flutter or atrial tachycardia (n = 8). Mean acute "R wave" was 11.3mV, threshold of 0.55Vx0.24ms and impedance of 833Ω. Uneventful AV node ablation was performed in all of them immediately after LP implantation. Additional mean fluoroscopic time was 3.0 minutes.

There were no vascular or arrhythmic complications after the implantation. After a mean follow-up of  19.9± 12 months, all patients remained alive without notable event, and electrical parameters remained unchanged.(Figure 1)

Conclusions

Conconmitant AVN ablation after LP implantation seems feasible without remarkable complications in the long run.  In our  experience, this approach appears more comfortable for the patients and less time-consuming than conventional pacemaker implantation with sequential AV node ablation. There were no device macrodislodgements or unexpected device malfunctions in the follow-up period. Abstract Figure. Electrical performance

One-center experience in leadless pacemakers after heart valve replacement

Funding Acknowledgements

Type of funding sources: None.

Introduction

Leadless pacemakers (LPM) have demonstrated adequate electrical performance and safety in patients with multiple commorbidities. Limited information has been published about patients with LPM and heart valve replacements.

Purpose

We were interested to present our experience in patients with LPM and heart valve replacements.

Methods

This was a prospective observational study in which we include all consecutive LPM implantation in a 5 year period (June 1 2005 to January 1 2020). Clinical, electrical and echocardiographic characteristics were described and evaluated in 2 different groups with and with-out surgical procedure.

Results

A total of 242 LPM were implanted. We describe clinical and echocardiographic characteristics in patients table 1. There were no significant differences in electrical performance in between both groups (Figure 1).

Conclusions

In our series with LPM we observed adequate electrical performance as well as safety at implant and follow-up in patients with heart valve replacements. No valve procedure185Valve procedure61pAge79.2 (±6.4)79.7 (±8)0.6395Men114340.78866Hypertension151440.899914Diabetes Mellitus58190.635131COPD3470.345258Renal insufficiency29160.000717Ischemic cardiomiopathy36140.495789LVEF59.9 (±7.6)590.036577Single mechanical replacement18Single bioprosthetic replacement12Bioprosthetic valve + TV annuloplasty3Bioprosthetic valve + MV & TV annuloplasty1Mechanical valve + TV annuloplasty2Sigle MV annuloplasty1MV & TV annuloplasty2Abstract Figure.

P1466Leadless pacemaker mid and long term follow-up in a single center-study

Introduction and objectives

Initial results of Leadless pacemakers (LPM) has been promising in worldwide, nevertheless there are still no long term experience published, so the objective of our study was to evaluate electrical parameters at mid  and long term follow-up, describing as well total complications and mortality in a single center-study.

Methods

 

This was a prospective, observational clinical trial that included 183 consecutive patients, with an indication for a single-chamber pacemaker implantation.

Results

 

All successful implantation included a total of 183 patients with a mean age of 79,2 ±6,6 years (range 54-93y/o); 111 (60,6%) were men and more frequent rhythm was permanent atrial fibrillation (160), including those in which a node ablation was performed in the same procedure (22). Clinical and echocardiographyc characteristics are described in table 1.Mean follow-up was of 26 ±10 months including: 64 patient at 24 months, 46 at 36 months and 7 patients at 48 months. Electrical parameters are represented in figure 1, which were stable and flawless at long term follow-up.  Total complications were 3,3%, with only 2 patient requiring surgery for resolution (1,7%), and all were acute during LPM implantation. A total of 17 patients (9,3%) died with no relation to pacemaker. 

Conclusions

In our experience, leadless pacemakers electrical performance continues stable, appropriate at long term follow-up, and no other complications developed.

Baseline Characteristics of Patients Age(years) 79.2 ± 6.6[54-93] Male gender, n (%) 118 (60.6%) Hypertension, n (%) 149 (81.7%) Diabetes mellitus, n (%) 64 (34.9%) COPD, n (%) 33(18.3%) Renal dysfunction, n (%) 30 (16.7%) Valvular disease, n (%) 74 (41.1%) Atrial Fibrillation, n (%) 161 (98.0%) LVEF(%) 60.0 ± 8 OAC, n (%) 123(67.2%) NOAC, n (%) 23 (10.0%)

Abstract Figure. Electrical performance

P658CHA2DS2-VASc score calibration in anticoagulated vs non-anticoagulated patients in a healthcare area

Introduction

Atrial fibrillation (AF) is a highly prevalent heart disease, affecting a significant proportion of patients over 65 years old. The CHA2DS2-VASc score predicts 1 year risk of a thromboembolic (TE) event and is well validated against several populations. However, calibration may vary if there is subgroup heterogeneity.

Purpose

To compare the CHA2DS2-VASc score calibration, in patients with or without anticoagulation (AC) in a real population of AF patients in our healthcare area.

Methods

Patients with an episode with atrial fibrillation/flutter were selected from a general population in a healthcare area (383,000 subjects), with 21/12/2013 as a cut-off date. Patients with valve disease, anticoagulation or antiplatelet therapy were identified.

The CHA2DS2-VASc score was calculated as stipulated in the European Society of Cardiology guidelines. A CHA2DS2-VASc score of 0 is considered to be low risk for TE events (0% at 1 year), score of 1 intermediate risk (0.6% rate at 1 year), and greater than 1 high risk (3% rate at 1 year).

Quantitative variables are presented as mean and standard deviation (SD). Categorical variables were presented as frequencies and percentages. A logistic regression was fitted to predict 1-year risk TE outcomes with CHA2DS2-VASc as the only covariate. Model calibration was assessed using the predicted versus actual probabilities of TE events. All analyses were performed using R v.3.4 (R Core Team, Vienna, Austria) with the packages rms and ggplot2.

Results

CHA2DS2-VASc was calculated in 7990 patients with AF. A total of 1824 patients were excluded either due to valvular disease (846) or due to previous antiplatelet treatment (1047). From them, 143 patients were excluded for an incomplete follow-up time (<1 year).

As of December 31, 2015, 67 stroke cases had been notified from 6023 patients (1.1%) (Table 1). Mortality rate was 181 (3%) at 1 year.

Patients presented overall low risks of stroke with a poor score calibration. Higher scores presented risks that were lower than predicted by CHA2DS2-VASc. Event rate at 1 year was similar regardless of the AC regime at the initial date, and also similar to a previous cohort of anticoagulated patients (Lip et al.). This similarity may indicate confounding by later AC therapy initiation, before the final assessment date.

Table 1. Comparison of thromboembolic event rates in several studies % (No-AC) % (AC) % Lip 2010 % Poli 2011 % Friberg 2012 % Okumura 2014 0.01 0.01 0.02 4.5 4.5 1 AC: anticoagulation.

CHA2DS2VASc score calibration

Conclusion

Higher CHA2DS2-VASc scores are not associated to higher risks of stroke in our healthcare area, in patients with non-valvular AF and without antiplatelet therapy.

P6554Utility of accelerometer programmation in leadless pacemaker regardind location. CARDIOCHUS registry

Background

Real-world data reinforce positive results in different implant locations of leadless pacemaker (LPM). LPM have special characteristics regarding accelerometer programmation.

Purpose

The purpose of the study was to describe our experience with LPM different implantation location and its programmation according the vector accelerometer.

Methods

We performed a prospective observational one center study including all patients with LPM implantation within 3 years (June 2015-December 2018). Location of deployment was classified as apicalseptal, midseptal or right ventricle outflow tract (RVOT). Vector programmation was performed from the second visit in patients with acceptable mobility and heart rate below 80 bpm, with the abbreviated protocol recommended by the brand. Clinical evaluation according to vector programmed was performed 3 to 6 months later.

Results

We include a total of 144 LPM, and exercise test was performed in 86 patients. There were 86 men (59.7%) with a mean age of 79.1±6.9 years-old (54 to 89). Location of deployment was distributed as follows: 32.4% in apicalseptal, 54.5% in midseptal and 13.1% in RVOT. Vector 1 was the more frequent programmation, specially in apicalseptal position. Correlation between location and vector of programmation could not be predicted (p=0.2381), but there was a non-significant tendency (p=0.08) between patients with LPM in RVOT location and Vector 3 programmation. Table 1 and Figure 1.

Table 1. Micra Location and Activity Vector Apicalseptal Midseptal RVOT P Value Test Vector 39 (84.8%) 40 (58.5%) 7 (46.7%) NS Vector 1 22 (56.4%) 26 (65.0%) 2 (28.6%) NS Vector 2 8 (20.5%) 4 (10.0%) 1 (14.3%) NS Vector 3 9 (23.1%) 10 (25.0%) 4 (57.1%) 0.08

Figure 1

Conclusions

In our series, Vector 1 was the predominant accelerometer programmation specially in apicalseptal LPM position and Vector 3 in RVOT position.

P6549Conventional single lead ventricular pacemaker against leadless pacemaker system in real-world patients: prospective one center study. CARDIOCHUS Registry

Background

As more experience is obtained with leadless pacemakers systems (LPM), a great group of patients is considered for its implantation. There are issues that cannot be completely avoided with conventional transvenous pacemaker (VVI-PM) such as infectious or pocket related complications in which LPM are clearly superior.

Purpose

The aim of the study was to compare the clinical and device performance between LPM and VVIPM in the same period of time in a “real-world” population.

Methods

We performed a prospective, observational, one center study, including all patients with a single chamber pacemaker implantation within 3 years (June 2015-December 2018) and its mid-term follow-up. All clinical, electrical and echocardiographic characteristics, as well as implantation characteristics and complications, were described.

Results

We included a total of 339 patients with transvenous pacemakers, 195 patients with VVI-PM and 144 LPM. There were no significant differences in mortality between both groups during the follow-up (12,3±10 months), Figure 1. Although there were no significant differences in major complications (P-value 0,54), the number of total complications was lower in the LPM group (P-value 0,01) at the expense of fewer minor ones (P-value 0,02), Table 1.

Table 1. Complications TVP (195) LPM (144) P value Major complications 11 (5.6%) 6 (4.2%) 0.54 Minor complications 10 (5.1%) 0 (0.0%) 0.01 Total Complications 21 (10.7%) 6 (4,2%) 0.02

Figure 1

Conclusions

In our study, during the med-term follow-up, there were no significant differences in terms of mortality and the major complications between LMP and VVI-PM. Although, the number of minor complications were less with the LMP.

Clinical characteristics and prognosis of hospitalised inpatients with heart failure and preserved or reduced left ventricular ejection fraction

OBJECTIVE

To determine the clinical and prognostic differences between patients with heart failure who had preserved or deteriorated systolic function, defined as a left ventricular ejection fraction of > 50% or < 50%, respectively, within two weeks of admission to hospital.

METHODS

The records of 229 patients with congestive heart failure were studied. There were 95 women and 134 men, mean (SD) age 66.7 (11.7) years, who had been admitted to a cardiology department for congestive heart failure in the period 1991 to 1994, and whose left ventricular systolic function had been evaluated echocardiographically within two weeks of admission. Data were collected on the main clinical findings, supplementary investigations, treatment, and duration of hospital admission. Follow up information was obtained in the spring of 1998 by searching the general archives of the hospital and by a telephone survey.

RESULTS

Left ventricular systolic function was preserved in 29% of the patients. The preserved and deteriorated groups differed significantly in the sex ratio (more women in the preserved group) and in the presence of a third heart sound, cardiomegaly, alveolar oedema, ischaemic cardiomyopathy, and treatment with angiotensin converting enzyme (ACE) inhibitors (all more in the deteriorated group). There were no significant differences in age, New York Heart Association functional class, rhythm disturbances, left ventricular hypertrophy, treatment with drugs other than ACE inhibitors, or survival. In the group as a whole, the survival rates after three months, one year, and five years were 92.6%, 80%, and 48.4%, respectively.

CONCLUSIONS

In view of the unexpectedly poor prognosis of patients with congestive heart failure and preserved left ventricular systolic function, controlled clinical trials should be carried out to optimise their treatment.