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Cardiac arrhythmias and conduction disorders monitoring after transcatheter aortic valve replacement procedure, using a mobile electrocardiogram 6 lead device. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
In the early post transcatheter aortic valve replacement (TAVR) discharge era, rate of readmission for permanent pacemaker implantation (PPM-I) due to delayed conduction disturbances (CDs) has significantly increased. This issue has powered post procedural ambulatory electrocardiogram (AECG) monitoring by using implantable cardiac monitors or mobile cardiac telemetry devices, despite several disadvantages as frequent electrode changes and costs.
Purpose
In this scenario we aimed to evaluate the incidence of post-TAVR new onset arrhythmias and delayed CDs, performing an AECG monitoring through a 30s spot digital ECG (AeECG), by using a mobile electrocardiogram 6 lead (ME6L) device in a 30 days period after a TAVR procedure.
Methods
Between March 2021 and February 2022 we consecutively enrolled all patients undergoing a TAVR at the University Hospital of Pisa, excepting who already had a PM. At discharge, all patients received ME6L device and were asked to record a spot eECG for 1 month: 1 eECG per day during the first week and then 1 eECG per week. Clinical and follow-up data were collected and analyzed, and eECG scheduling compliance and quality recordings were explored.
Results
Among 185 consecutive TAVR patients, 12 were excluded due to pre-existing pacing device and 33 due to PPM-I <2 days post TAVR; 3 died before enrollment and 10 refused the enrollment; 18 were excluded because failed the ME6L training phase, 6 for severe postprocedural complications and the last 3 because affected by isolated aortic regurgitation.The remaining ones (100) had 30-day AeECG data. Delayed CDs with a Class I/IIa indications for PPM-Ioccurred in 8 patients with a median of 6 days (range 4–8 days) post-TAVR. New onset documented arrhythmias were AT/AF in 3 patients, isolated PVCs in 10 patients, and competitive transitory junctional rhythm in 2 patients. Delayed PPM-I versus non-delayed PPM-Ipatients were more likely to have a non-self-expandable valve (3 vs 69; p=0.02) and longer PR and QRS intervals at discharge (250.00±53,29 ms vs 179.17±39.17 ms; p=0,003; 125±33.38 ms vs 102.55±30.48 ms; p=0,04). The overall eECG schedule level compliance was 96.5%. Out of a total of 965 sent eECGs, 950 (98,4%) have been correctly recorded and transmitted.
Conclusion
Delayed CDs requiring PPM-I are the most important drawback of TAVR procedure. In our study, AeECG was seen to be safe and helpful in the identification and treatment of delayed CDs requiring PPM-I, with a very high eECG schedule level of compliance and quality. Further prospective studies are needed to better identify patient selection for outpatient monitoring, making safer and safer the early post TAVR discharge approach.
Funding Acknowledgement
Type of funding sources: None.
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High density catheter approach with liveview dynamic display improves procedural efficiency of atrial fibrillation ablation. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
PVI isolation confirmation after RF ablation is often time-consuming, especially in case of a single transeptal catheter approach into the left atrium. A novel Live View (LV) dynamic display mapping software, utilized in combination with the High Density (HD) Grid mapping catheter, allows to display beat-to-beat, dynamic regional mapping data.
Purpose
We evaluated the feasibility and the procedural impact of a procedural left atrial workflow with a single transeptal-single HD catheter analysis, incorporating the LV Mapping Software for the assessment of PVI after ablation.
Methods
Paroxysmal and persistent AF patients scheduled for AF ablation were prospectively enrolled. All patients underwent only PVI under LSI guidance (LSI between 5.5 and 6 anteriorly; LSI between 4.5 and 5 posteriorly) with a point by point strategy and an inter-lesion distance <6 mm. According to the HD mapping strategy used to confirm entrance block after first pass PVI, patients were divided in two groups. The HD-LV Group included patients mapped with the HD-LV software and the HD-standard mapping (SM) group included patients which received a conventional PVI validation with a static voltage/activation map. Left PVI was evaluated during distal coronary sinus pacing and right PVI during sinus rhythm. Exit block was also evaluated to confirm bidirectional block. Procedural efficiency parameters were compared between groups.
Results
Forty-six patients with AF (58% paroxysmal) were prospectively enrolled. Twenty-five patients were included in the HD-LV Group and 21 in the HD-SM Group. PVI was successful in all patients. LV dynamic display analysis was feasible in all patients and allowed a simple and fast validation of right and left PVI, without the necessity of introducing a second catheter into the left atrium. The split screen modality, with a dynamic activation map on the left and a dynamic voltage map on the right, allowed to switch from CS pacing to sinus rhythm without the necessity of a remap. The overall mapping time (27±10 vs 37±14 min, p=0.006), total procedure time (138±33 vs 178±50 min, p=0.006) and fluoroscopy time (14±5.3 vs 23±11 min, p=0.006) were significantly lower in the HD-LV Group. No complication was seen in either group.
Conclusions
A simplified clinical utilization of LiveView dynamic display with a single transeptal-single HD catheter approach is feasible and efficient after PVI, potentially simplifying the procedural workflow. A real-time dynamic mapping in daily practice may further enhance the clinical benefits of HD mapping during radiofrequency (RF) catheter ablation procedures.
Funding Acknowledgement
Type of funding sources: None.
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Transvenous removal of pacing and ICD leads: single Italian referral center experience. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Device related complications are rising the need of Transvenous Lead Removal (TLR). Transvenous extraction of Pacing (PL) and Defibrillating Leads (DL) is a highly effective technique. Aim of this report is to analyse the longstanding experience performed in a single Italian Referral Center.
Methods
From January 1997 to December 2021, we managed 2925 consecutive patients (2220 men, mean age 65.3 years) with 5370 leads (mean dwell time 74.0 months, range 1–576). PL were 4209 (1903 ventricular, 1801 atrial, 505 coronary sinus leads), DL were 1161 (1140 ventricular, 6 atrial, 15 superior vena cava leads). Indications to TLR were infection in 78% (systemic 27%, local 51%) of leads. We performed mechanical dilatation using a single polypropylene sheath technique and, if necessary, other intravascular tools; we performed an approach through the Internal Jugular Vein (JA) in case of free-floating leads or failure of the standard approach.
Results
We attempted removal in 5359 leads because the technique was not applicable in 11 PL. Among these, 5223 leads were completely removed (97.4%), 51 (1.0%) were partially removed, 85 (1.6%) were not removed. Among 5271 exposed leads: manual traction removed 879 (16.7%) leads; mechanical dilatation using the venous entry site removed 3860 (73.2%) leads; femoral approach (FA) removed 50 (0.9%) leads; and JA removed 346 (6.6%) leads. All the free-floating leads were completely removed, 26.1% by FA and 73.9% by JA. Major complications occurred in 23 cases (0.78%): cardiac tamponade (21 cases, 5 deaths), hemothorax (2 cases, 1 death).
Conclusions
Our experience shows that in centers with wide experience, TLR using single sheath mechanical dilatation has a high success rate and a very low incidence of serious complications. TLR through the Internal Jugular Vein increases the effectiveness and safety of the procedure also in case of free-floating or challenging leads.
Funding Acknowledgement
Type of funding sources: None.
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Non-invasive continuous arterial pressure monitoring during transcatheter atrial fibrillation ablation: a feasibility prospective study. Europace 2022. [DOI: 10.1093/europace/euac053.188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Transcatheter atrial fibrillation (AF) ablation is still carried out with continuous invasive radial arterial blood pressure (BP) monitoring in many centers. Continuous noninvasive blood pressure (CNBP) measurement using the volume-clamp method is a non invasive alternative method used in ICU. No data on CNBP reliability are available in the electrophysiology lab during AF ablation, where rhythm variations are common.
Purpose
The objective of the present study was to compare continuous noninvasive arterial pressure measured with the ClearSight device with invasive radial artery pressure, used as the reference method during AF ablation.
Methods
We prospectively enrolled 55 consecutive patients (age 62±11 years, 79% male) undergoing transcatheter AF ablation (62% paroxysmal, 38% persistent) at our center. Standard of care invasive BP monitoring via a radial cannula and a contro-lateral non-invasive finger volume-clamp continuous BP measurement device were positioned simultaneously in all patients for the entire procedure. Bland-Altman analysis was used to analyze agreement between the two techniques.
Results
A total of 1219 paired measurements for systolic, diastolic, and mean arterial pressure were obtained in 55 subjects, with a mean (SD) of 22 (9) measurements per patient. Mean bias (SD) was -12,97 (13,89) mmHg for systolic pressure (level of agreement -14,24–40,20; correlation coefficient 0,84), -1,85 (8,52) mmHg for diastolic pressure (level of agreement -18,54–14,84; correlation coefficient 0,77) and 2,31 (8,75) mmHg for mean pressure (level of agreement -14,84–19,46; correlation coefficient 0,85).
Conclusion
In patients undergoing AF ablation, non-invasive finger volume-clamp continuous BP monitoring with the ClearSight device showed acceptable agreement with standard of care invasive BP monitoring. Larger studies are needed to confirm potential clinical implications of a continuous non-invasive BP monitoring during AF ablation.
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ELECTRa Registry Outcome Score (EROS): validation in a single center population. Europace 2022. [DOI: 10.1093/europace/euac053.521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
The ELECTRa Registry Outcome Score (EROS) was developed to identify patients at increased transvenous lead extraction (TLE) risk
Purpose
Aim of the study is to explore the efficiency of EROS for stratifying patients undergoing TLE.
Methods
We performed a retrospective analysis of 1293 patients who underwent to TLE in our center. We performed extraction procedures with manual traction or mechanical dilatation. We calculated EROS, and we divided patients into 3 groups depending on the EROS class. For this purpose, we made statistical analysis and comparison between EROS 1+2 vs. EROS 3 groups. We used an X2 for among-group comparisons or Fisher’s exact test if the expected cell count was less than five.
Results
Our analysis included 1293 patients. EROS-1 counted 726 patients (56,1%), EROS-2 367 (28,4%) patients and EROS-3 200 (15,5%) patients. There was no statistical difference in peri-procedural death between EROS-1+2 and EROS-3 (0.18% vs 1.50%, p=0.134). Major complications (0.82% vs. 3.00%, p=0.014), minor complications (3.11% vs. 6.50%, p=0.019) and use of internal jugular approach (6.13% vs. 14.50%, p<0.001) was significantly higher in EROS 3 patients.
Conclusion
EROS effectively separates patients at higher risk of complications. Use of internal jugular approach was significantly higher in EROS 3 patients.
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The in-ear region as a novel anatomical site for ecg signal detection: validation study on patients affected by atrial tachyarrhythmias. Europace 2022. [DOI: 10.1093/europace/euac053.568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Purpose
Early detection of cardiac arrhythmias is a major opportunity for mobile health, as portable devices nowadays available can detect multiple-lead electrocardiogram (ECG). The study aims to validate the in-ear region as a new anatomical site for ECG signal detection in patients (pts) affected by atrial tachyarrhythmias.
Methods
We performed the ECG using KardiaMobile 6L device on 20 patients affected by tachyarrhythmias and admitted to our hospital for electrical cardioversion. All the digital ECGs were detected in a modified modality or using the left in-ear region instead of the right hand. All the recorded ECGs were analyzed by the device and the results checked by two cardiologists.
Results
We successfully collected all 20 modified digital ECGs performed on the group of 20 pts (age 68.4 ± 9.2 years; male 60%; 14pts in atrial fibrillation (AF); 6pts in atrial flutter (AFl); medium HR 94±28.4bpm; 65% affected by hypertension; 5% affected by diabetes mellitus; 95% in NOACs).
In case of AF, the KardiaMobile 6L diagnosis of the ECG detected by this modified modality was correct in 100% of cases. In the 6 pts affected by AFl the KardiaMobile 6L diagnosis was "normal" in 3 cases and "not classified" in the other 3. For that reason, in these 6 pts, we performed a new digital ECG using the KardiaMobile 6L in the standard modality, and the diagnosis for each patients was the same.
Conclusion
The in-ear region could be a reliable novel anatomical site for ECG signal detection in patients affected by atrial fibrillation. Further studies are needed to overcome the misdiagnosis of digital ECG in case of patients affected by atrial flutter. These data support the development of new portable ECG devices using the left in ear region and so leaving at least one hand free.
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Never too old for something new: feasibility and long-term outcomes of leadless pacemaker implant in the elderly. Europace 2022. [DOI: 10.1093/europace/euac053.399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Elderly patients may be at great risk of complications and present a higher incidence of comorbidities which make challenging PM implant procedure. The use of leadless pacing systems has imposed itself to overcome peri- and post-procedural complications related to the presence of transvenous leads and the post-operative recovery, being a favorable option in elderly patients.
The study aimed to investigate feasibility and long-term outcomes of M-TPS implant in a specific patient population, like the elderly, which represent a challenge for conventional cardiac pacing.
Methods
Between May 2014 and November 2021, 155 patients (120 males, mean age 78±9 y) underwent M-TPS implantation in our Center, targeting a non-apical site of delivery when feasible. A subgroup of 69 patients (52 males, 75.36%) were older than 80 years. All patients fulfilled standard criteria for PM implantation with specific indication to receive VVI pacing. Study population was divided into two groups according to age (group 1 < 79 years vs group 2≥80 years). The outcome evaluation included electrical performance (capture threshold, pacing impedance, R wave amplitude) before hospital discharge and then followed at 1, 6, and 12 months and then annually. Major complications were defined as life-threatening events, required surgical intervention or any event causing significant hemodynamic instability or resulting in death.
Results
In 69/155 cases (52 males, 75.36%) M-TPS was implanted in patients older than 80 years. There were no statistically significant differences between groups for demographics characteristics, except for age. The implant procedure was successful in all cases and no device-related events were registered during follow-up. In particular, no device infection and/or malfunction were reported. Patients were followed-up for an average of 24 months (median 18 months). No differences were observed between groups in procedure duration, single device delivery (group 1 vs group 2: 62.79% vs 65.22%, p=0.75), fluoroscopy time (group 1 vs group 2: 11.46 ±6.12 vs 11.37 ± 8.37 minutes, p=0.23), electrical performance at implant (group 1 vs group 2: pacing threshold 0.56 ± 0.37 V/0.24 ms vs 0.58 ± 0.31 V/0.24 ms, p=0.55; impedance 737.86 ± 173.50 Ohm vs 759.56 ± 255.35 Ohm, p=0.87; R wave amplitude 10.5 ± 5.18 mV vs 9.19 ± 4.45 mV, p=0.14) and at 18 [VB2] month F-U (group 1 vs group 2: pacing threshold 0.64 ± 0.55 V/0.24 ms vs 0.51 ± 0.1 V/0.24 ms, p=0.85; impedance 535.34 ± 102.53 Ohm vs 577.34 ± 69 Ohm, p=0.40; R wave amplitude 12.56 ± 4.56 mV vs 12.00 ± 5.8 mV, p=0.77[VB3] ).
Conclusions
The demand for cardiac pacing is strongly related to ageing, driving the clinical practice to look for the best solution for a considered fragile patient population. MTP-S implant is an effective and safe procedure in elderly patients, with similar electrical performance and outcome compared with younger patients at long-term follow.
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Feasibility and long-term outcomes of leadless pacemaker implant after transvenous lead extraction. Europace 2022. [DOI: 10.1093/europace/euac053.414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Infections and malfunction are major indications to transvenous lead extraction. Managing extracted patients represents a clinical and interventional challenge, since this population may be at higher risk for mechanical, vascular or infective complications.
The use of leadless pacing systems has been described as a potentially useful technology that could tackle the obstacles that affect this peculiar population.
The study aimed to investigate feasibility and long-term outcomes of M-TPS implant in a specific patient population, like post transvenous lead extraction patients, which represent a challenge for conventional cardiac pacing.
Methods
Between May 2014 and November 2021, 155 patients (120 males, 77.42%, mean age 78 ± 9 y) underwent M-TPS implantation in our Center, targeting a non-apical site of delivery when feasible. A subgroup of 48 patients (39 males, 81.25%) had undergone transvenous lead extraction. All patients fulfilled standard criteria for pacemaker implantation with specific indication to receive VVI pacing. The outcome evaluation included electrical performance (capture threshold, pacing impedance, R wave amplitude) before hospital discharge and then followed at 1, 6, and 12 months and then annually. Major complications were defined as life-threatening events, required surgical intervention or any event causing significant hemodynamic instability or resulting in death. High pacing threshold (HPT) was defined as 1.0 V/0.24 ms.
Results
In 48/155 cases (39 males, 81,25%) M-TPS was implanted after successful transvenous lead extraction. There were no statistically significant differences between groups for demographics characteristics, and PM implant indications. The implant procedure was successful in all cases and no device-related events were registered during follow-up. In particular, no device infection and/or malfunction were reported. Patients were followed-up for an average of 24 months (median 18 months). No differences were observed between groups in procedure duration, single device delivery (group 1 vs group 2: 63.21% vs 73.91%, p=0.20), fluoroscopy time (group 1 vs group 2: 11.79 ± 7.53 vs 10.49 ± 6.19 minutes, p=0.64), electrical performance at implant (group 1 vs group 2: pacing threshold 0.54 ± 0.35 V/0.24 ms vs 0.62 ± 0.32 V/0.24 ms, p=0.09; impedance 758.02 ± 227.89 Ohm vs 724.26 ± 178.14 Ohm, p=0.36; R wave amplitude 10.1 ± 4.73 mV vs 9.59 ± 5.30 mV, p=0.50) and at 18 month F-U (group 1 vs group 2: pacing threshold 0.50 ± 0.10 V/0.24 ms vs 0.85 ± 0.9 V/0.24 ms, p=0.45; impedance 559.58 ± 94.43 Ohm vs 543.34 ± 64.39 Ohm, p=0.69; R wave amplitude 12.00 ± 5.06 mV vs 13.42 ± 5.77 mV, p=0.55).
Conclusions
Leadless pacemaker implant is a feasible, safe and effective option for patients treated with transvenous lead extraction, with electrical performance and outcomes comparable to a cohort of naïve patients at long-term follow up.
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Left atrial thrombus and smoke resolution in patients with atrial fibrillation or flutter under chronic oral anticoagulation. Europace 2022. [DOI: 10.1093/europace/euac053.282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Data on left atrial/left atrial appendage (LA/LAA) thrombus resolution after non–vitamin K antagonist (VKA) oral anticoagulant treatment (OAT) are scarce.
Purpose
The aim of this study was to explore retrospectively the resolution of LA/LAA spontaneous echo-contrast or thrombus in patients with nonvalvular atrial fibrillation (AF) or atrial flutter (AFL) after OAT in a real-world single center practice.
Methods
A single center retrospective analysis of patients with AF/AFL who underwent a transesophageal echocardiography (TEE) for an electrical cardioversion and/or atrial fibrillation ablation was performed. Patients showing LA/LAA echo-contrast or thrombus and with at least one TEE follow up to detect the resolution of LA/LAA echo-contrast/thrombus were included and analyzed.
Results
Among 277 TEE performed, 73 cases (26%) of LA/LAA echo-contrast or thrombus were detected in our hospital. Among them, a total of 53 patients showed LAA/LA echo-contrast (19%) and 20 (7%) patients showed a thrombus. Patients with echo-contrast or thrombus were usually male (78% vs 72%, p=0.05) with more comorbidities, as hypertension (90% vs 72%, p=0.03) and congestive heart failure (36% vs 17%, p=0.007) and with an overall higher CHA2DS2-Vasc score (3.5±1.5 vs 3±1, p=0.0001). All they were under chronic anticoagulation with a VKA (65%) or with a NOAC (35%), without differences between groups. (p=NS). At the TTE/TEE analysis, they showed a comparable ejection fraction (55±11 vs 55±22%, p=NS), a trend for an increased LA dilatation (27±8 vs 26±6 cm2, p=0.07) and a low LAA peak velocity (94% vs 19%, p=0.0001). The Echo-contrast Group maintained the same OAT strategy in 49 patients (93%), switching from VKA to NOAC in 3 cases (6%) and from NOAC to NOAC in 1 (1%). The Thrombus Group kept the same OAT strategy with a NOAC in 6 cases (30%) and changed the strategy in 14 patients (70%). Particularly, they titrated NOAC dose in 1 (5%) and the VKA dose in 4 (20%), switched from NOAC to VKA in 5 (25%), from VKA to NOAC in 3(15%) and from NOAC to NOAC in 1 (5%). Smoke resolution was observed in LA/LAA smoke group in 1/10 cases (10%) after a median time of 52 days (20-135) and LA/LAA thrombus resolution 8/15 (53%) after a median time of 45 days (25-180). Patients with the thrombus resolution had a lower CHA2DS2-Vasc score (3.5±2 vs 4±1, p=0.05), and showed a trend for a more frequent use of a NOAC (37.5 vs 28%, p=0.07) and a longer overall anticoagulation time (7.5 vs 4 months, p=0.08). At one-year follow-up, 1 ischemic stroke (1.9%) and 2 deaths (3.8%) were observed only in the Echo-contrast group.
Conclusion(s)
In OAT patients with an LA/LAA thrombus changing the OAT strategy is associated with thrombus resolution in more than 50% of cases, after an appropriate anticoagulation period and in lower CHAD2S2Vasc patients. Chronic OAT strategy confirmation, also with NOAC, is rarely effective, also in case of echo-contrast resolution.
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C1 THE ROLE OF ATRIAL ELECTRO–MECHANICAL COUPLING AS PREDICTOR OF CATHETER ABLATION EFFICIENCY. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Background
Atrial fibrillation (AF) results in electrical and structural remodeling of the atria, and the extent of remodeling has already been found to be associated with higher AF recurrence rate after catheter ablation (CA). Recently, a novel echocardiographic parameter derived from tissue Doppler imaging (TDI), called PA–TDI, has been introduced to assess the total atrial activation time, as a non–invasive surrogate of fibrosis and atrial cardiomyopathy. The aim of the study was to investigate the role of PA–TDI interval as predictor of AF ablation efficacy.
Methods
Consecutive patients with persistent or paroxysmal symptomatic AF referred to our Center to perform radiofrequency ablation or cryoablation procedures were prospectively enrolled. In these patients, a complete transthoracic echocardiographic examination was performed before and after the ablation procedure, including assessment of the PA–TDI interval.
Results
From October 2018 to May 2020, 221 consecutive patients (mean age 61 ± 9 years, 74% male, mean BMI 26.5 ± 3.6, mean Ejection Fraction 61 ± 6%) symptomatic for AF, undergoing the procedure ablation (first procedure or re–do) were enrolled. Out of the blanking period, 25% of patients experienced recurrence of arrhythmia during follow–up (mean 16 months). Compared to patients who did not relapse, patients with AF recurrence have a generally longer post–procedural PA–TDI interval (139.6 ± 22.1 msec vs 153.9 ± 33 msec, respectively). In the multivariable analysis only post–procedure PA–TDI and re–do interventions were found to be independent predictors of AF recurrence. A PA–TDI cut–off> 144msec identifies patients at risk of post ablation AF recurrence with sensitivity 58.7% and specificity 73.5% (AUC 0.697).
Conclusions
The PA–TDI interval is an independent predictor of AF recurrence after catheter ablation. This echocardiographic parameter is easily obtainable, low–cost, reproducible, and accessible even in peripheral centers.
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Clinical impact of high density mapping in atypical atrial flutters ablation: outlining critical circuits in complex atrial tachycardias. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Mapping and ablation of atypical atrial flutter (AFL) continue to be a challenge for clinical electrophysiologists. The advent of high-density (HD) mapping has allowed the generation of electro-anatomic maps with a very high resolution level.
Purpose
In this single center retrospective analysis, we evaluated the clinical impact of the ultra HD activation sequence mapping compared with the standard low density (LD) ablation catheter mapping technique in the treatment of AFLs.
Methods
We performed a 7 years-single center retrospective analysis of patients undergoing radiofrequency ablations (RFA) for right and left atypical AFL. We evaluated procedural and clinical outcomes of patients approached with a Low Density (LD) electro-anatomical (EAM) strategy compared with patients mapped with new automatic multipolar HD Mapping (HD Group).
Results
Seventy-five patients were included. Patients were almost male (60%), relatively old (65±8 years), with a moderate CHA2DS2Vasc score (2.3±1.3), a preserved ejection fraction (58±6) and moderate atrial dilatation (44±7 mm). Baseline clinical characteristics were comparable between groups (p=NS). Among 88 AFLs, 10 (11%) were located in the right and 78 (89%) in the left atrium, including 22 (28%) roof dependent and 37 (47%) mitral dependent (p=NS). Regarding procedural outcomes, Sinus rhythm restoration during ablation was more frequently observed in the HD Group (79% vs 56%, p=0.037), even if no differences in mapping time, procedural time and radiological dose were observed (p=NS). Freedom from AFL/atrial fibrillation (AF) at 1-year was lower in the HD Group (83% vs 45%, p=0.009) with an increased trend for AF recurrences during long term follow-up (17% vs 23% at 1 and 3-years respectively, p=0.059). At the multivariate analysis, HD map (OR 0,17; 95% CI 0,04–0,66) and younger age (OR 1,09; 95% CI 1,01–1,19) were identified as independent predictors of ablation success at 1 year.
Conclusions
Acute procedural success of ablation of atypical atrial flutter is higher in case of HD mapping strategy. Patient age and HD strategy resulted independent predictors of overall atrial arrhythmias recurrences. During follow-up, AFL recurrences are rare beyond 12 months, differently from AF which continues to show increasing trends.
Funding Acknowledgement
Type of funding sources: None. Procedural outcomesAtypical atrial flutter HD map
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Leadless pacemaker implant in the elderly: a safe and feasible solution. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
The use of leadless pacing systems could overcome peri-and post-procedural complications related to the presence of transvenous leads and the post-operative recovery, being a favorable option in elderly patients.
The study aimed to investigate feasibility and outcomes of M-TPS implant in a specific patient population, like the elderly, which represent a challenge for conventional cardiac pacing.
Methods
Between May 2014 and March 2021, 138 patients (106 males, 77%, mean age 78) underwent M-TPS implantation in our Centre, targeting a non-apical site of delivery when feasible. A subgroup of 59 patients (43 males, 73%) were older than 80 years. All patients fulfilled standard criteria for pacemaker implantation with specific indication to receive VVI pacing. Study population was divided into two groups according to age (group 1 <80 years vs group 2 ≥80 years). The outcome evaluation included electrical performance (capture threshold, pacing impedance, R wave amplitude) before hospital discharge and then followed at 1, 6, and 12 months and then annually. Major complications were defined as life-threatening events, requiring surgical intervention or any event causing significant hemodynamic instability or resulting in death. High pacing threshold (HPT) was defined as >1.0 V@ 0.24 ms.
Results
In 59/138 cases (43 males, 73%) M-TPS was implanted in patients older than 80 years. There were no statistically significant differences between groups for demographics characteristics, except for age, and PM implant indications. The implant procedure was successful in all cases and no device-related events were registered during follow-up. In particular, no device infection and/or malfunction were reported. Patients were followed-up for an average of 22,19±20,66 months (median 18 months). No differences were observed between groups in procedure duration (44,97±20,24 min vs 45,80±23,27 min; P=0,83), single device delivery (group 1 vs group 2: 63,16% vs 66,07%; P=0,73), fluoroscopy time (11,64±6,22 min vs 12,13±8,67 min; P=0,72) electrical performance at implant [group 1 vs group 2: pacing threshold 0,56±0,37 vs 0,58±0,32, P=0,78; impedance 727,53±170,36 vs 752,88±256,21, P=0,49; R wave amplitude 10,39±4,86 vs 9,26±4,66, P=0,18] and at median follow-up [group 1 vs group 2: pacing threshold 0,63±0,55 vs 0,51±0,1, P=0,40; impedance 535,34±102,53 vs 577,34±69,02, P=0,20; R wave amplitude 12,56±4,56 vs 12,00±5,80, P=0,77]
Conclusions
The demand for cardiac pacing is strongly related to ageing, driving the clinical practice to look for the best solution for a considered fragile population. MTP-S implant is an effective and safe procedure in elderly patients, with similar electrical performance and outcome compared with younger patients at mid-term follow-up.
Funding Acknowledgement
Type of funding sources: None.
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Transvenous removal of pacing and ICD leads: single italian referral center experience. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Device related complications are rising the need of Transvenous Lead Removal (TLR). Transvenous extraction of Pacing (PL) and Defibrillating Leads (DL) is a highly effective technique. Aim of this report is to analyse the longstanding experience performed in a single Italian Referral Center.
Methods
Since January 1997 to December 2019, we managed 2769 consecutive patients (2100 men, mean age 65.5 years) with 5086 leads (mean pacing period 73.6 months, range 1–576). PL were 3998 (1828 ventricular, 1704 atrial, 466 coronary sinus leads), DL were 1088 (1067 ventricular, 6 atrial, 15 superior vena cava leads). Indications to TLR were infection in 79% (systemic 27%, local 52%) of leads. We performed mechanical dilatation using a single polypropylene sheath technique and if necessary, other intravascular tools; an Approach through the Internal Jugular Vein (JA) was performed in case of free-floating leads or failure of the standard approach.
Results
Removal was attempted in 5076 leads because the technique was not applicable in 10 PL. Among these, 4952 leads were completely removed (97.6%), 49 (1.0%) partially removed, 75 (1.4%) not removed. Among 4989 exposed leads, 818 were removed by manual traction (16.4%), 3664 by mechanical dilatation using the venous entry site (73.4%), 48 by femoral approach (FA) (1.0%) and 335 by JA (6.7%). All the free-floating leads were completely removed, 25.3% by FA and 74.7% by JA. Major complications occurred in 20 cases (0.72%): cardiac tamponade (19 cases, 4 deaths), hemotorax (1 death).
Conclusions
Our experience shows that in centers with wide experience, TLR using single sheath mechanical dilatation has a high success rate and a very low incidence of serious complications. TLR through the Internal Jugular Vein increases the effectiveness and safety of the procedure also in case of free-floating or challenging leads.
Funding Acknowledgement
Type of funding source: None
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The addition of strict stability criteria does not reduce recurrences after atrial fibrillation ablation using ablation index and can impact on procedure efficiency. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Ablation Index (AI) is a proprietary lesion quality marker that combines power, contact force and time. Recent studies showed that radiofrequency (RF) pulmonary vein isolation (PVI) using AI can deliver high arrhythmia-free survival rates at mid-term follow-up in patients with paroxysmal atrial fibrillation.
Purpose
The aim of this multicenter study was to compare the outcome of three different strategies of PVI using AI (group 1 and 2) or VISITAG module with average force and strict criteria of stability as target parameters (group 3).
Methods
We enrolled 132 consecutive naive patients (97 males, mean age 61,03±9,42) affected by paroxysmal atrial fibrillation who underwent PVI at two high volume centres between January 2017 and February 2019. AI target was set at ≥380 at the posterior wall and ≥500 at the anterior wall. A strict stability criteria (VISITALY criteria: 3 mm for a time of 15 s and a FOT >5 g for 60% of the time) was set for Group 1 procedures (65 patients), whereas Group 2 procedures (67 patients) were carried out with standard stability criteria (VISTAX criteria: 3 mm for a time of 3 s and FOT >3 g for 25% of the time). We then compared those strategies with a historical cohort of 72 patients (40 males, mean age 60,74±8,53) treated at our centres with RF PVI using the VISITAG module with average force and strict stability criteria as target parameters. An interlesion distance ≤6 mm was a target parameter for all procedures. Recurrence was defined as any AF, atrial tachycardia (AT) or atrial flutter (AFL) during the 12 months after ablation, excluding a blanking period of 90 days.
Results
There were no significant differences in terms of age (Group 1 59,2±8,97; Group 2 62,81±9,58; Group 3 60,74±8,53 years) and left atrial area (Group 1 24,16±20,46; Group 2 22,55±12,32; Group 3 20,74±3,84 cm2). Group 1 showed a slightly higher number of males (Group 1 78,46%; Group 2 68,66%; Group 3 55,56%; p=0,004). Procedure duration was significantly lower in Group 2 compared to Groups 1 and 3 (176,67±50,88 vs 224,05±47,21 min, p<0,001; 176,67±50,88 vs 203,96±52,38 min p=0,02). Fluoroscopy time was significantly higher in Group 1 compared with Group 2 (11,85±4,38 vs 10,39±6,4 min; p=0,014). There was a slight trend to have a higher freedom from AF/AT/AFL at 12 months in group 2 compared to the others (Group 1 86,15% vs Group 2 91,04% vs Group 3 84,72%; p=0,2).
Conclusion
A strategy of PVI using AI with standard stability criteria performed the best in terms of procedure efficiency, with a significant benefit in terms of procedure duration, delivering a 12 months arrhythmia-free survival rate comparable with other strategies. Combination of AI with strict stability criteria provided no benefit, at a cost of a higher fluoroscopy time and longer procedure duration.
Funding Acknowledgement
Type of funding source: None
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Off-label combination of leadless pacemakers and subcutaneous defibrillators in bilateral venous occlusion: a new reimplantation strategy after lead extraction. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Subcutaneous implantable cardioverter-defibrillator (S-ICD) and leadless pacemakers (LPM) provide an alternative to transvenous implantable devices. Sometimes, after transvenous (TV) lead extraction, patients show a bilateral venous occlusion, resulting not eligible for TV reimplantation.
Purpose
This analysis was designed to provide preliminary data on feasibility and short-term outcome of an hybrid combination (Hyb) of s-ICD plus LPM after TV-ICD explantation, in patients without anatomical transvenous reimplantation options.
Methods
Among 2684 consecutive extracted patients, 31 (1.1%) were reimplanted with a LPM, 66 (2.4%) with a s-ICD and 6 (0.2%) patients with an Hyb combination. Hyb strategy was considered in patients with a pacing plus defibrillating indication, and an anatomical barrier, as bilateral superior venous occlusion or massive bilateral skin erosion.
Results
Hyb patients were old (72±10 years), with a prevalent ischemic disease (4/6) and a reduced ejection fraction (43±16%). Extraction indication was infection in 4 and severe venous occlusion in 2, and included 2 single chamber, 2 dual chamber and 2 biventricular ICD. After extraction, reimplantation timing was 7±6 days, LPM was implanted before and sICD the day after.
LPM reimplantation indication was sinus node dysfunction in 2 and AV block in 4. Implantation duration was 68±23 and fluoroscopy time 9.4±2.3 min. ICD reimplantation indication was primary prevention in 4 and secondary prevention in 2. Implantation duration was 118±10 min. No complications were observed. At 1 year, no complications were observed, including device related cross-talks.
Conclusions
The Hyb strategy is a potential option after TV-ICD explantation in pacemaker dependent patients, when transvenous implantation is not available.
Extraction and Reimplantation Session
Funding Acknowledgement
Type of funding source: None
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Transvenous lead extraction: procedural outcomes and in-hospital mortality in octogenarian patients. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Managing elderly patients with infection or malfunction deriving from a cardiac implantable electronic device (CIED) may be challenging. The aim of this study was to evaluate safety and efficacy of mechanical transvenous lead extraction (TLE) in elderly patients.
Methods
Patients who had undergone TLE in single tertiary referral center were divided in two groups (Group 1: ≥80 years; group 2:<80 years) and their acute and chronic outcomes were compared. All patients were treated with manual traction or mechanical dilatation.
Results
Our analysis included 1316 patients (group 1: 202, group 2: 1114 patients), with a total of 2513 leads extracted. Group 1 presented more comorbidities and more pacemakers, whereas the dwelling time of the oldest lead was similar, irrespectively of patient's age. In group 1 the radiological success rate for lead was higher (99.0% vs 95.9%; P<0.001) and the fluoroscopy time lower (13.0 vs 15.0 minutes; P=0.04) than in group 2. Clinical success was reached in 1273 patients (96.7%), without significant differences between groups (group 1: 98.0% vs group 2: 96.4%; P=0.36). Major complications occurred in 10 patients (0.7%) without significative differences between patients with more or less than 80 years (group 1: 1.5% vs group 2: 0.6%; P=0.24). In the elderly group no in-hospital mortality occurred (0.0% vs 0.5%; P=0.42).
Conclusions
Mechanical TLE in elderly patients is a safe and effective procedure. In the over-80s, a comparable incidence of major complications with younger patients was observed, with at least a similar efficacy of the procedure and no procedural-related deaths.
Funding Acknowledgement
Type of funding source: None
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Real-time local impedance monitoring to assess tissue lesion during pulmonary vein isolation: a new tool for AF ablation. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Contact force catheter ablation is the gold standard for treatment of atrial fibrillation (AF). Local tissue impedance (LI) evaluation has been recently studied to evaluate lesion formation during radiofrequency ablation.
Purpose
Aim of the study was to assess the outcomes of an irrigated catether with LI alghorithm compared to contact force (CF)-sensing catheters in the treatment of symptomatic AF.
Methods
A prospective, single-center, nonrandomized study was conducted, to compare outcomes between CF-AF ablation (Group 1) and LI-AF ablation (Group 2). For Group 1 ablation was performed using the Carto 3© System with the SmartTouch SF catheter and, as ablation target, an ablation index value of 500 anterior and 400 posterior. For Group 2, ablation was performed using the Rhythmia™ System with novel ablation catheter with a dedicated algorithm (DirectSense) used to measure LI at the distal electrode of this catheter. An absolute impedance drop greater than 20Ω was used at each targeted. According to the Close Protocol, ablation included a point by point pulmonary vein isolation (PVI) with an Inter-lesion space ≤5 mm in both Groups. Procedural endpoint was PVI, with confirmed bidirectional block.
Results
A total of 116 patients were enrolled, 59 patients in Group 1 (CF) and 57 in Group 2 (LI), 65 (63%) with a paroxismal AF and 36 (37%) with a persistent AF. Baseline patients features were not different between groups (P=ns). LI-Group showed a comparable procedural time (180±89 vs 180±56, P=0.59) but with a longer fluoroscopy time (20±12 vs 13±9 min, P=0.002). Wide antral isolation was more often observed in CF-Group (95% vs 80%, P=0.022), while LI-Group 2 required frequently additional right or left carina ablation (28% vs 14%, P=0.013). The mean LI was 106±14Ω prior to ablation and 92.5±11Ω after ablation (mean LI drop of 13.5±8Ω) during a median RF time of 26 [19–34] sec for each ablation spot. No steam pops or complications during the procedures were reported. The acute procedural success was 100%, with all PVs successfully isolated in all study patients. Regarding safety, only minor vascular complications were observed (5%), without differences between groups (p=0.97). During follow up, 9-month freedom from atrial fibrillation/atrial flutter/atrial tachycardia recurrence was 86% in Group 1 and 75% in Group 2 (P=0.2).
Conclusions
An LI-guided PV ablation strategy seems to be safe and effective, with acute and mid-term outcomes comparable to the current contact force strategy. LI monitoring could be a promising complementary parameter to evaluate not only wall contact but also lesion formation during power delivery.
Procedural Outcomes
Funding Acknowledgement
Type of funding source: None
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P1470Outcome of leadless pacemaker implantation in a referral centre for lead extraction: a comparison with transvenous pacemaker. Europace 2020. [DOI: 10.1093/europace/euaa162.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Leadless cardiac pacing is a promising technology in terms of efficacy and safety.
Purpose
The aim of the study was to compare the long-term clinical and electrical performance of Micra leadless pacemaker with ventricular single-chamber transvenous pacemaker (VVI TV-PM) in a high-volume centre for transvenous lead extraction (TLE).
Methods
Between May 2014 and April 2019, 100 patients (group 1) underwent Micra implant at our centre. We identified 100 patients (group 2) who underwent VVI TV-PM implant in the same period for a 1:1 comparison matched by age, sex, left ventricular systolic ejection fraction and previous TLE.
Results
The implant procedure was successful in all patients. In group 1, the procedure duration was lower than in group 2 (43.86 ± 22.38 vs 58.38 ± 17.85 min, p < 0.001), while the fluoroscopy time was longer (12.25 ± 6.84 vs 5.32 ± 4.42 min, p < 0.001). There was no difference about the rate of septal deployment at the right ventricle (group 1 vs group 2: 76% vs 86%, p = 0.10). Patients were followed-up for a median of 12 months. We did not observe any acute and chronic procedure-related complications in group 1, while we reported acute complications in seven patients (0 vs 7%, p = 0.02) and long-term complications in three patients (0 vs 3%, p = 0.24), needing for a system revisions in 6 cases (0 vs 6%, p = 0.038) in group 2. One systemic infection occurred during follow-up in a patient with VVI TV-PM. Electrical measurements were stable during follow-up in both groups, with a longer estimated battery life in group 1 (mean delivered energy at implant group 1 vs group 2: 0.14 ± 0.21 vs 0.26 ± 0.22 μJ, p < 0.001).
Conclusion
Micra pacemaker implant is a safe and effective procedure, with a lower rate of acute complications and system revisions and a longer estimated battery life compared to VVI TV-PM, even in a real life setting including patients who underwent TLE.
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P1469Micra pacemaker implant at septal site induces a smaller increase on qrs duration than traditional pacemaker: a single center experience. Europace 2020. [DOI: 10.1093/europace/euaa162.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Leadless pacemakers have been introduced into the clinical practice as a breakthrough technology that could tackle most of the major sources of complication of traditional pacemakers (PM). The excellent safety profile and optimal electrical performance of Micra have been already largely described, nevertheless the impact on QRS duration has not been investigated so far. We aimed to compare changes in QRS duration after septal Micra implant in comparison to patients who received transvenous right ventricular leads in the same position.
METHODS
We enrolled all patients who underwent Micra implantation (group 1) at our Center from April 2017 to March 2019. A septal placement was attempted in all cases. Duration of spontaneous and paced QRS and their difference (delta QRS) were measured using a polygraph. To provide a comparison group, we analyzed the QRS duration in a matched group of patients (group 2) who received a traditional single chamber pacing system with a transvenously implanted lead at septal position in the same period. Confounding variables that were used to provide the control group were age, sex, left ventricle ejection fraction, and rhythm at implant. High pacing threshold was defined as ≥1.0 V at pulse duration of 0.24 ms.
RESULTS
Twenty-eight consecutive patients (mean age 78 ± 3 years; 71.43% males) who underwent successful Micra implant were enrolled. A septal position was achieved in all cases with a single device delivery in 17/28 patients (60.7%). Mean pacing threshold at implant was 0.56 ± 0.34V/0.24 ms with only 3/28 patients (10.7%) presenting a high pacing threshold. No significant differences in demographic, clinical characteristics and ventricular pacing site were observed between groups. QRS duration was slightly longer in group 1 compared to group 2 before implant (median 123 ms (IQR 104-146.5 ms) vs median 116 ms (IQR 90-125 ms); p = 0.09). Nevertheless, there was a significantly lower delta QRS after implant in Micra compared to the traditional pacing group (15.82 ± 31.77 ms vs 35.82 ± 22.13 ms, p = 0.008).
CONCLUSION
Right ventricular stimulation induces ventricular dyssynchrony, which is correlated with the amount of QRS enlargement after pacing. Micra implant, in a non-apical position, produces significantly smaller changes on the QRS duration in comparison with transvenous lead implanted at the same site, although larger studies are necessary to confirm these results.
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1260Transvenous lead extraction: efficacy and safety of the procedure in octogenarian patients. Europace 2020. [DOI: 10.1093/europace/euaa162.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
the management of patients with infection or malfunction of a cardiac implantable electronic device (CIED) may be challenging.
Purpose
The aim of the study is to evaluate the safety and efficacy of transvenous lead extraction (TLE) in elderly patients.
Methods
a retrospective analysis of patients who underwent to TLE in our center was performed. Patients were divided in two groups: 1) patients 80 years of age or older, 2) patients younger than 80 years. All patients were treated with manual traction or mechanical dilatation.
Results
our analysis included 1316 patients, with a total of 2513 leads extracted. Group 1 (≥80 years) counted 202 patients and group 2 (<80 years) 1114 patients. The group of elderly patients presented more comorbidities, as hypertension, chronic kidney disease, atrial fibrillation and pulmonary disease. Patients 80 years of age or older had more pacemakers than ICDs, whereas the dwelling time of the oldest lead, the number of leads and the presence of abandoned leads was similar despite patients age. In group 1 the rate of radiological success for lead was higher than in group 2 (99.0% vs 95.9%; P < 0.001). The clinical success was obtained in 1273 patients (96.7%), without significative differences between groups (98.0% vs 96.4%; P = 0.36). Major complications occurred in 10 patients (0.7%), without significative differences (1.5% vs 0.6%; P = 0.24) (figure 1).
Conclusion
TLE in elderly patients is a safe and effective procedure. In patients older than 80 years there are not more major complications than in younger patients, and the efficacy of the procedure seems to be superior.
Abstract Figure 1
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P1358Atrial electromechanical interval in patients with arrhythmias: is everyone the same? Europace 2020. [DOI: 10.1093/europace/euaa162.372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Atrial electromechanical delay, assessed calculating the PA-TDI interval using tissue Doppler imaging, is a known and promising determinant for atrial fibrillation recurrence prediction after pulmonary vein isolation and electrical cardioversion.
Purpose
To determine the relationship between atrial electromechanical delay and the presence of atrial fibrillation.
Methods
We prospectively enrolled patients presenting at our Unit in sinus rhythm scheduled for an arrhythmogenic substrate ablation (atrial fibrillation -AF-, supraventricular tachycardia -SVT- and premature ventricular contractions -PVC-). Demographic and echocardiographic characteristics were evaluated upon admission. Atrial electromechanical delay was inferred via the PA-TDI interval, obtained by calculating the time difference between the P wave onset and the A" wave peak on TDI recordings.
Results
From October 2018 to August 2019, 200 patients (60% male, mean age 58,21 ± 14,26, mean BSA 1,9 ± 0,21 m2, mean BMI 26,42 ± 6,28 kg/m2, mean EF 60,91% ± 5,43%) were admitted to our unit to undergo AF (group 1: n = 145; 72,50%), SVT or PVC ablation (group 2: n = 55; 27,5%). Compared with the control group (group 2), patients admitted for AF ablation had a larger LA size (group 1 vs group 2: mean LA area 23,21 ± 5,07 vs 16,87 ± 4,01 cm2, p < 0,001; mean indexed LA volume 46,71 ± 20,41 ml vs 32,04 ± 14,7 ml, p < 0,001; mean LAD 41,77 ± 5,66 vs 33,84 ± 6,06, p < 0,001) and a longer PA-TDI interval (lateral 148,55 ± 28,5 vs 128,57 ± 20,9, p < 0,001; medial 125,34 ± 21,02 vs 109,11 ± 21,49, p < 0,001; average 141,43 ± 27,58 vs 119,08 ± 18,63, p < 0,001).
Conclusion
The PA-TDI interval is a non-invasive and easily achievable echocardiographic parameter, which is demonstrated to be prolonged in patients with a history of AF in contrast with patients with other arrhythmias, as expression of atrial conduction heterogeneity.
Abstract Figure. PA-TDI measurement
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P2836Role of pre-procedural CT-imaging on catheter ablation in patients with atrial fibrillation: procedural outcomes and radiological exposure. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Cardiac computerized tomography (CT) is commonly used to study left atrial (LA) and pulmonary veins (PVs) anatomy before atrial fibrillation (AF) ablation. However, it remains unclear whether pre-procedural imaging actually is associated with an improvement of efficiency, efficacy, and safety.
Purpose
Aim of the the study was to determine the impact of pre-procedural imaging using CT with 3-D reconstruction on procedural outcomes and radiological exposure in patients who undergo radiofrequency catheter ablation (RFA) to eliminate AF.
Methods
In this registry, 493 consecutive patients (age 62±8 years, 70% male) with paroxysmal (316) or persistent (177) AF who underwent RFA were included. A CT scan was obtained in 324 (66%) patients (CT Group) prior to RFA, while 169 (34%) didn't have any pre-procedural imaging (No-CT Group). Antral PVs isolation was performed in all patients along using an open-irrigation-tip catheter with a 3-D electroanatomical navigation system. Additional ablation applications were targeted if required. Procedural outcome, including radiological exposure, and clinical outcomes were compared among patients who underwent RFA with (CT-Group) and without (No CT-Group) pre-procedural imaging.
Results
Acute PV isolation was obtained in all patients. Additional ablation targets were targeted along the CTI (71/324 [22%] vs. 40/169 [24%], P=NS), the roof line (74/324 [23%] vs. 40/169 [24%], P=NS), the mitral isthmus (33/324 [10%] vs. 12/169 [7%], P=NS) and CFAEs (28/324 [8.6%] vs. 12/169 [7.1%], P=NS), without significant differences among groups. Complication rate were comparable between CT and No CT patients (4.3% vs 3%, P=0.7). In one Redo procedure of the No-CT Group, for the impossibility of identifying left PVs, a 3D LA fluoro-angiography was performed, which confirmed a left PVs occlusion. (Figure) No differences were observed about mean duration of the procedure (231±60 vs 233±58 min, P=0.7) and fluoroscopy time (13±10 vs 13±8 min, P=0.6) between groups. Cumulative radiation dose resulted significantly higher in the CT-Group (8.9±24 vs 4.8±15 mSV, P=0.02). Compared to paroxistical AF, persistent AF patients showed a comparable procedural-ED (6.6±26 vs 6±19, P=0.8) but with an higher CT-ED (1.7±2.9 vs 1.1±1.9, P=0.01).At 1 year, 227/324 (70%) and 119/169 (70%) of the patients who did and did not have pre-procedural imaging were free from AF (P = NS).
Figure 1
Conclusions
Pre-procedural CT does not improve safety and efficacy of AF ablation, increasing significantly the cumulative radiological exposure. Considering that patients candidate to AF ablation are often young, the cumulative radiation dose per life span and radiation dose reduction strategies should remain a matter of concern for doctors.
Acknowledgement/Funding
None
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3255Characterization of the arrhythmogenic substrate with multimodality imaging in ischemic patients undergoing VT ablation: relationship between cardiac computed tomography and magnetic resonance. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Cardiac magnetic resonance (CMR)-aided ventricular tachycardia (VT) substrate ablation has shown to improve VT recurrence-free survival, through a better identification of the arrhythmogenic substrate. However, the access to CMR may be limited in certain centers or sometimes Its use can be contraindicated in patients with cardiac implantable electronic device. Cardiac computed tomography (CT) has shown to improve the results of substrate ablation, correlating with low-voltage areas and local abnormal ventricular activity, and identifying ridges of myocardial tissue (CT-channels) that may be appropriate target sites for ablation.
Purpose
To evaluate the correlation between CT and CMR imaging in identifying anatomical heterogeneous tissue channels (CMR-channels) or CT-channels in ischemic patients undergoing VT substrate ablation.
Methods
The study included 30 post-myocardial infarction (MI) patients (mean age 69±10; 94% male, left ventricular ejection fraction 35±10%), who underwent both CMR and cardiac CT before VT substrate ablation. Using a dedicated post-processing software, the myocardium was segmented in 10 layers from endocardium to epicardium both for the CMR and CT, characterizing the presence of CMR-channels and CT-channels, respectively, by two blinded operators, assigned either to CMR or CT analysis. CMR-channels were classified as endocardial (CMR-channels in layer <50%), epicardial (CMR-channels in layers ≥50%) or transmural (in both endo and epicardial layers). Presence and location of CT and CMR-channels were compared.
Results
In 26/30 patients (86.7%) 91 CT-channels (mean 3.0±1.9 per patient) were identified while 30/30 (100%) showed CMR-channels (n=76; mean 2.4±1.2 per patient). We found 190 CT-channel entrances (mean 6.3±4.1 per patient), and 275 CMR-channel entrances (mean 8.9±4.9 per patient) on cardiac CT and CMR, respectively. There were 47/91 (51.6%) true positive CT-channels. On the contrary, 44/91 (48.4%) CT-channels were considered false positives [19/91 (20.9%) identified out of CMR scar], and 29/76 (38.2%) CMR-channels could not be identified on CT. Thirty-six out of 76 (47.4%) CMR-channels were considered as non-endocardial (epi- or transmural). Twenty-nine out of 36 (80.5%) non-endocardial CMR-channels were coincident with CT-channels.
CT and CMR Channels
Conclusion
CT shows a modest sensitivity in identifying CMR-channels and fails in ascertain their complexity, underestimating the number of entrances; however, channels location at CT fit well with CMR for those classified as transmural or epicardial.
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P3874Impact of site of implantation on long-term performance of micra transcatheter pacing system. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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P3871Feasibility and acute outcomes of Micra implant after cardiac implantable electronic device extraction. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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P2932Safety and efficacy of the subcutaneous implantable defibrillator after trans-venous ICD explant: experience in a high volume centre for treatment of CIED complications. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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P6642Correlation between arrhythmia substrate and perfusion/innervation mismatch and its impact on outcome in scar related ventricular arrhythmias. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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P404Feasibility and effectiveness of a non-apical site of implantation of Micra transcatheter pacing system: results from a referral centre for pacemaker lead extraction. Europace 2018. [DOI: 10.1093/europace/euy015.215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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P370Impact of intraprocedural electrical cardioversion and the use of contact force sensing catheters on atrial fibrillation recurrences after pulmonary vein isolation: a single centre experience. Europace 2018. [DOI: 10.1093/europace/euy015.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Determination of volatile organic compounds in exhaled breath of heart failure patients by needle trap micro-extraction coupled with gas chromatography-tandem mass spectrometry. J Breath Res 2017; 11:047110. [PMID: 29052557 DOI: 10.1088/1752-7163/aa94e7] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The analytical performances of needle trap micro-extraction (NTME) coupled with gas chromatography-tandem mass spectrometry were evaluated by analyzing a mixture of twenty-two representative breath volatile organic compounds (VOCs) belonging to different chemical classes (i.e. hydrocarbons, ketones, aldehydes, aromatics and sulfurs). NTME is an emerging technique that guarantees detection limits in the pptv range by pre-concentrating low volumes of sample, and it is particularly suitable for breath analysis. For most VOCs, detection limits between 20 and 500 pptv were obtained by pre-concentrating 25 ml of a humidified standard gas mixture at a flow rate of 15 ml min-1. For all compounds, inter- and intra-day precisions were always below 15%, confirming the reliability of the method. The procedure was successfully applied to the analysis of exhaled breath samples collected from forty heart failure (HF) patients during their stay in the University Hospital of Pisa. The majority of patients (about 80%) showed a significant decrease of breath acetone levels (a factor of 3 or higher) at discharge compared to admission (acute phase) in correspondence to the improved clinical conditions during hospitalization, thus making this compound eligible as a biomarker of HF exacerbation.
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P3344Three-dimensional full automated software in the evaluation of the left ventricle function: from theory to clinical practice. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p3344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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P6187Dynamic changes of B-lines in acute heart failure: comparison with non-invasive hemodynamic data and BNP values. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p6187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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P2402Low flow aortic stenosis: early improvement in left ventricular function after TAVI. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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P2406The integrated value of sST2 and global longitudinal strain in the early stratification of patients with severe aortic valve stenosis: a translational imaging approach. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Poster session 5The imaging examinationP1097Correlation between visual and quantitative assessment of left ventricle: intra- and inter-observer agreementP1099Incremental prognostic value of late gadolinium-enhanced by cardiac magnetic resonance in patients with heart failureAnatomy and physiology of the heart and great vesselsP1100Left ventricular geometry and diastolic performance in erectile dysfunction patients; a topic of differential arterial stiffness influenceAssessment of diameters, volumes and massP1101Impact of the percutaneous closure of atrial septal defect on the right heart "remodeling"P1102Left Ventricular Mass Indexation in Infants, Children and Adolescents: a Simplified Approach for the Identification of Left Ventricular Hypertrophy in Clinical PracticeP1103Impact of trabecules while quantifying cardiac magnetic resonance exams in patients with systemic right ventricleP1104Detection of subclinical atherosclerosis by carotid intima-media thickness: correlation with leukocytes telomere shorteningAssessments of haemodynamicsP1105Flow redirection towards the left ventricular outflow tract: vortex formation is not affected by variations in atrio-ventricular delayAssessment of systolic functionP1106Reproducibility and feasibility of cardiac MRI feature tracking in Fabry diseaseP1107Normal left ventricular strain values by two-dimensional strain echocardiography; result of normal (normal echocardiographic dimensions and functions in korean people) studyP1108Test-retest repeatability of global strain following st-elevation myocardial infarction - a comparison of tagging and feature trackingP1109Cardiotoxicity induced by tyrosine kinase inhibitors in patients with gastrointestinal stromal tumors (GIST)P1110Finite strain ellipses for the analysis of left ventricular principal strain directions using 3d speckle tracking echocardiographyP1111Antihypertensive therapy reduces time to peak longitudinal strainP1112Right ventricular systolic function as a marker of prognosis after inferior myocardial infarction - 5-year follow-upP1113Is artery pulmonary dilatation related with right but also early left ventricle dysfunction in pulmonary artery hypertension?P1114Right ventricular mechanics changes according to pressure overload increasing, a 2D-speckle tracking echocardiographic evaluationAssessment of diastolic functionP1115Paired comparison of left atrial strain from P-wave to P-wave and R-wave to R-waveP1116Diagnostic role of Tissue Doppler Imaging echocardiographic criteria in obese heart failure with preserved ejection fraction patientsP1117Evaluation of diastolic function of right ventricle in idiopathic pulmonary arterial hypertensionP1118Severity and predictors of diastolic dysfunction in a non-hypertensive non-ischemic cohort of Egyptian patients with documented systemic autoimmune disease; pilot reportP1119correlation between ST segment shift and cardiac diastolic function in patients with acute myocardial infarctionIschemic heart diseaseP1120Computed tomography coronary angiography verSus sTRess cArdiac magneTic rEsonance for the manaGement of sYmptomatic revascularized patients: a cost effectiveness study (STRATEGY study)P1121Utility of transmural myocardial mechanic for early infarct size prediction after primary percutaneous coronary intervention in STEMI patientsP1122Progressive Improvements of the echocardiographic deformation parameters in ST Elevation Myocardial Infarction after five years follow-upP1123Long-term prognostic value of left ventricular dyssynchrony as assessed by cardiac magnetic resonance feature-tracking imaging after a first st-segment elevation myocardial infarctionP1124Differences in mitral annulus remodeling in acute anterior ST elevation and acute inferior ST elevation myocardial infarctionP1125Reduction of microvascular injury using a novel theragnostic ultrasound strategy: a first in men feasibility and safety studyP1126Impact of focused echocardiography in clinical decision of patient presented with st elevation myocardial infarction underwent primary angioplastyHeart valve DiseasesP1127Aortic valve area calculation in aortic stenosis: a comparison among conventional and 3D-transesophageal echocardiography and computed tomographyP1128Myocardial fibrosis and microRNA-21 expression in patients with severe aortic valve stenosis and preserved ejection fraction: a 2D speckle tracking echocardiography, tissutal and plasmatic studyP1129Quantification of calcium amount in a new experimental model: a comparison between calibrated integrated backscatter of ultrasound and computed tomographyP1130Altered diffusion capacity in aortic stenosis: role of the right heartP1131Osteoprotegerin predicts all-cause mortality in calcific aortic stenosis patients with preserved left ventricle ejection fraction in long term observationP1132Mitral regurgitation as a risk factor for pulmonary hypertension in patients with aortic stenosisP1133The relationship between the level of plasma B-type natriuretic peptide and mitral stenosisP1134Aortic regurgitation, left ventricle mechanics and vascular load: a single centre 2d derived-speckle tracking studyP1135Feasibility and reproducibility issues limit the usefulness of quantitative colour Doppler parameters in the assessment of chronic aortic and mitral regurgitation severityP1136Predictors of postoperative outcome in degenerative mitral regurgitationP1137Left ventricular mechanical dyssynchrony in patients with severe mitral regurgitation of rheumatic etiology; three dimensional echocardiography studyP1138Functional mitral regurgitation and left atrial dysfunction concur in determining pulmonary hypertension and functional status in subjects with left ventricular systolic dysfunctionP11393D echocardiography allows more effective quantitative assessment of the severity of functional tricuspid regurgitation than conventional 2D/Doppler echocardiographyP1140Prosthetic valve thrombosis: still a severe disease? 10-years experience in a university hospitalP1141Validity of echocardiography in the hospital course of patients with feverP1142Do baseline 3DTEE characteristics of mitral valve apparatus predict long term result in patients undergoing percutaneous valve repair for degenerative regurgitation?P1143Influence of baseline aortic regurgitation on mitral regurgitation change after transcatheter aortic valve replacement for aortic stenosisP1144Prevalence of echocardiography detected significant valvular regurge in subclinical rheumatic carditis in assiut childrenCardiomyopathiesP1145Can we early detect left ventricular systolic dysfunction in patients with Duchenne muscular dystrophy using global longitudinal strain assessment?P1146Prevalence of isolated papillary muscle hypertrophy in young competitive athletesP1147Troponin release after exercise in patients with hypertrophic cardiomyopathy: associations with clinical and mr imaging characteristicsP1148Atrial fibrillation in hypertrophic cardiomyopathy: can we score the risk?P1149Impact of hypertrophy on multiple layer longitudinal deformation in hypertrophy cardiomyopathy and cardiac amyloidosis compared to controlsP1150Functional evaluation in hypertrophic cardiomyopathy combining cardiopulmonary exercise testing combined with exercise-echocardiographyP1151Refinement of the old diagnostic criteria of left ventricular noncompaction cardiomyopathy (LVNC) based on cardiac magnetic resonance (CMR)P1152Differences of clinical characteristics and outcomes between acute myocarditis with preserved and reduced left ventricular systolic functionP1153Value of longitudinal strain for distinguishing left ventricular non-compaction from idiopathic dilated cardiomyopathyP1154Speed of recovery of left ventricular function is not related to the prognosis of Takotsubo cardiomyopathy. A Portuguese multicentre studyP1155Predictors of in-hospital left ventricular systolic function recovery after admission with takotsubo cardiomyopathy. Portuguese multicentre studyP1156Mid-ventricular takotsubo detected by initial echocardiogram associates with recurrence of takotsubo cardiomyopathy - a portuguese multicentre studySystemic diseases and other conditionsP1157Relations between left ventricle remodelling and expression of angiotensin 2 AT2R1 geneP1158Impact of renal denervation on long-term blood pressure variability and surrogate markers of target organ damage in individuals with drug-resistant arterial hypertensionP1159Greater improvement of coronary artery function, left ventricular deformation and twisting by IL12/23 compared to TNF-a inhibition in psoriasisP1160Advanced glycation end products play a role in adverse LV remodeling following MIP1161Incidence of subclinical myocardial dysfunction in patients with systemic sclerosis and normal left ventricular systolic and diastolic functionP1162Left atrial remodeling and dysfunction occur early in patients with systemic sclerosis and normal left ventricular functionP1163Intrinsic vortex formation : a unique performance indicatorP1164P-wave morphology is unaffected by training-induced biatrial dilatation: a prospective, longitudinal study in healthy athletesP1165Usefulness of transthoracic echocardiography in diagnosis of young patients with ischemic strokeP1166Primary cardiac lymphoma: role of echocardiography in the clinical managementP1167Abnormal echocardiographic findings in cancer patients before chemotherapyMasses, tumors and sources of embolismP1168Three-dimensional transesophageal echocardiography of the left atrial appendage reduces rate of postpone electrical cardioversionP1169Detection of ventricular thrombus by cmr after reperfused st-segment elevation myocardial infarction correlated with echocardiographyP1170Clinical and transthoracic echocardiographic predictors of left atrial appendage thrombus in patients with atrial fibrillationStress echocardiographyP1171Pharmacological stress echocardiography complications: a 4-year single center experienceP1172Myocardial functional and perfusion reserve in type I diabetesP1173Feasibility of incorporating 3D Dobutamine stress echocardiography into routine clinical practiceP1174Right ventricular isovolumic acceleration at rest and during exercise in children after heart transplantP1175Right ventricular systolic and diastolic response to exercise in children after heart transplant -a bicycle exercise studyP1176Determinants of functional capacity in heart failure patients with reduced ejection fractionP1177Handgrip stress echocardiography with emotional component compared to conventional isometric exercise in coronary artery disease diagnosisP1178The relationship between resting transthoracic echocardiography and exercise capacity in patients with paroxysmal atrial fibrillationP1179Correlation between NT-proBNP and selected echocardiography parameters at rest and after exercise in patients with functional ischemic mitral regurgitation qualified for cardiosurgical treatmentReal-time three-dimensional TEEP1180Vena contracta area for severity grading in functional and degenerative mitral regurgitation: A study based on transesophageal 3D colour Doppler in 419 patientsP1181Proximal flow convergence by 3D echocardiography in the evaluation of mitral valve area in rheumatic mitral stenosisP1182Quantification of valve dimensions by transesophageal 3D echocardiography in patients with functional and degenerative mitral regurgitationTissue Doppler and speckle trackingP1183Automatic calculation of left ventricular volume changes over a cardiac cycle from echocardiography images by nonlinear dimensionality reductionP1184Effect of the mitral valve repairs on the left ventricular blood flow formationP1185Quantification of left atrial strain using cardiovascular magnetic resonance. a comparison between hypertrophic cardiomyopathy and healthy controlsP1186The role of early systolic lengthening in patients with non-ST elevation acute coronary syndrome and its relation to syntax scoreP1187Different standard two dimensional strain methods to quantity left ventricular mechanicsP1188Atrial function and electrocardiography caracteristics in sportsmen with or without paroxysmal atrial fibrillationP1189Right ventricular outflow premature contractions induce regional left ventricular dysfunctionP1190Ultrasound guided venous access for pacemaker and defibrillators. Randomized TrialP1191Atrial function analysis correlates with symptoms and quality of life of heart failure patientsP1192The use of tissue doppler echocardiography in myocardial iron overload in patients with thalassaemia majorP1193Independent association between pulse pressure and left ventricular global longitudinal strainP1194Global and regional longitudinal strain identifies the presence of coronary artery disease in patients with suspected reduction of coronary flow reserve and absence of wall motion abnormalitiesP1195Prognostic value of invasive and noninvasive parameters of right ventricular function in patients with pulmonary arterial hypertension receiving specific vasodilator therapyP1196Myocardial deformation analysis to improve arrhythmic risk stratificationP1197Quantitative assessment of regional systolic and diastolic function parameters for detecting prior transient ischemia in normokinetic segmentsP1198Left atrial function in patients with corrected tetralogy of Fallot - a three-dimensional speckle-tracking echocardiographic studyP1199Left atrial ejection force correlates with left atrial strain and volume-based functional properties as assessed by three-dimensional speckle tracking echocardiographyP1200Acute angulation of the aortic arch late after the arterial switch operation for transposition of the great arteries: impact on cardiac mechanicsP1201Circumferential deformation of the ascending thoracic aorta in hypertensive patients by three-dimensional speckle tracking echocardiographyCardiac Magnetic ResonanceP1202The incremental value of cardiac magnetic resonance on diagnosis myocardial infarction and non-obstructed coronary arteriesP1204Reference ranges of global and regional myocardial T1 values derived from MOLLI and shMOLLI at 3TComputed Tomography & Nuclear CardiologyP1205Deformation of the left atrial appendage after percutaneous closure with the Amplatzer cardiac plugP1206Prognostic impact of non-obstructive coronary artery disease on coronary computed tomographic angiography: A single-center study. Eur Heart J Cardiovasc Imaging 2015. [DOI: 10.1093/ehjci/jev275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Poster session 4: Friday 5 December 2014, 08:30-12:30 * Location: Poster area. Eur Heart J Cardiovasc Imaging 2014. [DOI: 10.1093/ehjci/jeu256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Factors related to outcome of early and delayed prosthetic joint infections. J Infect 2014; 70:30-6. [PMID: 25077990 DOI: 10.1016/j.jinf.2014.07.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 07/14/2014] [Accepted: 07/16/2014] [Indexed: 01/19/2023]
Abstract
UNLABELLED In this prospective study, we evaluate the impact of adherence to a diagnostic and therapeutic protocol on prosthetic joint infections (PJI) diagnostic accuracy and outcome. PATIENTS AND METHODS Patients with early or delayed PJI referred over a 5-year period were included. Diagnosis was based on characteristic clinical signs, radiographic findings and microbiological evidence. Antibiotics were chosen on the basis of microbiological findings, and drugs active against methicillin-resistant staphylococci were administered if no microbiological evidence had been obtained. RESULTS Inclusion criteria were met in 159 cases (median age 64 years, males 45%). 56 were early infections and 103 delayed infections. Comorbidities were reported in 99 (62%) cases. Positive cultures were obtained in 122/159 (77%), coagulase-negative staphylococci were cultured in 20%, Staphylococcus aureus in 28%, and Pseudomonas aeruginosa in 7%. In early infections, cure rate after debridement and antibiotic therapy was 80%. In delayed infections, cure rate after two-stage exchange was 85%. Of 28 patients with delayed infection treated with antibiotics without surgery, only 8 (29%) infections were suppressed 48 weeks after treatment discontinuation. Rifampin afforded a better outcome. CONCLUSION Appropriate diagnostic and surgical procedures and microbiologically driven antibiotic therapy including rifampin are recommended to improve diagnostic accuracy and outcome.
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Mood and coping in clinically isolated syndrome and multiple sclerosis. Acta Neurol Scand 2014; 129:374-81. [PMID: 24172013 DOI: 10.1111/ane.12194] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Few studies have examined behavioural changes in the early phase of multiple sclerosis (MS). The aim of the study is to investigate mood alterations and to explore coping strategies regarding patients with clinically isolated syndrome (CIS) and relapsing-remitting MS (RRMS). MATERIALS AND METHODS The communication of diagnosis was made by one neurologist using a standardized approach. Depression, anxiety and coping questionnaires were filled in within 1 month from the diagnosis and at 3, 6, 12, 18 and 24 months subsequently. RESULTS Thirty-nine patients were examined (11 CIS, 28 RRMS), also 39 healthy controls. At entry, patients showed a lower degree of hostile behaviour and a higher level of depression than the controls. At follow-up, a reduction in depression, anxiety and a better coping adjustment was observed. A higher reliance on 'Accepting responsibilities' coping score was seen in patients with higher levels of depression and anxiety. No significant differences were revealed by group comparisons between CIS and RRMS. CONCLUSIONS This study highlights transient mood alterations and an improving of adaptive coping over a period of time in patients with CIS and RRMS. Similar emotional reactions and coping in clinical subgroups suggest that these factors are independent from the type of information provided during the communication of the diagnosis.
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Poster session Thursday 12 December - PM: 12/12/2013, 14:00-18:00 * Location: Poster area. Eur Heart J Cardiovasc Imaging 2013. [DOI: 10.1093/ehjci/jet204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
A 49-year-old woman had a haemangiopericytoma in the distal third of the arm, which is an extremely rare location. There was no recurrence of the tumor 5 years after wide margin surgical excision.
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Abstract
An unusual case is reported of posttraumatic nonunion of the clavicle in a 7-year-old girl, which was treated by surgical stabilization with a Kirschner wire and apposition of cancellous bone chips taken from the proximal right tibial metaphysis. At clinical examination 2 years after surgery, the patient was symptom-free, and she had a full range of motion of the shoulder. Radiographs showed a very good remodeling of the bone, with only a minimal difference between the two clavicles.
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