EP Europace最新文献

{"title":"Systolic blood pressure and effects of screening for atrial fibrillation with long-term continuous monitoring","authors":"L. Xing, S. Diederichsen, S. Hoejberg, D. Krieger, C. Graff, M. Olesen, A. Brandes, L. Koeber, K. Haugan, J. Svendsen","doi":"10.1093/europace/euac053.281","DOIUrl":"https://doi.org/10.1093/europace/euac053.281","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: Other. Main funding source(s): The LOOP Study was supported by Innovation Fund Denmark [grant number 12-1352259], The Research Foundation for the Capital Region of Denmark, The Danish Heart Foundation [grant number 11-04-R83-A3363-22625], Aalborg University Talent Management Program, Arvid Nilssons Fond, Skibsreder Per Henriksen, R og Hustrus Fond, the European Union’s Horizon 2020 program [grant number 847770 to the AFFECT-EU consortium], Læge Sophus Carl Emil Friis og hustru Olga Doris Friis’ Legat, and an unrestricted grant from Medtronic.\u0000 \u0000 \u0000 \u0000 The recently published LOOP Study was a randomized controlled clinical trial to evaluate systematic atrial fibrillation (AF) screening with long-term continuous monitoring in an elderly population at risk and found no significant reduction in stroke. However, the screening effects seemed to differ across levels of systolic blood pressure (SBP). It is well-known that hypertension constitutes a prominent risk factor for clinical AF and stroke alike, but data on the impacts of SBP on subclinical AF and hereby AF screening efficacy are lacking.\u0000 \u0000 \u0000 \u0000 With this post hoc analysis of the LOOP Study, we aimed to provide insights into the interaction between SBP and benefits of systematic AF screening.\u0000 \u0000 \u0000 \u0000 The LOOP Study randomized individuals aged 70-90 years with ≥1 stroke risk factor (hypertension, diabetes, heart failure, or previous stroke) and without prior AF to either monitoring with implantable loop recorder (ILR) and initiation of oral anticoagulation upon detection of new-onset AF episodes lasting ≥6 minutes, or usual care (control group). In total, 5997 participants with available SBP measurements at enrolment were included in the present analysis. The interaction between SBP and ILR screening efficacy on stroke or systemic arterial embolism (SAE), as indicated by hazard ratio (HR) for ILR versus control, was assessed with polynomial moving-average regression. The lowest SBP threshold with significant screening benefits was further determined and used to examine clinical outcomes and the occurrence of AF with respect to dichotomized SBP. Additionally, penalized spline models were employed to assess AF occurrence by SBP as a continuous variable.\u0000 \u0000 \u0000 \u0000 HR of stroke/SAE for ILR versus control decreased with increasing SBP and the lowest threshold for significant screening benefits was at SBP ≥150 mmHg. ILR screening of participants with SBP ≥150 mmHg yielded a 45% risk reduction of stroke/SAE (HR 0.55 [0.37-0.82]). Within the ILR group, SBP ≥150 mmHg was associated with an increased risk of AF episodes ≥24 hours as compared to lower SBP (HR 1.57 [1.01-2.45]), but not with the overall occurrence of AF (HR 1.14 [0.95-1.36]). No significant association between SBP and AF occurrence in the ILR group was reported in penalized spline models either (p-value: 0.73).\u0000 \u0000 \u0000 \u0000 The benefits of ILR screening for AF on stroke/SAE increased with increasing blood pressure. SBP ≥150 ","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87404594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A positive toxicology screen is a rare finding in sports-related sudden cardiac deaths","authors":"C. Hansen, J. Svane, J. Isbister, Y. Ben-Haim, B. Morentin, P. Molina, E. Behr, J. Lucena, C. Semsarian, M. Sheppard, J. Tfelt‐Hansen","doi":"10.1093/europace/euac053.556","DOIUrl":"https://doi.org/10.1093/europace/euac053.556","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: Public Institution(s). Main funding source(s): University of Copenhagen\u0000 \u0000 \u0000 \u0000 Sports-related sudden cardiac deaths (SrSCD) are rare events often occurring in healthy individuals. An underlying cardiac disease may, in combination with strenuous exercise, trigger lethal arrhythmias. Intake of drugs (legal and illicit) increases the risk of sudden cardiac death (SCD), but knowledge on toxicological findings in SrSCD remains sparse.\u0000 \u0000 \u0000 \u0000 This study aimed to characterize the SrSCD population in an international consortium by investigating the epidemiology and autopsy findings in SrSCD.\u0000 \u0000 \u0000 \u0000 Participating centers of the consortium (Denmark, Australia, England, Spain) provided data on all forensically autopsied SCDs aged 12—49 years in their respective cohorts, spanning from 2000—2019. Demographics, autopsy findings, and toxicology screen were assessed. A toxicology screen was considered positive if any drug was detected, except drugs related to resuscitation.\u0000 \u0000 \u0000 \u0000 Of all 5,029 SCDs, we identified 435 (9%) SrSCD. The majority (88%) died during sports while the remaining 12% died within one hour from exercise. SrSCD occurred more often in males (91% vs 71%, p<0.001) who were younger (32 vs 36 years). In SrSCD, the autopsy more frequently revealed an underlying structural cardiac cause of death (64% vs 54%, p<0.001); the most frequent causes of death among SrSCDs were sudden unexpected death (SUD), ischemic heart disease (IHD), and arrhythmogenic cardiomyopathy (ACM). Toxicological screens were performed in approx. 90% of cases, regardless of relation to sport. Among SrSCD cases, the rate of a positive toxicology was less than half compared to other SCDs (18% vs 44%, p<0.001). The most frequent toxicological findings among SrSCDs were ethanol, central stimulants, cannabinoids, and non-opioid analgesics.\u0000 \u0000 \u0000 \u0000 Sports-related SCD accounted for 9% of all SCDs in our population aged 12—49 years. The majority of sports-related deaths (88%) occurred during exercise activity. SrSCDs more often had an underlying structural cardiac disease, mainly IHD and ACM. Positive toxicology screens were half as frequent in SrSCDs compared with non-SrSCDs.\u0000","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"53 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77259236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel CineECG to identify disease onset and progression in pathogenic plakophilin-2 mutation carriers","authors":"M. Boonstra, M. Kloosterman, F. Asselbergs, P. V. van Dam, P. Loh","doi":"10.1093/europace/euac053.040","DOIUrl":"https://doi.org/10.1093/europace/euac053.040","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Dutch Heart Foundation\u0000 \u0000 \u0000 \u0000 Arrhythmogenic cardiomyopathy (ACM) is a heterogeneous progressive disease. Identification of patients at risk for malignant ventricular arrhythmias is challenging, making extensive cardiac follow-up necessary. CineECG provides insight in the average cardiac pathway of cardiac electrical activity. In previous studies, CineECG proved useful to detect disease progression.\u0000 \u0000 \u0000 \u0000 Evaluate the applicability of CineECG to monitor disease progression in plakophilin-2 (PKP2) pathogenic mutation carriers.\u0000 \u0000 \u0000 \u0000 To compute the CineECG, a 3D heart/torso model and 12 lead ECG is used. From 68 PKP2 pathogenic mutation carriers, all raw ECGs were extracted from the patient database. In pathogenic mutation carriers with definite ACM, the ECG ±2 years before (ECG1), at (ECG2) and ±2 years after (ECG3) diagnosis were selected. In pathogenic mutation carriers without definite ACM, the most recent ECG (ECG2) and the ECG ±2 years before (ECG1) were selected. CineECGs were computed for the QRS complex and the distance between CineECG location at end QRS was determined per subject for subsequent CineECGs.\u0000 \u0000 \u0000 \u0000 In 53 pathogenic mutation carriers ≥2 ECGs were available. 33 pathogenic mutation carriers were diagnosed with definite ACM of whom 4 had an ECG before, at and after diagnosis. Average distance between CineECG location at end QRS was 7.8±6.8 mm. In pathogenic mutation carriers with definite ACM, CineECG before and at diagnosis (figure, example 1&2) were different whereas CineECG at and after diagnosis did not always change. In pathogenic mutation carriers without definite ACM, in 14/19 changes in CineECG were observed (figure, example 3), whereas in the others (figure, example 4) not.\u0000 \u0000 \u0000 \u0000 Our preliminary results show that CineECG provides additional insight in the changes of cardiac activation in ACM patients and may enable detection of disease progression. Further analysis will also include cardiac repolarization.\u0000","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"41 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83645678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term impact of activation circuit-based ventricular tachycardia ablation on ventricular arrhythmia burden","authors":"F. Freire Barbas De Albuquerque, G. Portugal, P. Silva Cunha, B. Valente, A. Lousinha, A. Delgado, M. Paulo, T. Rosa, M. Brás, R. Cruz Ferreira, M. Oliveira","doi":"10.1093/europace/euac053.350","DOIUrl":"https://doi.org/10.1093/europace/euac053.350","url":null,"abstract":"Type of funding sources: None. Ventricular arrhythmias (VA) are a major cause of morbidity and mortality in heart failure patients. Ventricular tachycardia (VT) ablation is an established treatment for the reduction of recurrent implantable cardioverter-defibrillator (ICD) therapies in this population. In patients with substrate-related VT, mapping of the entire tachycardia circuit, when feasible, may allow for more accurate targeting of the clinical VT. To assess the long-term impact of catheter ablation based on activation mapping of substrate-related VT on VA burden. Consecutive patients submitted to VT ablation between January 2013 and October 2021 were included. A comprehensive review of clinical records and device monitoring was performed to assess VA burden, defined as all ICD therapies and clinically documented VTs, before and after ablation. The primary outcome was reduction in the overall burden of VA after ablation. The impact of ablation on VA burden was assessed by fixed-effects Poisson regression; comparison at fixed time intervals was performed with a paired-sample Wilcoxon signed-rank test (STATA 12, JASP). A total of 134 VT ablation procedures were performed during the study period. Of these, there were 21 procedures where complete mapping of the VT activation circuit was achieved, corresponding to 18 patients. Mean age was 56.7 years, 88% male sex, mean left ventricular ejection fraction 39 ± 13%, BNP 540 ± 627 pg/mL. Etiology was ischemic in 44%, non-ischemic dilated cardiomyopathy in 39%, arrhythmogenic right ventricular dysplasia in 11% and hypertrophic cardiomyopathy in 6%. Mechanical support was in situ in 3 patients (two with temporary VA ECMO and one with LVAD as destination therapy); all but one patient had an ICD. Procedural duration was 209 ± 61 minutes. One patient developed complete AV block; no other peri-procedural complications were observed. During follow-up two patients died due to heart failure, one patient died from refractory cardiogenic shock with refractory incessant VT and one patient underwent orthotopic heart transplant. The mean follow-up time after ablation was 2.2 ± 1.9 years. A significant reduction in VA burden was observed (Figure 1) at 3 months (92.5% reduction, p=0.002) and 6 months after ablation (83.3% reduction, p=0.041). After fixed-effects Poisson regression, there was an estimated long-term reduction of 75% (CI 12-93%, p=0.031) of VA burden after VT circuit ablation. Targeted circuit ablation is feasible in a subset of patients referred to VT ablation and leads to a significant sustained decrease in VA burden and device therapies.","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85334561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increased 18F-fluorodeoxyglucose uptake in the cardiac atria: an evidence for increased atrial inflammation in patients with atrial fibrillation?","authors":"O. Nakamura, C. Goetz, P. Meyer, T. Arentz, A. Jadidi","doi":"10.1093/europace/euac053.599","DOIUrl":"https://doi.org/10.1093/europace/euac053.599","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: None.\u0000 \u0000 \u0000 \u0000 Atrial inflammation and fibrotic remodelling underlie the pathophysiology of atrial cardiomyopathy, which is associated with the development of atrial fibrillation (AF) and atrial flutter (AFL). 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) has been used to detect inflammatory processes. Recent studies have revealed an increased FDG-uptake in the atria of patients with AF, but also in patients with diagnosis of cardiac sarcoidosis with ventricular inflammation.\u0000 \u0000 \u0000 \u0000 This study aimed to assess the capability of PET/CT to detect and quantify the degree of atrial inflammation (FDG-uptake) in a population with dedicated cardiac FDG-PET/CT.\u0000 \u0000 \u0000 \u0000 We investigated 101 patients suspected of sarcoidosis (57±12 years, 72% male) who underwent 18F-FDG PET/CT scan with dedicated cardiac specific preparation (heparin infusion, 12 hours fasting, and high-fat low-carbohydrate diet). We excluded patients with active ventricular cardiac sarcoidosis or undergoing high-dose immunosuppressive therapy (prednisolone ≥20mg/day or prednisolone combined with other immunotherapy like methotrexate). We measured the maximum standardized uptake value (SUVmax) in atrial myocardium and mean standardized uptake value (SUVmean) in blood pool and calculated the target-to-background ratio (TBR) of SUVmax in atrial myocardium to SUVmean in blood pool. All medical records, ECG data on arrhythmia type and diagnosis of systemic sarcoidosis (with absence of ventricular involvement) were used for the analysis. Sarcoidosis was diagnosed based on the criteria established in 2006 by the Japanese Ministry of Health and Welfare. The collected data were sorted according to presence of arrhythmia and systemic sarcoidosis and TBR of each group were compared.\u0000 \u0000 \u0000 \u0000 AF or AFL was found in 30/101 patients. Systemic sarcoidosis was found in 37/101 patients. Patients with known AF/AFL had significantly increased TBR within the atrial tissue compared to those without AF/AFL: (median: 1.26, 1st-3rd quartile: 1.20-1.33) versus (median: 1.22, 1st-3rd quartile: 1.14-1.25; p = 0.004; figure A). Arrhythmia-associated atrial inflammation was consistently observed, independently of presence of concomitant systemic sarcoidosis (figure B). Patients with both atrial arrhythmias and systemic sarcoidosis had the highest atrial inflammation level, as identified by TBR (figure B).\u0000 \u0000 \u0000 \u0000 Development of atrial fibrillation or flutter is associated with an increased atrial FDG-uptake as metabolic marker of atrial inflammation. The level of atrial inflammation is further enhanced by additional presence of systemic sarcoidosis.\u0000","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90759372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrasounds versus fluoroscopy guidance for axillary vein puncture for cardiac devices implantation : a multicenter randomized comparison","authors":"S. Bun, P. Taghji, P. Massoure, N. Roche, F. Squara, D. Scarlatti, P. Moceri, J. Deharo, E. Ferrari","doi":"10.1093/europace/euac053.404","DOIUrl":"https://doi.org/10.1093/europace/euac053.404","url":null,"abstract":"Type of funding sources: None. Axillary vein (AV) puncture, an emerging route for cardiac implantable electronic devices (CIED), can be performed under ultrasounds (US) or fluoroscopic (Fluo) guidance. To compare US to fluroroscopy-guided AV puncture in a multicenter randomized controlled trial. Consecutive patients admitted for CIED (first implant or upgrade, including resynchronization therapy) intervention were prospectively randomized between US or Fluo guidance for AV puncture in the three participating centers. Access performances, radiation exposure and complications were compared in both groups. 102 patients were included (n = 51 patients per group). The two groups had similar characteristics concerning age (79.4 ± 10 years), and LVEF (47 ± 17%). 92 leads were implanted in both groups. AV catheterization was successful in 50/51 (98 %) in the US group versus 49/51 in the Fluo group (96 %, p = 0.56). AV access time and procedure time were not different between the two groups, respectively (156 ± 274 in the US group versus 137 ± 151 sec, p = 0.66; 54 ± 24 versus 61 ± 26 min; p = 0.13). Total fluoroscopy time (FT) and dose-area product were respectively lower in the US group, but without reaching significance: 197 ± 231 versus 247 ± 293 sec, p = 0.32; 0.39 ± 0.95 versus 0.75 ± 1.58 mGy.m², p = 0.14. FT for AV access was significantly higher in the Fluo group (51 ± 55 sec versus 0, p < 0.0001). There were two complications in each group during the 9 ± 6 months follow-up. Our study demonstrates that both US and fluoroscopy-guided AV catheterization for CIED are highly effective and safe techniques. Despite similar AV access time, compared to fluo guidance, US reduce time radiation exposure by 20 %.","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"18 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91017587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transvenous lead extraction: the Tandem approach","authors":"Z. Akhtar, Z. Zuberi, Lwm Leung, C. Kontogiannis, K. Waleed, AI Elbatran, M. Sohal, M. Gallagher","doi":"10.1093/europace/euac053.535","DOIUrl":"https://doi.org/10.1093/europace/euac053.535","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: None.\u0000 \u0000 \u0000 \u0000 Transvenous lead extraction (TLE) has become an important strategy in the management of patients with cardiac implantable electronic devices (CIEDs). A rising population of patients with CIEDs coupled with an expanding indication for TLE, has fuelled demand. There are notable procedural risks however development of techniques and tools have contributed to an improvement in the safety and efficacy of TLE. The mechanical rotational dissecting sheath is safe and efficacious whilst the Needle’s Eye Snare (NES) is an additional ‘bail-out’ strategy contributing to procedural success.\u0000 \u0000 \u0000 \u0000 We sought to evaluate the outcomes of TLE performed from the superior access in conjunction with counter-traction provided by snaring of the targeted lead via the femoral access.\u0000 \u0000 \u0000 \u0000 The ‘Tandem’ procedure consisted of the rotational powered sheath performing dissection of the adhesions encapsulating the leads (at the superior access), in ‘Tandem’ with the Needle’s Eye Snare providing countertraction via the femoral vein. In brief: after deployment of the locking stylet in the lead lumen, the NES was used to grasp the lead in the right atrium and hold it tort while a rotational sheath was used to dissect through the veins. Once the sheath reached the right atrium, the lead was released from the snare and the sheath was used to continue dissection toward the lead tip. Data for all consecutive ‘Tandem’ procedures performed between 1/1/2021 – 1/1/2022 in our high-volume TLE institute were collected and evaluated for safety and efficacy.\u0000 \u0000 \u0000 \u0000 Forty patients aged 69.2±16.3 (70% male), underwent TLE of 75 leads (45 right ventricle, 25, right atrium, 5 left ventricle) with dwell time of 150.1±80.3 months for a non-infectious indication (65%). Of the 40 cases, 27 were hypertensives, 14 had ischaemic heart disease whilst 5 suffered diabetes with a left ventricle ejection fraction of 46.8±10.2%; 12 (30%) were pacing dependent. Procedures were performed by cardiologists in the cardiac catheterisation suite under general anaesthesia (95%) using a locking stylet (100%) with an Evolution RL (11-french 58.7%); a NES 13 millimetres curve (88%) was used to successfully snare 91% of the targeted leads. Complete procedural success was achieved in 92% of leads with 98.7% clinical success. Minor complications occurred in 2 cases (pneumothorax, pocket haematoma requiring intervention), in the absence of any major complications or peri-procedural mortality; there was no 30-day mortality.\u0000 \u0000 \u0000 \u0000 The ‘Tandem’ procedure provides an additional strategy to improve the safety and efficacy of TLE, especially in leads of a long dwell time.\u0000","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89440016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ventricular arrhythmias and implantable cardioverter-defibrillator therapy in women: a propensity score-matched analysis","authors":"G. Maglia, M. Giammaria, G. Zanotto, A. D'Onofrio, P. Della Bella, M. Marini, G. Rovaris, S. Iacopino, V. Calvi, E. Pisanò, F. Caravati, G. Balestri, D. Giacopelli, A. Gargaro, M. Biffi","doi":"10.1093/europace/euac053.472","DOIUrl":"https://doi.org/10.1093/europace/euac053.472","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: None.\u0000 \u0000 \u0000 \u0000 The implantable cardioverter-defibrillator (ICD) is an established therapy for the prevention of sudden cardiac death in selected patients. Although current guidelines apply to both women and men, there is a growing awareness that the incidence of cardiac arrhythmias and device interventions is influenced by sex.\u0000 \u0000 \u0000 \u0000 To investigate sex-specific risk of sustained ventricular arrhythmias (SVAs) and device therapies, using remote monitoring data from ICDs and cardiac resynchronization therapy defibrillators (CRT-Ds).\u0000 \u0000 \u0000 \u0000 Study endpoints were time to the first appropriate SVA, time to the first appropriate device therapy for SVA, and time to the first ICD shock. Appropriateness of device-detected SVAs was adjudicated by three expert electrophysiologists. Results were compared between women and a 1:1 propensity score (PS)-matched subgroup of men.\u0000 \u0000 \u0000 \u0000 In a cohort of 2,532 patients with an ICD or CRT-D (median age, 70 years), 488 patients (19.3%) were women. As compared to men, women more frequently had a CRT-D (51% vs. 40%, p<0.001), and nonischemic cardiomyopathy (65% vs. 45%, p<0.001). After a median follow-up of 2.1 years, SVAs occurred in 123 women (25.2%) and in 174 of the 488 PS-matched men (35.6%) with an adjusted hazard ratio (HR) of 0.65 (95% confidence interval [CI], 0.51-0.81; p<0.001). Women also showed a reduced risk of any device therapy (HR, 0.59; CI, 0.45-0.76; p<0.001) and shocks (HR, 0.66; CI, 0.47-0.94, p=0.021). Differences in sex-specific SVA risk profile were not confirmed in CRT-D patients (HR, 0.78; CI, 0.55-1.09; p=0.14) and in those with an ejection fraction <30% (HR, 0.80; CI, 0.52-1.23; p=0.31).\u0000 \u0000 \u0000 \u0000 In our analysis of remote monitoring data, women exhibited a lower SVA risk profile than PS-matched men in the subgroup of patients with an ICD or/and ejection fraction ≥30%.\u0000","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89483910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pre-ablation interatrial conduction delay or block predicts atrial fibrillation recurrence after ablation among obese patients","authors":"H. Tandon, K. Stout, D. Shin, R. Ruskamp, J. Payne, N. Goyal, S. Tsai, A. Easley, F. Khan, J. Windle, D. Anderson, JW Schleifer, N. Naksuk","doi":"10.1093/europace/euac053.240","DOIUrl":"https://doi.org/10.1093/europace/euac053.240","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: None.\u0000 \u0000 \u0000 \u0000 Obesity is associated with greater risk of atrial fibrillation (AF) recurrence post-ablation and higher incidence of conduction delay compared to non-obese patients. Pre-ablation P-wave duration (PWD) and morphology (PWM) indicating interatrial delay are easily assessed in the clinic and may predict AF recurrence post-ablation in these patients.\u0000 \u0000 \u0000 \u0000 Evaluate the predictive value of PWD and PWM on AF recurrence post-ablation in obese patients.\u0000 \u0000 \u0000 \u0000 Pre-ablation PWD and PWM (negative P-wave in lead II or III) were analyzed on consecutive patients with BMI ≥30 kg/m2 who underwent initial AF ablation from 2012–19. The primary outcome was recurrent AF after a 3-month post-ablation blanking period. Multivariate analysis adjusted for baseline characteristics was performed.\u0000 \u0000 \u0000 \u0000 For 205 patients (61.0±9.5 years old, 39.0% female), mean BMI was 36.9±5.7 kg/m2 and 71.7% had persistent AF pre-ablation. Recurrent AF post-ablation occurred in 115 (56.1%) during a median follow up of 491 (270, 1001) days. PWD >130 ms was significantly associated with higher AF recurrence (AHR of 1.62, 95%CI 1.04-2.57, p=0.03) after adjusting for age, persistent AF and left atrial volume index (LAVI). In a subgroup with LAVI <42 mL/m2 (n=112), PWD >130 ms and negative P-waves in lead II or III were independently associated with increased risk of recurrent AF (AHR 2.06, 95%CI 1.12-3.91; p=0.019 and AHR 1.94, 95% CI 1.00-3.56; p=0.05, respectively) (Figure 1).\u0000 \u0000 \u0000 \u0000 AF recurred in >50% of obese patients within 1.5 years of ablation. Pre-ablation PWD >130 ms and negative P-waves in lead II or III independently predicted recurrent AF post-ablation in this cohort of obese patients. These easily assessed findings add predictive value to other risk factors.\u0000","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89495063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors of mortality after secondary procedures during the world-wide randomized antibiotic envelope infection prevention trial (WRAP-IT)","authors":"S. Mittal, J. Poole, C. Kennergren, U. Birgersdotter-Green, DL Lustgarten, GF Tomassoni, G. Hilleren, J. Lande, C. Lensing, B. Wilkoff, K. Tarakji","doi":"10.1093/europace/euac053.524","DOIUrl":"https://doi.org/10.1093/europace/euac053.524","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: Private company. Main funding source(s): Medtronic\u0000 \u0000 \u0000 \u0000 Previous analysis of WRAP-IT (World-wide Randomized Antibiotic Envelope Infection Prevention trial) data identified both patient and procedural characteristics as risk factors for cardiac implantable electronic device (CIED) infection. In the current analysis, we sought to similarly use prospectively collected WRAP-IT data to assess risk factors of all-cause mortality. Understanding if mortality risk can be modified and identifying baseline characteristics associated with high risk can help guide physician decision making.\u0000 \u0000 \u0000 \u0000 To identify modifiable and non-modifiable risk factors for 1-year all-cause mortality after a secondary (replacement, revision, or upgrade) CIED procedure.\u0000 \u0000 \u0000 \u0000 This analysis included 5,461 secondary procedure patients from the WRAP-IT study. Included as candidate factors were patient and procedural characteristics. Patients with more than one year follow-up were censored at one year. A multivariate Cox Proportional Hazards model was reached by stepwise selection to minimize Akaike Information Criterion.\u0000 \u0000 \u0000 \u0000 The overall one-year mortality rate was 5.2% after secondary procedures. Of the 26 patient and 18 procedural characteristics analyzed, the following variables best predicted risk of a 1-year all-cause mortality: age, NYHA class, renal dysfunction, anticoagulant use, ischemic cardiomyopathy, diabetes, BMI, procedure time, myocardial infarction, valve surgery, and hypertrophic cardiomyopathy (Table).\u0000 \u0000 \u0000 \u0000 In WRAP-IT patients undergoing secondary procedures, the only procedure characteristics that had any association with all-cause 1-year mortality risk was procedure time suggesting that most of the risk factors of mortality are non-modifiable. Baseline patient characteristics and co-morbidities were the principal risk factors of all-cause 1-year mortality. Specifically, increasing age, NYHA class, and a history of renal dysfunction were strongly associated with mortality.\u0000","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"74 3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90095829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}