EP Europace最新文献

{"title":"Patients’ perspective on a pill-in-the-pocket oral anticoagulation as an alternative stroke prevention strategy in atrial fibrillation","authors":"A. Briosa e Gala, M. Pope, M. Leo, T. Lobban, T. Betts","doi":"10.1093/europace/euac053.293","DOIUrl":"https://doi.org/10.1093/europace/euac053.293","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: None.\u0000 \u0000 \u0000 \u0000 Oral anticoagulation (OAC) decisions are binary: if atrial fibrillation (AF) is detected and additional risk factors are presented, lifelong continuous OAC is recommended regardless of AF burden or temporal patterns. AF-related stroke risk appears to be lower in patients with paroxysmal AF and, therefore, indefinite OAC may have limited benefit whilst exposing patients to a significant bleeding risk. ‘Pill-in-the-pocket’ OAC during and shortly after AF challenges this dichotomous approach to OAC and is being explored in several pilot studies as an alternative AF-related stroke prevention strategy.\u0000 \u0000 \u0000 \u0000 This patient questionnaire sought to examine patients’ perspective of ‘pill-in-the pocket’ OAC strategy.\u0000 \u0000 \u0000 \u0000 An 8-question interactive survey was developed in collaboration with AF Association (UK based charity) and included a short description of implantable cardiac monitors main features, implant procedure and associated risks. The survey was available online on the AF Association website from 30/09/2020 to 2/11/2020.\u0000 \u0000 \u0000 \u0000 Overall, 321 participants with an underlying diagnosis of AF replied to the online survey over the course of four and half weeks. The majority (82%) were taking direct oral anticoagulants. Just over two thirds of patients had concerns regarding bleeding side-effects from taking OAC and, approximately, a quarter had experienced a bleeding event (1.5% major bleeding and 24.2% minor bleeding). When asked if it was shown to be safe to monitor their heart rhythm continuously and take anticoagulants only during an episode of AF and for a small number of days afterwards (i.e. ‘pill-in-the-pocket’), 53.7% of participants would use guided by an implantable cardiac monitored. Slightly lower number of patients (48%) would take pill-in-the-pocket oral anticoagulation guided by a wearable device. In the comments the main reasons not to pursue ‘pill-in-the-pocket’ were permanent AF, previous thromboembolic events and concerns regarding reliability of monitoring technologies. In contrast, those who were receptive to this alternative approach had previous bleeding episodes, had very infrequent AF episodes and wanted to reduce their medication burden.\u0000 \u0000 \u0000 \u0000 Approximately half of patients with choose a ‘pill-in-the-pocket’ OAC guided by daily rhythm monitoring with an ICM if proven to be safe and effective at reducing thromboembolism.\u0000","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":"75393734","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":"Comparison between his-bundle pacing and biventricular pacing as cardiac resynchronization therapy for heart failure patients: a systematic review and meta-analysis","authors":"N. T. Toding Labi, D. Rampengan, S. Rampengan","doi":"10.1093/europace/euac053.479","DOIUrl":"https://doi.org/10.1093/europace/euac053.479","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: None.\u0000 \u0000 \u0000 \u0000 Cardiac resynchronization therapy (CRT) has demonstrated significant improvements in cardiovascular outcomes of selected heart failure patients. However, conventional biventricular CRT implantation can be challenging due to unfavorable coronary sinus anatomy, leads to lead instability, poor capture, and insufficient cardiac resynchronization. His-bundle pacing has gained interest as alternative strategy for patients underwent biventricular CRT implantation when coronary sinus lead implantation is unsuccesful or in non-responder cases.\u0000 \u0000 \u0000 \u0000 This study aims to compare the efficacy of his-bundle pacing and biventricular pacing in improving electrocardiographic, echocardiographic, and clinical parameters of heart failure patients that required resynchronization therapy.\u0000 \u0000 \u0000 \u0000 A search for eligible studies was conducted until August 2021 on three databases (PubMed, ScienceDirect, ProQuest). Included studies were evaluated for risk of bias. Our primary outcomes of interest were mean difference in QRS duration, left ventricular ejection fraction (LVEF), and change in systolic blood pressure (SBP). We also investigated left ventricular activation time, left ventricular dyssynchrony index, left ventricular end-systolic volume (LVESV), New York Heart Association (NYHA) functional class, 6-minute walk test, quality of life, heart failure hospitalization and cardiovascular or all cause death. Review Manager (RevMan) 5.4 was utilized to compute mean differences.\u0000 \u0000 \u0000 \u0000 We identified five studies from 2010 to 2019, involving 95 heart failure patients underwent CRT implantation. Pooled analysis showed that his-bundle pacing resulted in significant narrowing of QRS duration compared to biventricular pacing [Mean Difference -23.17 ms (95% CI -36.10, -10.24; p=0.0004; I2=0.63)]. Left ventricular activation time and left ventricular dyssynchrony index were significantly improved in his bundle pacing. There were no significant differences of changes in LVEF, LVESV, and SBP. Clinical parameters such as NYHA functional class, 6-minute walk test, and quality of life were significantly improved in both pacing modality. No significant difference in heart failure hospitalization and cardiovascular or all cause mortality.\u0000 \u0000 \u0000 \u0000 His-bundle pacing delivers better decrease of QRS duration, also reduction in left ventricular activation time and left ventricular dyssynchrony index compared to biventricular pacing. These suggests that his-bundle pacing is a reasonable alternative option for cardiac resynchronization therapy.\u0000","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"46 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74531852","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":"Non-invasive delineation of ventricular tachycardia substrates for cardiac stereotactic body radiotherapy: utility of in-silico pace-mapping","authors":"S. Monaci, S. Qian, K. Gillette, R. Mukherjee, U. Haberland, M. Elliott, R. Rajani, C. Rinaldi, M. O'Neill, G. Plank, A. King, M. Bishop","doi":"10.1093/europace/euac053.342","DOIUrl":"https://doi.org/10.1093/europace/euac053.342","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: Public Institution(s). Main funding source(s): EPSRC\u0000 \u0000 \u0000 \u0000 Cardiac stereotactive body radiotherapy (CSBRT) is an emerging, non-invasive ablation modality that targets ventricular tachycardia (VT) substrates in patients with limited conventional treatment options. Success of CSBRT hinges primarily on the correct identification of VT targets, which requires non-invasive planning. Current non-invasive, pre-procedure strategies employ multi-electrode electrocardiographic imaging (ECGi). Given its significant cost and potential challenges in detecting endocardial, intramural and/or septal VT sites, there is a need to optimise VT delineation strategies for CSBRT; patient-specific simulations may show promise at guiding such planning non-invasively.\u0000 \u0000 \u0000 \u0000 We aim to perform non-invasive, in-silico pace-mapping on an image-based computational model to identify VT substrates for CSBRT. We intend to show the utility of our fast computational pipeline - relying on CT imaging data only - to provide further insights on inaccessible, scar-related VT episodes.\u0000 \u0000 \u0000 \u0000 A detailed computational torso model of a CSBRT candidate with incessant VT was generated from CT imaging data. Extracellular content volumes (ECVs) were used to identify different tissue types (healthy, border zone and non-conducting), and scale model tissue conductivities accordingly. In-silico pace-mapping was performed by simulating ~360 paced beats across the LV, and computing corresponding 12-lead ECGs within a fast electrophysiological (EP) simulation environment combining reaction-eikonal and lead field methods. QRS complexes from simulated paced beats were used to construct the virtual correlation pace-map against the measured QRS of the clinically-induced VT, along with a ‘reference-less’ virtual pace-map constructed from neighbouring paced-beat QRSs (within a 20 mm radius). An epicardial activation map of the clinically-induced VT was reconstructed from ECGi measurement, and used for comparison against our virtual pace-maps.\u0000 \u0000 \u0000 \u0000 Correlations between simulated paced-beat QRS complexes and the clinically-induced VT QRS were higher in mid-apical, infero-septal segments - segment 9 (85.71%), 10 (87.95%) and 15 (89.58%) - identifying septal origin and pathway of the induced re-entrant circuit. A possible septal VT isthmus was also identified by a high gradient in the virtual reference-less pace-map in segment 9 (> 2.5%/mm). Our in-silico predictions were in agreement with the clinical regions identified for CSBRT (segment 9 and 15), and provided additional information on the 3D and septal dynamics of the VT episode.\u0000 \u0000 \u0000 \u0000 Our in-silico pace-mapping study successfully localised VT substrates in a patient unable to receive standard ablative procedures, and provided further clinical insight on the induced VT dynamics. Our rapid in-silico pace-mapping approach may be utilised to support optimal identification of VT target volumes for CSBRT.\u0000","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"43 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73403240","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":"PVC ablation without fluoroscopy","authors":"J. Peña Mellado, P. Sánchez Millán, G. Gutiérrez Ballesteros, L. Tercedor, M. Álvarez López","doi":"10.1093/europace/euac053.356","DOIUrl":"https://doi.org/10.1093/europace/euac053.356","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: None.\u0000 \u0000 \u0000 \u0000 Premature ventricular complex(PVC) catheter ablation is required in a wide spectrum of the population.Ionizing radiation exposure in this procedure carries health risks, especially in young patients.\u0000 \u0000 \u0000 \u0000 In this prospective observational study we describe our experience in PVC ablation without fluoroscopy\u0000 \u0000 \u0000 \u0000 26 patients were included, submitted to PVC ablation without fluoroscopy between October 2018 and November 2021, in our center. Baseline characteristics of the population, acute success and complications derived from the procedure were evaluated, as well as recurrence rate during follow-up.\u0000 \u0000 \u0000 \u0000 Mean age was 45.5± 16.3 years old, with a 46.2% of men. Most often cause of ablation were palpitations(73.1%),followed by reduced LVEF(19.2%). Mean LVEF by transtoracic echocardiography was 52.4 ± 11%. 38.5% had a cardiopathy, among them the most common was tachycardiomyopathy(49.9%).Mean PVC burden pre-ablation was 23.6±11.5%. 65% of patients were taking beta blockers. The most frequent PVC origin was the right ventricle outflow tract(RVOT), with a 65.4% prevalence, followed by the left ventricle outflow tract(LVOT) with 15.4%.We used a 3D electroanatomical navigation system in all cases,while intracardiac echocardiography was used in 88.5% and a contact force catheter for mapping(57.7%) and ablation(92.3%).The mean maximum radiofrequency power applied was 34 ±5.8W, with a median time of 240 seconds. Median number of applications was 6 and mean total time of procedure was 210 ±67,5 minutes. 28ms median best prematurity.\u0000 Suppression of PVC was achieved in 88.5%. There was only two complications(7.6%): pericardial effusion without the need for pericardiocentesis and right brunch block.Median follow-up of 3 months, with 23% of recurrences. Most of patients(57.7%) did not require antiarrhythmics drugs during it.\u0000 \u0000 \u0000 \u0000 Zero fluoroscopy PVC ablation is a safe procedure with no major complications and good rates of success and recurrence in our experience\u0000","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"47 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75553489","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":"Major procedure-related complications in a real-world cohort of patients undergoing transvenous lead extraction","authors":"M. Doring, J. Lucas, K. Bode, S. Nedios, S. Hilbert, M. Ebert, C. Moscoso Ludueña, G. Hindricks, S. Richter","doi":"10.1093/europace/euac053.539","DOIUrl":"https://doi.org/10.1093/europace/euac053.539","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: None.\u0000 \u0000 \u0000 \u0000 Transvenous lead extraction (TLE) is the mainstay therapy for device-related infections. Though TLE procedures are associated with low complication and high success rates, risk factors for major procedure-related complications remain not well defined.\u0000 \u0000 \u0000 \u0000 To evaluate the safety and efficacy of TLE in a large single centre cohort and to identify risk factors for major complications.\u0000 \u0000 \u0000 \u0000 All consecutive patients undergoing TLE in our department between May 2012 and December 2021 were included in a prospective registry. Our protocol for TLE followed a stepwise approach according to lead dwell time and estimated complexity of the procedure: use of simple traction ± locking stylet (LS) ± mechanical and/or powered sheaths ± snare technique via a femoral or jugular access. Patient characteristics, procedural data and complications were gathered and analysed. Logistic regression analysis was applied to identify risk factors for major procedure related complications.\u0000 \u0000 \u0000 \u0000 A total of 2218 leads (25.7% ICD leads) were targeted for TLE in 1060 patients (67.7 ± 14.8 years; 74% male). The mean lead dwell time was 82 ± 62 months. The leading indication for TLE was cardiac device related infection (CDRI) in 695 patients (65.6%), 373 (35.2%) had systemic and 322 (30.4%) localized infection. Leads were extracted by simple traction in 30%, traction with LS in 3.7%, dilator sheaths with LS in 47.7%, and additional use of powered mechanical sheaths in 14.6%. The snare technique was used in 3.9%, with additional venous entry from femoral in 3.5% and jugular in 1.0% of all targeted leads. TLE was completely successful in 92.6%, partially successful with lead fragments <4cm in 4.2%, and failed in 3.1% of all patients, which translated to a clinical success rate of 96.9%.\u0000 Twenty-nine patients (2.7%) experienced minor and 18 patients (1.7%) had major procedure-related complications (cardiac tamponade/perforation) including 2 intraprocedural deaths (0.2%). Presence of abandoned leads (HR 8.41, 95% CI 3.21–22.02; p<0.001), lead-years-per-patient (HR 1.063, 95% CI 1.037–1.090; p<0.001), dwelling time of the oldest lead (HR 1.011, 95% CI 1.006–1.016; p<0.001), and a right-sided implantation (HR 2.68, 95% CI 1.05–6.83; p=0.04) were significant predictors of major complications in logistic regression analysis.\u0000 \u0000 \u0000 \u0000 TLE is feasible, effective and safe in our large single centre experience. Overall complication and failure rates are low. Following our TLE protocol, the presence of abandoned leads, a right-sided implantation and dwelling time of the extracted leads were associated with major procedure-related complications.\u0000","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"80 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74188141","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":"Familial clustering of unexplained heart failure - A Danish nationwide cohort study","authors":"C. Glinge, S. Rossetti, L. Bruun Oestergaard, N. Stampe, M. Ravn Jacobsen, L. Koeber, T. Engstroem, C. Torp-Pedersen, G. Gislason, R. Jabbari, J. Tfelt‐Hansen","doi":"10.1093/europace/euac053.008","DOIUrl":"https://doi.org/10.1093/europace/euac053.008","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: Public grant(s) – EU funding. Main funding source(s): This project has received funding from the European Union’s Horizon 2020 research and innovation programme under acronym ESCAPE-NET, registered under grant agreement No 733381, and the European Union’s COST programme under acronym PARQ, registered under grant agreement No CA19137.\u0000 \u0000 \u0000 \u0000 Although family history of heart failure (HF) is associated with increased risk of HF, the extent to which a family history contributes to the risk of HF needs further investigation.\u0000 \u0000 \u0000 \u0000 To determine whether a family history of unexplained HF in first-degree relatives (children or sibling) increases the rate of unexplained HF.\u0000 \u0000 \u0000 \u0000 Using Danish nationwide registry data (1978-2017), we identified patients (probands) diagnosed with first unexplained HF (HF without any known comorbidities) in Denmark, and their first-degree relatives. All first-degree relatives were followed from the HF date of the proband and until an event of unexplained HF, exclusion diagnosis, death, emigration, or study end, whichever occurred first. Using the general population as a reference, we calculated adjusted standardized incidence ratios (SIR) of unexplained HF in the three groups of relatives using Poisson regression models.\u0000 \u0000 \u0000 \u0000 We identified 57,845 first-degree relatives to individuals previously diagnosed with unexplained HF. Having a family history was associated with a significantly increased unexplained HF rate of 2.08 (95% CI 1.82-2.38) (Figure 1). The estimate was higher among siblings (SIR 4.82 [95% CI 3.17-7.32]). Noteworthy, the rate of HF increased for all first-degree relatives when the proband was diagnosed with HF in a young age (≤50 years, SIR of 3.60 [95% CI 2.37-5.47]) and having >1 proband (SIR of 2.73 [95% CI 1.14-6.56]). The highest estimate of HF was observed if the proband was ≤40 years at diagnosis (6.12 [95% CI 3.39-11.05]) (Figure 2).\u0000 \u0000 \u0000 \u0000 A family history of unexplained HF was associated with a two-fold increased rate of unexplained HF among first-degree relatives. If the proband age was ≤40 years, the risk was six-folded. These findings suggest that screening families of unexplained HF with onset below 50 years is indicated.\u0000","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"77 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72570664","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":"The in-ear region as a novel anatomical site for ecg signal detection: validation study on patients affected by atrial tachyarrhythmias","authors":"R. De Lucia, G. Zucchelli, S. Della Volpe, F. Fiorentini, M. Parollo, M. Giannotti Santoro, V. Barletta, A. Canu, L. Mazzocchetti, M. Bongiorni","doi":"10.1093/europace/euac053.568","DOIUrl":"https://doi.org/10.1093/europace/euac053.568","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: None.\u0000 \u0000 \u0000 \u0000 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.\u0000 \u0000 \u0000 \u0000 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.\u0000 \u0000 \u0000 \u0000 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).\u0000 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.\u0000 \u0000 \u0000 \u0000 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.\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":"72712933","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":"Should we implant cardioverter defibrillators in asymptomatic patients with Brugada syndrome?","authors":"N. Brankovic, N. Radovanovic, B. Kircanski, S. Pavlovic, N. Vujadinovic, V. Sajic, A. Milasinovic, V. Bisenić, M. Živković, G. Milasinovic","doi":"10.1093/europace/euac053.385","DOIUrl":"https://doi.org/10.1093/europace/euac053.385","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: None.\u0000 \u0000 \u0000 \u0000 Implantable cardiverter defibrillators (ICD) represent the only effective treatment in prevention of sudden cardiac death (SCD) in patients with Brugada syndrome (BrS). However, according to current ESC Guidelines, ICD implantation is recommended only in secondary prevention, while it should be considered in patients with a spontaneous diagnostic type I ECG pattern and history of syncope.\u0000 \u0000 \u0000 \u0000 We aimed to determine the frequency of ventricular tachyarrhythmias during the long-term follow-up among patients with BrS and ICDs implanted in primary or secondary prevention.\u0000 \u0000 \u0000 \u0000 This retrospective, observational study was conducted in a tertiary center among adult patients with BrS that underwent single or dual chamber ICD implantation from January 2008 to December 2017. The study group was devided into subgroups depending on weather the patients at the time of ICD implantation had documented sustained ventricular tachycardia (VT) or ventricular fibrillation (VF) regardless of the ECG type of BrS (group I), had BrS type I and history of syncope (group II) or had BrS type I and were asymptomatic but assessed as in high risk of SCD due to non-sustained VT episodes, younger age or history of SCD in close family members (group III). We used patients medical records for collecting the data about VT and VF episodes during the follow-up period.\u0000 \u0000 \u0000 \u0000 In the course of ten-year period, ICDs were implanted in 21 adult patients with BrS (66.7% were male). Mean age at the ICD implantation time was 40.3 ± 14.9 years. We analyzed 8 patients from group I, 7 patients from group II, and 6 patients from group III. Mean follow-up period was 82.5 ± 33.3 months. During the obsereved period, VT/VF episodes were appropriately detected in 7 patients from group I (87.5%), in 3 patients from group II (42.86%) and in one patient from group III (16.67%). Kruskal-Wallis test showed that there was a statistically significant difference in the occurrence of ventricular tachyarrhythmias among at least one pair of observed groups (p = 0.031). Using Dunn-Bonferroni post hoc analysis we found statistically significant difference between the patients with malignant arrhythmias and asymptomatic patients (p = 0.03), but not between the other pairs.\u0000 \u0000 \u0000 \u0000 Although asymptomatic patients with BrS are at significantly lower risk of SCD, it is important to identify high-risk patients in the low-risk group. Therefore, creating a tool for calculating the risk of SCD among these patients might be helpfull in everyday clinical practice.\u0000","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74584834","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":"Integration of structural and functional data in VT ablation -- SENSE2 protocol mapping","authors":"J. Collinson, F. Bangash, J. Dungu, S. Gedela, M. Westwood, C. Manisty, D. Farwell, S. Tan, H. Savage, K. Vlachos, R. Schilling, R. Hunter, N. Srinivasan","doi":"10.1093/europace/euac053.360","DOIUrl":"https://doi.org/10.1093/europace/euac053.360","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: None.\u0000 \u0000 \u0000 \u0000 We have previously developed the sense protocol functional substrate mapping technique for VT ablation(1). However, functional substrate characterizaiton can involve protracted mapping time.\u0000 \u0000 \u0000 \u0000 We incorporated the integration of MRI data using ADAS-3D software into the mapping workflow, to integrate structural mapping information into the functional mapping substrate characterization, in order to improve procedural efficiency.\u0000 \u0000 \u0000 \u0000 CMRs were performed in 20 patients with ischemic related VT and VT therapy in the previous 6 months. These were processed with the ADAS-3D software to characterize the extent of ventricular scars and also ADAS corridors which may correlate with VT channels. Focused substrate maps were then performed in patients, guided by the extent of ADAS scar and corridors, looking at the scar substrate in intrinsic rhythm and then functional channels using single extra pacing from the RV at 20ms above ERP (SENSE2 Protocol). Specifically healthy areas 2cm beyond the scar borderzone based on ADAS were not mapped, in order to reduce substrate mapping time and complete geometries were not created. Following delineation of functional channels pacemapping and entrainment mapping were used to confirm targets for ablation.\u0000 The ADAS 3D MRI was integrated into the into the VT substrate map on Ensite-Precision with alignment to the aorta, RV and PA (Figure 1). We compared our data with previous functional mapping data without the integration of MRI.\u0000 \u0000 \u0000 \u0000 20 patients (age 70 years; 19 male subjects) underwent ablation. Mean EF 28%. Median procedure time was 161 minutes compared with 246 minutes (in our previous study)(p=<0.001) Mean substrate mapping time was 32 mins vs 63 mins (p=<0.001). Mean ablation time was 22 mins vs 32 mins (p=0.11). 85% (17 of 20) patients were free from symptomatic VT/ anti-tachycardia pacing or implantable cardioverter defibrillator shocks at a median follow-up of 171 days. The mean VT burden was reduced from 22 events per patient in the 6 months’ pre-ablation to 1 event per patient in the median follow up period of 171 days post ablation (p=0.02). Mean shocks per-patient burden decreased from 3.5 to 0.08 in the same time period(p=0.03).\u0000 \u0000 \u0000 \u0000 The SENSE2 protocol involves the integration of structural and functional data into the VT workflow for substrate characterization. It enables focused substrate maps to be performed without the need for complete geometry to be created in large ventricles. Outcomes compare favourably with our previous data but with significantly shorter procedure times. This streamlined workflow has the potential to improve care in VT ablation by shortening procedure times with similar outcomes which may reduce risks for the patient.\u0000 Figure 1: Comparison of Voltage Map with MRI scar & corridors using ADAS\u0000","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75115214","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":"Prognostic impact of vascular disease in patients with atrial fibrillation: Insights from The Loire Valley Atrial Fibrillation Project","authors":"A. Fawzy, Q. Langouet, A. Bisson, A. Bodin, G. Lip, L. Fauchier","doi":"10.1093/europace/euac053.151","DOIUrl":"https://doi.org/10.1093/europace/euac053.151","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: None.\u0000 \u0000 \u0000 \u0000 Vascular disease which comprises peripheral artery disease, significant coronary artery disease and aortic disease is associated with both an increased risk of atrial fibrillation (AF) and ischaemic stroke in AF patients.\u0000 \u0000 \u0000 \u0000 We investigated the effect of vascular disease on the prognosis of AF patients.\u0000 \u0000 \u0000 \u0000 In this retrospective analysis, all patients with AF were identified and classified into 2 groups depending on the presence of vascular disease. 3 patients were excluded due to missing data. Primary outcome was a composite of death, stroke and thromboembolic events. Secondary outcomes included all-cause mortality, stroke or systemic embolism (SSE), ischaemic stroke, haemorrhagic stroke and major bleeding.\u0000 \u0000 \u0000 \u0000 A total of 8962 patients were included; 3021 with vascular disease and 5941 without vascular disease and followed up over a mean period of 929±1082 days. On the univariate analysis, patients with vascular disease were at a higher risk of all-cause mortality hazard ratio (HR) 1.728 ((confidence interval (CI)1.549-1.928), SSE HR HR 1.477 (CI 1.274-1.714), ischaemic stroke HR 1.441 (CI 1.202-1.727), major bleeding HR 1.488 (CI 1.292-1.713) and a composite of death and SSE HR 1.643 (CI 1.489-1.812), compared to patients without vascular disease. On a multivariate analysis, after adjusting for components of the CHA2DS2VASc score, oral anticoagulation (warfarin) use and antiplatelet use, the increased risk of all-cause mortality HR 1.460 (CI 1.285-1.658), SSE HR 1.226 (CI 1.030-1.458) and major bleeding HR 1.186 (CI 1.005-1.400) remained statistically significant, but the risk of ischaemic stroke was no longer significant, HR 1.187 (CI 0.960-1.469). Compared to those without vascular disease, patients with vascular disease were at a lower risk of haemorrhagic strokes but this was not significant.\u0000 \u0000 \u0000 \u0000 AF patients with vascular disease are at a higher risk of all-cause mortality, SSE and major bleeding compared to patients without vascular disease, indicating that patients with this combination require careful and holistic management in terms of risk factor control and treatment. Additional research is required to further characterise the relationship between the two.\u0000","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"33 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72660631","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}