EP Europace最新文献

{"title":"Adherence to oral anticoagulation in a Belgium atrial fibrillation population measured by a medical event monitoring system","authors":"L. Knaepen, M. Delesie, J. Vijgen, P. Dendale, J. Ector, L. Desteghe, H. Heidbuchel","doi":"10.1093/europace/euac053.285","DOIUrl":"https://doi.org/10.1093/europace/euac053.285","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: Other. Main funding source(s): The AF-EduCare study is a project supported by the Fund for Scientific Research, Flanders (T002917N). The AF-EduApp study is supported by an BMS/Pfizer European Thrombosis Investigator Initiated Research Program (ERISTA) grant.\u0000 \u0000 \u0000 \u0000 Treatment with oral anticoagulation (OAC) is one of the main pillars in the management of atrial fibrillation (AF). Therapy adherence to both VKA and NOAC is important. Education and intake monitoring are recommended to improve therapy adherence.\u0000 \u0000 \u0000 \u0000 The main purpose of this project was to evaluate the effect of personalized follow-up strategies on therapy adherence to OAC in AF patients.\u0000 \u0000 \u0000 \u0000 In a multicentre, Belgian randomized controlled trial, the AF-EduCare/AF-EduApp study, the effect of different personalized education strategies (i.e. in-person, online or app-based education) is evaluated on clinical outcome parameters of AF patients compared to standard care (SC). One of the outcome parameters is therapy adherence to OAC. During the first 3 months of the trial, patients’ adherence to NOAC or VKA was measured with the Electronic Medication Event Monitoring System (MEMS). The MEMS cap fits on a medication bottle and registers the date and time of every bottle opening. Regimen adherence was defined as the the number of days with the correct number of openings according to the specific OAC regimen divided by the total number of monitored days. As dabigatran has to be stored in the original package to protect it from moisture and VKAs have a variable scheme between patients, a proxy-medication (i.e. another oral drug that needed to be taken once or twice daily and on the same moment of the day as dabigatran or VKA) was chosen to measure medication adherence. Patients in the education groups received a MEMS cap with LCD screen providing direct feedback by showing the number of openings within 24h. A small sample of the SC group also received a MEMS cap as controls, but without LCD screen to minimally trigger these patients.\u0000 \u0000 \u0000 \u0000 A total of 593 AF patients underwent adherence monitoring, of which 514 (86.7%) in the intervention group and 79 (13.3%) in the SC group. The mean age was 70.1±7.7 years, mean time since AF diagnosis was 5.8±6.9 years, and mean CHA2DS2-VASc score was 3.2±1.5. Overall adherence was high: 94.8% of the patients had an adherence >80% and 80.9% had an adherence >90%. A small but significant difference in adherence was observed between the intervention groups and the standard care group (intervention group 97% (5-100); SC 96%(24-100); p=0.024; Figure1). Also between the four study groups a significant difference was seen (in-person 97% (93.5-99); online 98% (94-100); app-based 98% (92-99); p=0.049) driven by a significant difference between the online and SC group (p=0.009).\u0000 \u0000 \u0000 \u0000 Overall adherence to OAC in all study groups and even in SC was high. The high adherence percentage in the SC group could be related to the Hawthorn","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"67 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86690259","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 tachycardia channels ablation incorporating automated high-density mapping guidance: data from the CHARISMA registry","authors":"A. Battaglia, R. Calvanese, C. Pandozi, G. Tola, F. Solimene, L. Rossi, F. Cauti, S. Pedretti, Roberto Mantovan, G. Pelargonio, A. Castro, M. Gagliardi, G. Izzo, M. Malacrida, M. Scaglione","doi":"10.1093/europace/euac053.358","DOIUrl":"https://doi.org/10.1093/europace/euac053.358","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: None.\u0000 \u0000 \u0000 \u0000 Ventricular tachycardia (VT) ablation targeting conducting channels (CC)s based on timing of late potentials (LPs) during sinus rhythm (dechanneling) may facilitate a scar homogenization strategy without the need for extensive ablation and possibly lead to higher successful rate.\u0000 \u0000 \u0000 \u0000 We evaluated the feasibility and safety of a CC identification and ablation approach by means of an ultra-high density mapping system with a novel automated algorithm in ischemic VT procedures.\u0000 \u0000 \u0000 \u0000 Consecutive patients indicated for ischemic VT ablation were prospectively included. A complete map of the left ventricle was performed prior and after ablation through the Rhythmia mapping system. Channels were defined as any signal activity bounded by anatomic and functional barriers and characterized through the Lumipoint (LM) tool and continuous activation was used on the whole ventricular substrate. Procedural end point was the elimination of all identified CCs by ablation at the CC entrance and exit followed by abolition of any residual LPs inside the CC. The ablation endpoint was noninducibility. Data are reported as mean±SD.\u0000 \u0000 \u0000 \u0000 A total of 36 channels were identified through LM from 28 patients (1.2±0.5 per patient): 21 (75%) patients had 1 CC, 6 (21.4%) had 2 CCs and 1 (3.6%) had 3 CCs. LPs were identified inside CCs in 19 cases (67.9%). In 8 cases (28.6%) LPs were present both inside and outside and in 1 (3.6%) case LPs were present only outside the CC. LPs inside channels covered an area of 7.6±5 mm2 with a ratio between LPs area and CCs’ area of 67.4±31.8%. In 12 (43%) cases LPs area covered more than 90% of the CCs’ area. At voltage map analysis a total of 34 CC were identified: 1 CC was present in 75% of the cases, 2 CCs in 17.9% and 3 CCs in 3.6%. LPs were identified only inside CCs in 46.4% of the cases, both inside and outside in 42.9% and only outside in 10.7%. Healthy tissue (voltage level≥0.5mV) was prevalent (68.2±17%), followed by intermediate voltage areas (0.5-0.05 mV; 31.1±17%) and very low voltage areas (<0.05mV; 0.7±1%). LPs were found mostly at intermediate voltage areas (57.0±34% of the covered area; 39.1±33% at healthy tissue and 3.4±13% at very low voltage areas). LM was more accurate than traditional voltage mapping in identifying CCs: in 6 (21.4%) cases voltage map overestimated LPs areas, in 2 (7.1%) cases failed to fully identify LPs and only in 19 out 28 (67.8%) LM and voltage map had a complete agreement. All CCs’ entrance and exit were successfully ablated and abolition of any residual LPs inside the CC was achieved in all patients. No complication occurred. Noninducibility was achieved in all (100%) the cases.\u0000 \u0000 \u0000 \u0000 In this experience, a channel identification approach through the advanced Lumipoint tool was more accurate than traditional voltage mapping and seems to be safe, feasible, and effective at least in the acute setting of ischemic VT ablation.\u0000","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"12 21","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91442386","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 If current blockade increases right atrial mRNA expression of HCN4, encoding proteins for If","authors":"A. Scridon, V. Halatiu, AI Balan, D. Cozac, V. Moldovan, C. Bănescu, R. Serban","doi":"10.1093/europace/euac053.320","DOIUrl":"https://doi.org/10.1093/europace/euac053.320","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work was supported by a grant of the Romanian Ministry of Education and Research, CNCS - UEFISCDI, within PNCDI III\u0000 \u0000 \u0000 \u0000 Numerous long-term pharmacologic manipulations of cardiac ion channels have shown potential to modify the expression of genes encoding proteins for those channels.\u0000 \u0000 \u0000 \u0000 We aimed to investigate whether long-term pharmacologic inhibition of the hyperpolarization-activated inward current (If) using ivabradine affects the right atrial expression of genes encoding for hyperpolarization-activated cyclic nucleotide-gated (HCN) channels, responsible for If.\u0000 \u0000 \u0000 \u0000 The right atrial mRNA expression of HCN1, HCN2, and HCN4, and of the neuron-specific HCN3 isoform was quantified in 6 control (Control) and 12 ivabradine-treated (IVA; 10 mg/kg, 4 weeks) adult male Wistar rats. The expression levels of the target genes were normalized with GAPDH housekeeping gene levels and compared between the two groups.\u0000 \u0000 \u0000 \u0000 Right atrial HCN1 and HCN2 expression levels were both similar (both p >0.05) between the IVA and the Control rats. There was also no significant difference in the right atrial expression of the neuron-specific HCN3 isoform between the two groups (p = 0.22). However, the right atrial expression of HCN4, the most highly expressed HCN isoform in the sinus node, was significantly higher in the ivabradine-treated compared to the non-treated rats (p = 0.02).\u0000 \u0000 \u0000 \u0000 Our study shows that chronic If blockade using ivabradine significantly up-regulates right atrial HCN4 expression. Although the examined samples contained both nodal and non-nodal tissue, since HCN4 is highly expressed in the nodal pacemaker cells and only sparsely in the remaining atrial myocardium, it is likely that the HCN4 changes observed in our study reflect sinus node alterations. HCN4 and a consequent If up-regulation could render the sinus node less sensitive to acute vagal inputs and protect against excessive vagal-induced bradycardia. Further studies will have to evaluate this hypothesis.\u0000","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"14 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91465696","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":"How to better identify patients at high risk of inappropriate shocks before S-ICD implantation: Results from a multicenter experience","authors":"M. Ben Kilani, P. Jacon, N. Badenco, C. Marquié, P. Ollitrault, N. Béhar, P. Khattar, A. Carabelli, S. Venier, P. Defaye","doi":"10.1093/europace/euac053.464","DOIUrl":"https://doi.org/10.1093/europace/euac053.464","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: None.\u0000 \u0000 \u0000 \u0000 Despite the recent improvements, inappropriate shocks (IAS) in patients implanted with subcutaneous implantable cardioverter-defibrillator (S-ICD) remain a challenge in \"real-life\" practice. The purpose of this study was to assess the preoperative predictive factors of IAS with the latest generation of S-ICD, with a particular focus on data obtained during the screening procedure.\u0000 \u0000 \u0000 \u0000 Between January 2017 and March 2020, 300 patients implanted with Generation 3 S-ICD system for primary and secondary prevention were included in this multicentric study. Follow-up (FU) of at least 6 months and preoperative screening procedure data were mandatory for all patients.\u0000 \u0000 \u0000 \u0000 After a mean follow-up of 22.8 (±11.4) months, appropriate therapies occurred in 12.3% patients; while 26 patients (8.7%) experienced inappropriate therapies (incidence 4.9 per 100 patient-years). The total number of inappropriate shock episodes was 48; 9 patients experienced multiple episodes. Causes of IAS were: supraventricular arrhythmias (34.6%), cardiac (30.7%) and extra-cardiac noise oversensing (38.4%). In univariate analysis, availability of all 3 sensing vectors during preoperative screening significantly reduced inappropriate therapies occurrence (hazard ratio [HR], 0.32; 95% confidence interval [CI], 0.12-0.89, P=0.028). Clinical preoperative S-ICD inappropriate shocks predictors were: history of Supraventricular Tachycardia (SVT)(HR, 4.42; 95% CI, 1.45-13.47; P=0.009); overweight (BMI>25: HR, 1.93; 95% CI, 0.83-0.4.48; P=0.13); QRS duration (HR, 1.01; 95% CI, 0.1-1.03; P=0.14) and lower QRS/T wave ratio in lead I (for a threshold < 3: HR, 4.44; 95% CI, 1.88-10.48; P=0.001). By multivariate analysis, independent factors associated with IAS were: the availability of less than 3 sensing vectors during preoperative screening (p<0.05), a low QRS/T wave ratio in lead I (for a threshold <3; p<0.001), history of SVT (p<0.001) and overweight (BMI> 25; p<0.05).\u0000 \u0000 \u0000 \u0000 Automatic preoperative screening data is of high interest as a predictor of IAS with a quantitative value. ECG specificities in association with other clinical factors should be taken into consideration to identify patients at high risk for IAS.\u0000","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"23 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91494413","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":"Assessing the field of view of multisize electrodes in ischemic cardiomyopathy by validating against ex-vivo high resolution cardiac magnetic resonance","authors":"S. Omara, C. Glashan, BJ Tofig, Q. Tao, SA Blom, J. Nielsen, P. Lukac, S. Kristiansen, R. van der Geest, K. Zeppenfeld","doi":"10.1093/europace/euac053.344","DOIUrl":"https://doi.org/10.1093/europace/euac053.344","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: Public hospital(s). Main funding source(s): Leiden University Medical Centre\u0000 \u0000 \u0000 \u0000 Substrate identification after myocardial infarction (MI) relies on voltage mapping. Early reperfusion results in non-transmural scar (NTS). Narrow-spaced microelectrodes (ME) are thought to have a limited field of view (FOV). The role of ME for delineation of NTS is unclear.\u0000 \u0000 \u0000 \u0000 To evaluate mapping with multi-size electrodes for identifying NTS, validated against high-resolution ex-vivo cardiac magnetic resonance imaging (HR-LGE-CMR).\u0000 \u0000 \u0000 \u0000 Nine swine with early reperfusion MI underwent endocardial electroanatomical voltage mapping (EAVM) with the QDOT catheter which incorporates three ME in the 3.5mm tip electrode. HR-LGE-CMR (0.3mm slices) were obtained and merged with EAVM. At each EAVM point a transmural cylinder (5mm radius) was projected on the CMR and the volume of viable myocardium (VM) in the cylinder quantified (Otsu method). Unipolar (UV) and bipolar (BV) voltages from conventional (c) and microelectrodes (µ) were related to VM. Cut-off values for normal myocardium were based on 5th percentiles of areas without fibrosis.\u0000 \u0000 \u0000 \u0000 In each swine 220 (IQR 216-260) mapping points were collected (total 2322 points). Cut-off for normal myocardium were 3.18 mV, 0.85 mV, 3.28mV and 1.93 mV for UVc, BVc, UVµ and BVµ, respectively. Wall thickness (WT) was reduced in areas with fibrosis vs. no fibrosis (5.4mm, IQR 3.2- 6.9 vs. 7.4mm, IQR 5.3 - 9.6). All voltages were reduced at sites with fibrosis vs. no fibrosis (UVs 4.4mV vs. 6.8mV; BVc 1.2mV vs. 2.1mV; UVµ 2.5mV vs. 5.5mV, and BVµ 2.9mV vs. 5.4mV, all p<0.001).\u0000 For areas with any fibrosis, all voltages increased with increasing WT up to the maximal WT of 13mm (fig. 1). Similarly, all voltages increased with an increase in VM volumes from >200mm3 to >600 mm3 (equivalent to a cylinder with h=7.64mm) (fig. 2) with the strongest correlation for UVµ (r=0.47). Below a volume of 200mm3 VM voltages did not correlate significantly with VM.\u0000 \u0000 \u0000 \u0000 In NTS, UVc, BVc, and, notably, BVµ and UVµ increase with increasing WT and increasing transmural volume of VM, with the biggest role perhaps laid out for UVµ to estimate transmural VM. EAVM cannot accurately delineate areas with the lowest amount of VM, potentially due to insufficient far field cancellation in NTS. Both these findings argue against a limited FOV of ME.\u0000","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"91 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79103968","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":"Endurance training induced cellular electrophysiological remodeling in a small and a large animal athlete’s heart model","authors":"T. Topal, A. Polyák, N. Tóth, N. Zombori-Tóth, S. Déri, L. Virag, N. Jost, A. Farkas, I. Baczkó, A. Farkas, A. Varró","doi":"10.1093/europace/euac053.554","DOIUrl":"https://doi.org/10.1093/europace/euac053.554","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Funding: It was supported by NKFIH grants (K-19992, K- 135464, GINOP-2.3.2-15-2016-00047).\u0000 \u0000 \u0000 \u0000 The positive impact of regular exercise on a healthy and fulfilling lifestyle. Therefore, active athletes are considered the healthiest members of our society. However, there is an increasing amount of evidence that long-term high-intensity sporting activity could also have adverse effects on the heart, such as impaired electrophysiological properties. Heavy long-term training can lead to structural and functional remodelling of the heart, which in turn, can evoke malignant cardiac arrhythmias.\u0000 \u0000 \u0000 \u0000 To develop animal models with a significant translational value of the human athlete’s heart and to investigate underlying malignant drivers of cardiac arrhythmias due to the long-term endurance training in in vitro studies.\u0000 \u0000 \u0000 \u0000 24 dogs from both sexes and 26 male guinea pigs were randomly assigned to sedentary (’Sed’) and trained (’Tr’) groups (n = 12-12; n=13-13). The latter group underwent a long-term endurance interval-training program on the treadmill 5 days a week for 4 months. ECG recordings and echocardiography validated the characteristic of athlete’s heart. After heart removal, the degree of interstitial fibrosis was quantified and ventricular myocytes were enzymatically dissociated via retrograde perfusion. The transmembrane ionic currents were recorded using the whole-cell configuration of the patch-clamp technique. The action potentials were measured by the perforated patch-clamp technique. Immunocytochemistry measurements were performed to determine the density of transmembrane ion channels.\u0000 \u0000 \u0000 \u0000 Based on the ECG and ECHO results, the vigorous training program resulted in significant cardiac adaptation in both species. In addition, it caused mild ventricular fibrosis. The repolarization is reflected as the 90 percent of action potential duration (APD90). It was significantly lengthened in the left ventricular myocytes of ‘Tr’ dogs. (‘Tr’ vs. ‘Sed’ 472.8±29.6 ms; =29 vs. 369.3±31.4 ms; n=24, p=0.023) and there was no difference in the case of guinea pigs. The amplitude of the transient outward current (Ito), which is not expressed in the guinea pig heart, was significantly smaller in the ‘Tr’ dogs (‘Tr’ vs. ‘Sed’ 7.6±0.6 pA/pF, n=54 vs. 10.2±1.0 pA/pF, n=42, p<0.05). Under the currently used protocols, no differences were detected in the magnitude of other ionic currents. The HCN4 gene expression was significantly higher in isolated myocytes in ’Tr’ dogs.\u0000 \u0000 \u0000 \u0000 Increased ectopic activity is not rare among top athletes. Our results suggest an association between increased arrhythmia susceptibility and impaired repolarisation reserve related to down-regulation of Ito and prolonged APD90 and enhanced fibrotic changes. The overexpression of HCN4 gene in hypertrophic hearts, similar to heart failure, may evoke malignant ventricular arrhythmias. F","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":"79108063","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 effect of implantable cardioverter defibrillator in patients with cardiac resynchronizational therapy and diabetes mellitus","authors":"R. Masszi, E. Merkel, W. Schwertner, B. Veres, A. Behon, A. Pintér, I. Osztheimer, E. Zima, L. Gellér, D. Becker, A. Kosztin, B. Merkely","doi":"10.1093/europace/euac053.494","DOIUrl":"https://doi.org/10.1093/europace/euac053.494","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: Public grant(s) – National budget only. Main funding source(s): (NKFIA; NVKP_16-1-2016-0017 National Heart Program).\u0000 \u0000 \u0000 \u0000 Heart failure (HF) and diabetes mellitus (DM) are common causes of death on their own, but the coexistance of these two diseases are especially fatal. 1 In DM, sudden cardiac death (SCD) is more common than in non-DM patients, however in many cases, implantable cardioverter defibrillator (ICD) could not prevent SCD. 2\u0000 \u0000 \u0000 \u0000 Our aim is to decide which device warrant higher life expectancy, cardiac resynchronizational therapy with or without defibrillator.\u0000 \u0000 \u0000 \u0000 We examined retrospectively 2525 CRT implanted patients, with a mean follow-up time of 4.6 years. Implantaions were based on the current guidelines. The primary endpoint was all-cause mortality, while our composite end-point were all-cause mortality and heart failure hospitalization.\u0000 \u0000 \u0000 \u0000 In our population, 928 people (36%) had diabetes. We did not find statistical differences between age (68 vs. 68 years; p<0.099), gender (26% women, 23% women; p<0.08) LVEF (28% vs. 29% p<0.1425), incidence of atrial fibrillation (37% vs. 38%; p<0.76), implantation of an ICD (53% vs. 54%; p<0.847), NT-proBNP median levels (2939 pg/ml vs. 2778 pg/ml; p<0.35), and NYHA I (0,5% vs. 0,5%; p<0.898), and NYHA IV stadium (11% vs. 11%; p<0,82). However DM patients had higher BMI (28 kg/m2 vs. 26 kg/m2; p<0.001), lower eGFR levels (57 ml/min/1,73m2 vs. 60 ml/min/1,73m2; p<0.011) higher prevalence of hypertonia (82% vs. 66%; p<0.001), NYHA III stadium (39% vs. 33%; p<0,0008), ischemic etiology (56% vs. 44%; p<0.001), previous acute myocardial infartion (42,9% vs. 36%; p<0.001), a percutan coronaria intervention (35% vs. 25%; p<0.001) compared to non-DM patients. Those patients with DM showed a 25% higher risk of all-cause mortality (HR 1.25; 95% CI 1.12-1.40; p‹0.01) then non-DM patientes, also observable after adjusting for relevant clinical covariates such as age, gender, atrial fibrillation and the addition of an ICD (HR 1.17; 95% CI 1.06-1.31; p‹0.01).\u0000 \u0000 \u0000 \u0000 Adding an ICD for CRT patients with diabetes reduces the risk of all-cause mortality significantly by 32% (HR 0,68; CI 0,56-0,82; p‹0.001) during the first six years but diminished on longer follow-up time (HR 0,95; CI 0,80-1,12; p=0,54).\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":"79194699","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":"Feasibility and long-term outcomes of leadless pacemaker implant after transvenous lead extraction","authors":"M. Parollo, V. Barletta, L. Mazzocchetti, F. Gentile, R. De Lucia, S. Viani, L. Segreti, A. Di Cori, G. Zucchelli, M. Bongiorni","doi":"10.1093/europace/euac053.414","DOIUrl":"https://doi.org/10.1093/europace/euac053.414","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: None.\u0000 \u0000 \u0000 \u0000 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.\u0000 The use of leadless pacing systems has been described as a potentially useful technology that could tackle the obstacles that affect this peculiar population.\u0000 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.\u0000 \u0000 \u0000 \u0000 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.\u0000 \u0000 \u0000 \u0000 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).\u0000 \u0000 \u0000 \u0000 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.\u0000","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88502809","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":"Differentiating border-zone tissue from post-infarct scar using ripple mapping during VT ablation","authors":"D. Khanra, P. Calvert, P. Wright, S. Hughes, S. Mahida, M. Hall, D. Todd, D. Gupta, V. Luther","doi":"10.1093/europace/euac053.352","DOIUrl":"https://doi.org/10.1093/europace/euac053.352","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: None.\u0000 \u0000 \u0000 \u0000 Areas of post-infarct ventricular scar and border-zone slow conduction are often highlighted on a bipolar voltage map with generalized values 0.5mV–1.5mV. The true voltage that differentiates regions of conducting from non-conducting tissue is unknown. Ripple Mapping (RM)displays allows conducting tissue to be seen as areas supporting Ripple activation, and non-conducting tissue as areas devoid of Ripple activation.\u0000 \u0000 \u0000 \u0000 We describe application of Ripple Maps to differentiate areas of scar from conducting tissue during ischemic VT ablation.\u0000 \u0000 \u0000 \u0000 Dense bipolar voltage maps were created (Pentaray catheter, pacing 80-100bpm) and presented as a single value (e.g. 0.5mV-0.5mV) to binarize the color display (red and purple). RMs were superimposed on the voltage map and played above a pre-set noise threshold (>0.05mV). The voltage map mV limit was sequentially reduced (\"border-zone threshold\") until only those areas devoid of Ripple bars appeared red. The surrounding border-zone supporting ripple activation thus appeared purple. We performed off-line analysis of border-zone voltage thresholds from a series of RM guided VT ablations.\u0000 \u0000 \u0000 \u0000 10 consecutive patients (LVEF 32.3±7.5%) with remote myocardial infarction underwent VT ablation (median 19days (IQR 8-33) since last VT). Bipolar voltage mapping (5873±2841 points, median shell area 224cm2), revealed voltages<0.5mV covered a median 11% (IQR 7-17%) of the shell. The border-zone voltage threshold was median 0.2mV (range 0.12mV - 0.3mV). Non-conducting tissue below this value covered only median 5% (IQR 3-7%) of the entire shell. VT was mappable in 4 patients, and the isthmus was bordered by tissue below the same border-zone threshold as found in normal rhythm. The border-zone was homogenized with ablation(40-50W, median 29 mins (IQR 22-33), and clinical VT was non-inducible in all, and 9 pts (91%) remain sustained VT-free at median 90-day follow-up (IQR 23-139), 2-weeks blanking period).\u0000 Picture 1 presents an infero-lateral LV infarct collected in an RV paced rhythm (7340points) and displayed at conventional bipolar voltage settings 0.5-1.5mV. Tissue with voltages<0.5mV appear red and cover 30% of the total area. In this case, this border-zone voltage threshold was defined as 0.25mV. Non-conducting tissue, seen as areas devoid of ripple bars below this value, now appeared as red, and covered only 11% of the total area. Picture 2 demonstrates the morphologies of 4 poorly tolerated induced VTs during this case. Each had near perfect pacemaps to the exit sites of border-zone tissue defined using this approach, and were targets for ablation resulting in complete non-inducibility and no VT recurrence in early follow-up.\u0000 \u0000 \u0000 \u0000 The bipolar voltage that differentiates putative scar from bordering conducting tissue is unique to each patient, and far lower than 0.5mV-1.5mV. RM presents a practical approach to visualize the border-zone activation to guide ablation","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"51 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88577176","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":"Clinical validation of five direct-to-consumer smartwatches to detect atrial fibrillation in a real-world cohort of patients","authors":"D. Mannhart, E. Hennings, ML Lischer, DV Voegeli, J. Du Fay De Lavallaz, S. Knecht, B. Schaer, S. Osswald, M. Kuehne, C. Sticherling, P. Badertscher","doi":"10.1093/europace/euac053.572","DOIUrl":"https://doi.org/10.1093/europace/euac053.572","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: None.\u0000 \u0000 \u0000 \u0000 Atrial fibrillation (AF) is the most common cardiac arrhythmia with an estimated lifetime risk of one in four. Multiple smartwatches capable to \"screen\" AF are presently available. The sensitivity and specificity for the detection of AF may differ between the available smartwatches, but this has not yet been adequately investigated.\u0000 \u0000 \u0000 \u0000 We enrolled patients presenting to a cardiology service at a tertiary referral center in a prospective, observational study. The aim of this study was to assess and compare the accuracy of five smartwatches (Apple Watch 6, AliveCor Kardia Mobile, Fitbit Sense, Samsung Galaxy Watch 3 and Withings Scanwatch) in identifying AF compared to a nearly simultaneously acquired physician-interpreted 12-lead ECG in a real world cohort of patients. Each patient was assessed with at least 4/5 smartwatches. Secondary objective was to assess patient preference using smartwatches via predefined questionnaire.\u0000 \u0000 \u0000 \u0000 We prospectively enrolled 163 patients (32.9% female, mean age 64.7 years). AF was present in 47 patients (30.3%) at time of recording. We included 155 patients with 4 or 5 individual recordings for further analysis. Sensitivity and specificity for the detection of AF was similar between smartwatches: 90% and 95% for the Apple Watch 6, 97% and 96% for the AliveCor Kardia Mobile, 86% and 100% for the Fitbit Sense, 97% and 91% for the Samsung Galaxy Watch 3 and 91% and 95% for the Withings Scanwatch, respectively (Figure1). The rate of inconclusive tracings, meaning the algorithm was not able to determine the heart rhythm, was 17%, 26%, 21%, 20% and 24% for the Apple Watch 6, AliveCor Kardia Mobile, Fitbit Sense, Samsung Galaxy Watch 3 and Withings Scanwatch, respectively. Among inconclusive individual tracings from all devices, 63 tracings (40%) were due to high or low heart rate and 50 tracings (31%) due to motion artifacts. The inconclusive recordings were interpreted by blinded cardiologists to determine if these tracings are still clinically useful. By manual review the rhythm could be determined in 98.8% of 741 total individual recorded single-lead ECGs. Regarding patient acceptance, the Apple Watch was ranked first (37%) and the AliveCor Kardia Mobile last (7.6%) when patients were asked about their preferred device for daily rhythm monitoring.\u0000 \u0000 \u0000 \u0000 In this clinical validation of five direct-to-consumer smartwatches we found a high diagnostic accuracy among all assessed smartwatches. We found differences in the amount of inconclusive tracings. In a clinical setting manual review of tracings is required in about one fourth of cases for all assessed smartwatches. In addition, patient’s perception differed between smartwatches. This clinical validation study of these smartwatches may help to better advice patients and physicians in the usage and validity of single-lead ECG-devices for everyday use.\u0000","PeriodicalId":11720,"journal":{"name":"EP Europace","volume":"36 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89345932","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}