ABSTRACT The traditional pulse generator implantation site lies subcutaneous on the fascia of the pectoralis major muscle. This article describes a subpectoral pocket approach, which on anatomic investigation is actually... more
ABSTRACT The traditional pulse generator implantation site lies subcutaneous on the fascia of the pectoralis major muscle. This article describes a subpectoral pocket approach, which on anatomic investigation is actually "intrapectoral" and offers a much improved cosmetic result with the potential advantage of less erosion. In the authors' experience with over 1000 initial pacemaker implants and pulse generator replacements, the potential concerns of neurovascular and muscular damage have not been realized. There has been no pulse generator damage from the ribs, serious loculated hematomas, or unusual postoperative or chronic pain. From experience with pulse generator recalls, the replacement procedure has not been significantly more difficult than with the subcutaneous approach. The intrapectoral approach has now become the authors' routine in patients without significant adipose tissue overlying the pectoralis major muscle.
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A 16-year-old boy presented with exertional palpitations, which occurred particularly when he was playing tennis. There was no history of syncope or family history of sudden cardiac death. The boy was otherwise well and had not been... more
A 16-year-old boy presented with exertional palpitations, which occurred particularly when he was playing tennis. There was no history of syncope or family history of sudden cardiac death. The boy was otherwise well and had not been taking any medications. ECG showed sinus rhythm with no evidence of preexcitation and a normal corrected QT interval. A 24-hour Holter monitor demonstrated an irregular broadcomplex tachycardia with varying QRS morphology. At electrophysiologic study, the HV interval was normal at 35 ms. During atrial pacing with a single extrastimulus, tachycardia with a variable cycle length was induced (Fig. 1). During tachycardia, the QRS complexes demonstrated varying degrees of left bundle branch block (LBBB) morphology. Following reinduction, tachycardia with a right bundle branch block (RBBB) morphology was present, with the variation in tachycardia cycle length less apparent (Fig. 2). What is the mechanism of the tachycardia, and what accounts for the variation in tachycardia cycle lengths?
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Focal atrial fibrillation (AF) may initiate with an irregular rapid burst of atrial ectopic (AE) activity from a pulmonary vein (PV) focus, but how AF is maintained it is not known. The crista terminalis (CT) is an important line of block... more
Focal atrial fibrillation (AF) may initiate with an irregular rapid burst of atrial ectopic (AE) activity from a pulmonary vein (PV) focus, but how AF is maintained it is not known. The crista terminalis (CT) is an important line of block in atrial flutter (AFL), but its role in AF has not been determined. The aim of this study was to examine the conduction properties of the CT during onset of AF. In 10 patients (mean age 38 +/- 8 years), we analyzed conduction across the CT during onset of focal AF from an arrhythmogenic PV and during pacing from the same PV at cycle lengths of 700 and 300 ms. A 20-pole catheter was positioned on the CT using intracardiac echocardiography. In 10 control patients with no history of AF, we analyzed conduction across the CT during pacing from the distal coronary sinus at 700 and 300 ms. In all 10 AF patients, AF was initiated with 1 to 9 AE beats (median 5) from a PV. During sinus rhythm, there were no split components (SC) recorded on the CT. During PV AE activity, discrete SC were recorded on the CT in all patients over 6.3 +/- 0.9 bipoles (3.7 +/- 0.3 cm). Maximal splitting of SC was 66 +/- 31 ms (37-139). There was an inverse relationship between AE coupling intervals and the degree of splitting between SC in all patients. Degeneration to AF was preceded by progressive decrement across the CT. SC were recorded during PV pacing at 700 and 300 ms (maximal distance between SC of 24 +/- 3 ms and 43 +/- 5 ms, respectively, P < 0.001). Maximum SC at CT in controls was 13 +/- 8 ms at 700 ms (P = 0.06 vs AF patients) and 16 +/- 9 ms at 300 ms (P < 0.01 vs AF patients). (1) These observations provide evidence of anisotropic, decremental conduction across the CT during onset of focal AF and during pacing from the same PV. A line of functional conduction block develops along this anatomic structure (CT). Whether this line of block acts as an initiator of AF or simply contributes passively to nonuniform fibrillatory conduction is unknown. (2) In some patients with focal AF, development of conduction block along the CT may provide a substrate for typical AFL.
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Research Interests: Cardiology, Treatment Outcome, Medicine, Prospective studies, Humans, and 14 moreInternal Medicine, Female, Male, Atrial Fibrillation, Recurrence, Middle Aged, Randomized Controlled Trial, Ablation, Catheter ablation, Reconnection, Pulmonary vein isolation, Reoperation, Paroxysmal atrial fibrillation, and Cardiovascular medicine and haematology
Research Interests: Cardiology, Aging, Medicine, Prospective studies, Humans, and 13 moreInternal Medicine, Atrial Fibrillation, Aged, Middle Aged, Adult, Public health systems and services research, Age Factors, Right Atrium, Body Surface Potential Mapping, The American, Statistics as Topic, Cardiovascular medicine and haematology, and Heart atria
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Research Interests: Cardiology, Medicine, Electrocardiography, Heart Failure, Transplantation, and 15 moreHumans, Internal Medicine, Female, Male, Heart, Clinical Sciences, Aged, Middle Aged, Cardiac Arrhythmias, Adult, Catheter ablation, Atrial Flutter, Heart Transplantation, atrial tachycardia, and Lung Transplantation
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Introduction In selecting patients that may benefit from cardiac resynchronisation therapy (CRT), dyssynchrony assessment by echocardiography based only upon the timing of regional contraction is limited by being inherently independent of... more
Introduction In selecting patients that may benefit from cardiac resynchronisation therapy (CRT), dyssynchrony assessment by echocardiography based only upon the timing of regional contraction is limited by being inherently independent of underlying myocardial contractility. We hypothesised that patient selection may be enhanced using a strain-based parameter based not only the timing of myocardial segmental motion, but also on the amplitude of contraction, a potential measure of contractile reserve. We assessed a combined early and late strain index (ELSI) to predict CRT response. Methods Speckle tracking radial strain was performed in 67 heart failure patients scheduled for CRT (age 69±9 years, ischaemic 56%, QRS 154±12 ms, NYHA III/IV—63/4, ejection fraction 23±7%). The ELSI was calculated as the sum for each of the 12 non apical segments of the difference in peak radial strain and strain at aortic valve closure. CRT response was defined as a >15% reduction from baseline in LV end systolic volume (LVESV) at 6 months. The predictive value of the ELSI was compared to previously reported dyssynchrony measures including the SD of time to peak myocardial longitudinal velocity of the 12 non apical segments (Ts SD12), the anteroseptal–posterior wall radial strain delay (AS-P delay) and the SD of time to peak radial strain of 12 segments (Rs-SD12). Results Response to CRT occurred in 38/67 (57%) patients. Significant differences were seen between responders and non responders in the ELSI (91±45 vs 27±14%, p<0.01), AS-P delay (256±158 vs 94±87 ms) and the Rs-SD12 (143±62 vs 75±50 ms). There was no difference in the Ts SD12 between responders and non responders. The ELSI had the best correlation with LVESV reduction (r=0.61, p<0.001) and using an optimal cut-off of 40% (AUC=0.94), the ELSI was able to predict response to CRT with a sensitivity of 93% and specificity of 95%. This was much higher than for the AS-P (cut-off 130 ms, AUC=0.79, sensitivity 71%, specificity 74%) and Rs –SD12 (95 ms, AUC=0.82, sensitivity 73% specificity 75%). Conclusion A combined early and late strain parameter based on both the timing and amplitude of segmental strain has a stronger predictive value in determining CRT response compared to widely reported dyssynchrony parameters based on segmental timing alone.
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Cardiac device implantations are increasingly carried out using local anaesthesia (LA) with intravenous conscious sedation. The advantages include reduction of patients' anxiety and discomfort, and avoidance of risks of general... more
Cardiac device implantations are increasingly carried out using local anaesthesia (LA) with intravenous conscious sedation. The advantages include reduction of patients' anxiety and discomfort, and avoidance of risks of general anaesthesia (GA). However, concerns about the safety of sedation used without an anaesthetist have been expressed. The National Patient Safety Agency (NPSA) has identified serious problems in the use of intravenous midazolam for conscious sedation and reliance on flumazenil for reversal of over-sedation [1]. The aim of the study is to determine the safety of intravenous conscious sedation in patients undergoing cardiac device implantation and to determine patients' experience and comfort using conscious sedation. All patients undergoing device implantations (pacemaker and Cardiac Resynchronisation Therapy (CRT) implantation, elective unit replacements (EUR) andpacing leads revision) under conscious sedation were eligible. Patients with devices that were implanted under GAwere excluded. Intravenous midazolam and fentanyl could be administered alone or in combination based on operators' discretion. LA with 1% lignocaine without adrenaline was used in all patients. All data were prospectively collected. A patient questionnaire (Appendix A) was given to patients late after the procedure to allow as much time for effects of sedation towear off. A pain score of 10 reflects the worst pain possible, whereas score 1 reflects no pain. Written informed consent for the procedures was obtained. Patient participation for the questionnaire was voluntary. Verbal informed consent was obtained as per the ethics committee of the hospital. The authors of this manuscript have certified that they comply with the Principles of Ethical Publishing in the International Journal of Cardiology. The primary outcome was to determine the safety of conscious sedation administered without the presence of anaesthetist. The secondary outcome was to assess patients' satisfaction intraand postprocedure. Statistical comparisons for continuous data were performed using ANOVAs single factor, unpaired t-tests and chi-squared tests for categorical data. Logistic regression analysis was performed for multivariable predictors. All testswere two-sided and p values of a level≤0.05 were considered statistically significant.
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Research Interests: Cardiology, Medicine, Internal Medicine, Female, Animals, and 14 moreAnesthesia, Atrial Fibrillation, Periodicity, Recurrence, Behavioral Animal Models, Clinical Sciences, Goats, Public health systems and services research, Circulation, Disease Progression, Species Specificity, Time Course, Cardiovascular medicine and haematology, and Heart atria
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Introduction. Radiofrequency catheter ablation (RFA) is 1st line treatment in symptomatic adult patients with Wolff-Parkinson-White syndrome (WPW). Patients with WPW are often quoted a high success rate for RFA but does this reflect... more
Introduction. Radiofrequency catheter ablation (RFA) is 1st line treatment in symptomatic adult patients with Wolff-Parkinson-White syndrome (WPW). Patients with WPW are often quoted a high success rate for RFA but does this reflect reality? There is a paucity of recent literature and ongoing service developments in the UK may have a negative impact on success by reducing individual operator experience of adult WPW cases (i.e. increasing numbers of cardiac electrophysiologists in each department, patients more likely to undergo RFA as children). In contrast, technological developments (e.g. 3D mapping, steerable sheaths) may have a positive impact on success of RFA in WPW. Methods. We collected data on all patients with WPW scheduled for 1st time ablation between Jan 2006 and Dec 2018. All patients undergoing re-do RFA during this time were excluded. For comparison, we divided this timeframe into three periods: 2006-9, 2010-13 and 2014-18. Results. The number of patients scheduled f...
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Catheter ablation is an important adjunct to device implantation for secondary prevention of ventricular tachycardia (VT). However, several factors may influence the success of ablations in terms of long-term freedom from VT recurrence. A... more
Catheter ablation is an important adjunct to device implantation for secondary prevention of ventricular tachycardia (VT). However, several factors may influence the success of ablations in terms of long-term freedom from VT recurrence. A thus far little examined factor is the use of general anaesthetic (GA) versus conscious sedation during the procedure, which has been shown to improve outcomes in persistent atrial fibrillation (AF) ablation. Patients with structural heart disease VT undergoing ablations from January 2015 to March 2019 were retrospectively followed up at a single centre. End points were recurrent VT or device therapy (shock or anti-tachycardia pacing) at one year. Hazard ratios (HR) were generated using a multivariate Cox-regression proportional hazards model including variables of age at ablation, sex, amiodarone use at time of ablation, scar age, left ventricular ejection fraction, use of GA, and diagnosis of: diabetes mellitus (DM), hypertension (HTN), renal imp...
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Posters 270Oversensing in subcutaneous implantable cardioverter-defibrillators71Early stimulation of the fast-conducting endocardium is the primary factor in reducing myocardial activation times for endocardial cardiac resynchronisation therap72The impact of age on outcomes in primary prevention ...more
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We tested a simple noninvasive method for cardiac resynchronization therapy (CRT) optimization using standard finger photoplethysmography (FPPG). CRT can increase left ventricular cardiac output in patients with heart failure and... more
We tested a simple noninvasive method for cardiac resynchronization therapy (CRT) optimization using standard finger photoplethysmography (FPPG). CRT can increase left ventricular cardiac output in patients with heart failure and ventricular conduction delay. Optimal therapy delivery depends on an appropriate AV delay. Multiple invasive and noninvasive methods have been attempted to identify patients and the best AV delay for CRT, but all suffer from a combination of high patient risk, cost, complexity, and low reproducibility. FPPG and invasive aortic pressure data were simultaneously collected from 57 heart failure patients during intrinsic rhythm alternating with very brief periods of pacing at 4 to 5 AV delays. After correcting data for artifacts, the median percentage responses for each AV delay were classified as positive, negative, or neutral compared to baseline (Wilcoxon rank test). FPPG correctly identified positive aortic pulse pressure responses with 71% sensitivity (95% CI: 60-80%) and 90% specificity (95% CI: 84-94%) and negative aortic pulse pressure responses with 57% sensitivity (95% CI: 44-69%) and 96% specificity (95% CI: 91-98%). The magnitude of FPPG changes were strongly correlated with positive aortic pulse pressure changes (R(2) = 0.73, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .0001) but less well correlated with negative aortic pulse pressure changes (R(2) = 0.43, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .0001). FPPG selected 78% of the patients having positive aortic pulse pressure changes to CRT and identified the AV delay giving maximum aortic pulse pressure change in all selected patients. FPPG can provide a simple noninvasive method for identifying significant changes in aortic pulse pressure with high specificity, including identifying patients in whom aortic pulse pressure increases with CRT and the AV delay giving the maximum aortic pulse pressure.
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Aims Increase in life expectancy has led to increased rate of implantable cardioverter-defibrillator (ICD) implantation in patients in their 80s, but there are no current formal recommendations to guide physicians when elderly patients... more
Aims Increase in life expectancy has led to increased rate of implantable cardioverter-defibrillator (ICD) implantation in patients in their 80s, but there are no current formal recommendations to guide physicians when elderly patients with ICDs require elective unit replacement (EUR). This study aims at assessing survival and rates of ICD therapies in patients who have had ICD implantation or EUR above the age of 80, focusing on the latter. Methods and results Retrospective analysis of a prospectively kept database of all ICD-related procedures carried out in a single tertiary centre. Patients 80 years of age or older submitted to ICD implantation (n 42) or EUR (n 34) between November 1991 and May 2012 were included. Using collected baseline and outcome data from this cohort, we assessed survival of these patients and the rates of ICD therapies. Median additional years of life after ICD implantation and ICD EUR in patients who died before data retrieval was 2.5 and 1.2, respectivel...
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OBJECTIVES A new electroanatomic mapping system (Rhythmia, Boston Scientific, Marlborough, Massachusetts) using a 64-electrode mapping basket is now available; we systematically assessed its use in complex congenital heart disease (CHD).... more
OBJECTIVES A new electroanatomic mapping system (Rhythmia, Boston Scientific, Marlborough, Massachusetts) using a 64-electrode mapping basket is now available; we systematically assessed its use in complex congenital heart disease (CHD). BACKGROUND The incidence of atrial arrhythmias post-surgery for CHD is high. Catheter ablation has emerged as an effective treatment, but is hampered by limitations in the mapping system's ability to accurately define the tachycardia circuit. METHODS Mapping and ablation data of 61 patients with CHD (35 males, age 45 ± 14 years) from 8 tertiary centers were reviewed. RESULTS Causes were as follows: Transposition of Great Arteries (atrial switch) (n = 7); univentricular physiology (Fontans) (n = 8); Tetralogy of Fallot (n = 10); atrial septal defect (ASD) repair (n = 15); tricuspid valve (TV) anomalies (n = 10); and other (n = 11). The total number of atrial arrhythmias was 86. Circuits were predominantly around the tricuspid valve (n = 37), atriotomy scar (n = 10), or ASD patch (n = 4). Although the majority of peri-tricuspid circuits were cavo-tricuspid-isthmus dependent (n = 30), they could follow a complex route between the annulus and septal resection, ASD patch, coronary sinus, or atriotomy. Immediate ablation success was achieved in all but 2 cases; with follow-up of 12 ± 8 months, 7 patients had recurrence. CONCLUSIONS We demonstrate the feasibility of the basket catheter for mapping complex CHD arrhythmias, including with transbaffle and transhepatic access. Although the circuits often involve predictable anatomic landmarks, the precise critical isthmus is often difficult to predict empirically. Ultra-high-density mapping enables elucidation of circuits in this complex anatomy and allows successful treatment at the isthmus with a minimal lesion set.
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Maintenance of sinus rhythm has been associated with lower mortality, but whether atrial fibrillation (AF) ablation per se benefits hard outcomes such as mortality and stroke is still debated. To determine whether AF ablation is... more
Maintenance of sinus rhythm has been associated with lower mortality, but whether atrial fibrillation (AF) ablation per se benefits hard outcomes such as mortality and stroke is still debated. To determine whether AF ablation is associated with a reduction in all-cause mortality and stroke compared with medical therapy alone. Literature search looking for both randomized and observational studies comparing AF catheter ablation vs. medical management. Data pooled using random-effects. Risk ratios (RR) with 95% confidence intervals (CI) used as a measure of treatment effect. The primary and secondary outcomes were all-cause mortality and occurrence of cerebrovascular events during follow-up, respectively. Thirty studies were eligible for inclusion, comprising 78,966 patients (25,129 receiving AF ablation and 53,837 on medical treatment) and 233,990patient-years of follow-up. The pooled data of studies revealed that ablation was associated with lower risk of all-cause mortality: 5.7% v...
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Atrial fibrillation (AF) reduces survival and quality of life (QoL). It can be treated at the time of major cardiac surgery using ablation procedures ranging from simple pulmonary vein isolation to a full maze procedure. The aim of this... more
Atrial fibrillation (AF) reduces survival and quality of life (QoL). It can be treated at the time of major cardiac surgery using ablation procedures ranging from simple pulmonary vein isolation to a full maze procedure. The aim of this study is to evaluate the impact of adjunct AF surgery as currently performed on sinus rhythm (SR) restoration, survival, QoL and cost-effectiveness. In a multicentre, Phase III, pragmatic, double-blinded, parallel-armed randomized controlled trial, 352 cardiac surgery patients with >3 months of documented AF were randomized to surgery with or without adjunct maze or similar AF ablation between 2009 and 2014. Primary outcomes were SR restoration at 1 year and quality-adjusted life years at 2 years. Secondary outcomes included SR at 2 years, overall and stroke-free survival, medication, QoL, cost-effectiveness and safety. More ablation patients were in SR at 1 year [odds ratio (OR) 2.06, 95% confidence interval (CI) 1.20-3.54; P = 0.009]. At 2 years...
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Atrial fibrillation (AF) can be treated using a maze procedure during planned cardiac surgery, but the effect on clinical patient outcomes, and the cost-effectiveness compared with surgery alone, are uncertain. To determine whether or not... more
Atrial fibrillation (AF) can be treated using a maze procedure during planned cardiac surgery, but the effect on clinical patient outcomes, and the cost-effectiveness compared with surgery alone, are uncertain. To determine whether or not the maze procedure is safe, improves clinical and patient outcomes and is cost-effective for the NHS in patients with AF. Multicentre, Phase III, pragmatic, double-blind, parallel-arm randomised controlled trial. Patients were randomised on a 1 : 1 basis using random permuted blocks, stratified for surgeon and planned procedure. Eleven acute NHS specialist cardiac surgical centres. Patients aged ≥ 18 years, scheduled for elective or in-house urgent cardiac surgery, with a documented history (> 3 months) of AF. Routine cardiac surgery with or without an adjunct maze procedure administered by an AF ablation device. The primary outcomes were return to sinus rhythm (SR) at 12 months and quality-adjusted life-years (QALYs) over 2 years after randomis...
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Research Interests: Cardiology, Electrocardiography, Humans, Female, Male, and 15 moreHeart, Aged, Cardiac Catheterization, Middle Aged, Electrocardiogram, Coronary Angiography, Adult, Arrhythmia, Coronary Artery Disease, Ejection Fraction, Left Ventricular Function, Heart Ventricles, Prospective Study, Negative predictive value, and Cardiovascular medicine and haematology
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Outcome of persistent atrial fibrillation (AF) ablation remains suboptimal. Techniques employed to reduce arrhythmia recurrence rate are more likely to be embraced if cost-effectiveness can be demonstrated. A single-centre observational... more
Outcome of persistent atrial fibrillation (AF) ablation remains suboptimal. Techniques employed to reduce arrhythmia recurrence rate are more likely to be embraced if cost-effectiveness can be demonstrated. A single-centre observational study assessed whether use of general anaesthesia (GA) in persistent AF ablation improved outcome and was cost-effective. Two hundred and ninety two patients undergoing first ablation procedures for persistent AF under conscious sedation or GA were followed. End points were freedom from listing for repeat ablation at 18 months and freedom from recurrence of atrial arrhythmia at 1 year. Freedom from atrial arrhythmia was higher in patients who underwent ablation under GA rather than sedation (63.9% vs. 42.3%, hazard ratio (HR) 1.87, 95% confidence interval (CI): 1.23-2.86, P = 0.002). Significantly fewer GA patients were listed for repeat procedures (29.2% vs. 42.7%, HR 1.62, 95% CI: 1.01-2.60, P = 0.044). Despite GA procedures costing slightly more, ...
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Upgrade to cardiac resynchronization therapy (CRT) should be offered to patients who have developed pacing-induced cardiomyopathy with conventional right ventricular pacing. The extent to which these patients would also benefit from... more
Upgrade to cardiac resynchronization therapy (CRT) should be offered to patients who have developed pacing-induced cardiomyopathy with conventional right ventricular pacing. The extent to which these patients would also benefit from defibrillator back-up at the time of CRT upgrade is, however, unknown. Retrospective observational cohort study of 199 patients with pacing-induced cardiomyopathy and no history of sustained ventricular arrhythmia, including 104 upgraded to CRT-Pacemaker (CRT-P) and 95 upgraded to CRT-Defibrillator (CRT-D). The incidence of ventricular arrhythmias and the risk of sudden arrhythmic death obtained through a cause-of-death analysis based on clinical data and necropsy results were assessed and compared between the two groups. During a mean follow-up of 66 ± 24 months, 40 (38.5%) CRT-P patients died: three from primary arrhythmic death, while the remaining died of different causes (especially progressive heart failure), giving an incidence of 6.2 sudden arrhy...
Research Interests: Treatment Outcome, Risk assessment, Medicine, Humans, Female, and 15 moreMale, Risk factors, Clinical Sciences, Aged, Middle Aged, Cardiac Arrhythmias, Time Factors, Retrospective Studies, Risk Factors, Risk Assessment, Cardiomyopathies, Proportional Hazards Models, cardiac resynchronization therapy, Disease Free Survival, and Cause of death
Patients with nonischemic dilated cardiomyopathy (DCM) may be at lower risk for ventricular arrhythmias compared with those with ischemic cardiomyopathy (ICM). In addition, DCM has been identified as a predictor of positive response to... more
Patients with nonischemic dilated cardiomyopathy (DCM) may be at lower risk for ventricular arrhythmias compared with those with ischemic cardiomyopathy (ICM). In addition, DCM has been identified as a predictor of positive response to cardiac resynchronization therapy (CRT). The aim of this study was to investigate the impact of an additional implantable cardioverter-defibrillator over CRT, according to underlying heart disease, in a large study group of primary prevention patients with heart failure. This was an observational, multicenter, European cohort study of 5,307 consecutive patients with DCM or ICM, no history of sustained ventricular arrhythmias, who underwent CRT implantation with (n = 4,037) or without (n = 1,270) a defibrillator. Propensity-score and cause-of-death analyses were used to compare outcomes. After a mean follow-up period of 41.4 ± 29.0 months, patients with ICM had better survival when receiving CRT with a defibrillator compared with those who received CRT...
Research Interests: Cardiology, Medicine, Humans, Internal Medicine, Europe, and 12 moreFemale, Male, Dilated cardiomyopathy, Aged, Public health systems and services research, Implantable defibrillators-cardioverters, Cardiac-Resynchronization-Therapy-Devices-Market, Cohort Studies, Defibrillation, Myocardial Ischemia, cardiac resynchronization therapy, and Cardiovascular medicine and haematology(Female, Male, Dilated cardiomyopathy, Aged, Public health systems and services research, Implantable defibrillators-cardioverters, Cardiac-Resynchronization-Therapy-Devices-Market, Cohort Studies, Defibrillation, Myocardial Ischemia, cardiac resynchronization therapy, and Cardiovascular medicine and haematology)
(Female, Male, Dilated cardiomyopathy, Aged, Public health systems and services research, Implantable defibrillators-cardioverters, Cardiac-Resynchronization-Therapy-Devices-Market, Cohort Studies, Defibrillation, Myocardial Ischemia, cardiac resynchronization therapy, and Cardiovascular medicine and haematology)
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Abstracts16-01ArcticLine: A New Cryo Ablation Catheter for the creation of Linear Lesions16-02Plasma transforming growth factor β1-mediated atrial fibrosis to predict the recurrence of atrial fibrillation after surgical maze procedure16-03Prognostic significance of cytokine concentrations in the ...more
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Introduction Left ventricular (LV) lead placement to areas of scar has detrimental effects on response to resynchronization therapy (CRT). Speckle tracking 2D radial strain offers assessment not on...
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Six risk stratification scores have been developed to estimate mortality risk in patients receiving an implantable cardioverter-defibrillator (ICD). This study aims at validating and comparing these risk scores in patients having elective... more
Six risk stratification scores have been developed to estimate mortality risk in patients receiving an implantable cardioverter-defibrillator (ICD). This study aims at validating and comparing these risk scores in patients having elective ICD generator replacement (GR) and assessing the outcome of patients submitted to this procedure. Two hundred twenty three consecutive patients with ischaemic or non-ischaemic dilated cardiomyopathy submitted to elective ICD GR and followed-up for 44 ± 19 months were included. We evaluated which of six previously developed risk scores could predict post-discharge all-cause mortality risk in this context with the highest efficacy. Comparisons between these scores were made using receiver-operating characteristic curves and the integrated discrimination improvement (IDI) index. We further assessed risk of appropriate ICD therapies and all-cause mortality following ICD GR. The prognostic utility of the six scores was assessed by calculating the AUC for follow-up all-cause mortality prediction: Goldenberg - 0.758 ± 0.042, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001; Parkash - 0.754 ± 0.042, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001; Bilchick - 0.813 ± 0.038, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001; Kraaier - 0.721 ± 0.043, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001; REPLACE DARE - 0.746 ± 0.048, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001; Providencia - 0.739 ± 0.043, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001. Through measures of risk reclassification (IDI and relative IDI), the score by Bilchick et al. was shown to outperform all other scores. Binary logistic regression identified pre-GR-appropriate ICD therapy as an independent predictor of post-GR ICD therapy (OR 6.2, CI 95 % 3.0-12.7, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), along with male gender (OR 6.6, CI 95 % 0.8-55, p = 0.082) and history of atrial fibrillation (OR 2.28, CI 95 % 1.1-4.5, p = 0.019). Current prediction scores are useful in predicting mortality risk of patients considered for ICD generator replacement and can potentially help identify patients who may not benefit from continuous ICD treatment due to high mortality rates regardless of the ICD.