PM033 Benefits of the Additional Electrodes in Quadripolar Left Ventricular Leads in Providing More...
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Introduction: The chronotropic response to exercise and the heart rate recovery (HRR) following exercise are non-invasive measures of autonomic function, which are easily measured during maximal exercise stress testing. Both measures are independent predictors of sudden cardiac death. Abnormal ventricular repolarization, evidenced clinically by corrected QT interval (QTc) prolongation, may represent the mechanism leading to fatal sequelae. Objectives: The current study aimed to delineate relationships between the resting and post-exercise QTc with the HRR and chronotropic response during treadmill exercise stress testing. The study compared these associations in patients with and without diabetes. Methods: Data of 95 patients (34 with diabetes; mean age 61 years) referred for exercise stress testing were analysed retrospectively for QTc interval, chronotropic response and HRR. The QT interval was measured at rest and 30, 120, 210 and 300 s post-exercise, and was rate corrected using the Bazett, Fridericia, Framingham and Hodges formulae. No patients had evidence of cardiac ischaemia. Results: Significant inverse relationships were found between (1) resting Hodges QTc interval and HRR; (2) post-exercise QTc intervals and HRR at 30, 120, 210 and 300 s; and (3) resting and post-exercise QTc intervals and chronotropic index. Multivariate regression analysis using the entire patient group identified an independent association between the Bazett QTc interval 120 s and HRR 120 s (r¼-0.40, p<0.001). Diabetic patients showed significantly lengthened QTc intervals at rest and post-exercise and both attenuated chronotropic response and HRR compared to the control group. The strength of associa- tions between the QTc, HRR and chronotropic response were similar in patients with and without diabetes. Conclusion: The findings suggest abnormal ventricular repolarisation may be a mecha- nistic link by which blunting of the heart rate recovery and chronotropic response are related to sudden cardiac death. The inclusion of these non-invasive autonomic measures in routine exercise stress testing may provide additional risk stratification. Disclosure of Interest: None Declared PM031 Carotid intima media thickness is associated with reduced heart rate recovery time in patients with low cardiovascular risk profile Caglar E. Cagliyan* 1 , Ibrahim H. Kurt 2 , Gokhan Soker 3 , Serdar Turkmen 4 , Rabia E. Akıllı 5 , Halil Aktas 5 , Onur S. Deveci 5 , Ali Deniz 5 , Mehmet Balli 2 , Mesut Demir 5 , Ayhan Usal 5 1 Cardiology, Cukurova University Faculty of Medicine, 2 Adana Numune Training and Research Hospital, Adana, Turkey, 3 Radiology, Adana Numune Training and Research Hospital, Adana, 4 Cardiology, Sanko University, Gaziantep, 5 Cukurova University Faculty of Medicine, Adana, Turkey Introduction: Carotid intima media thickness (CIMT) is a well-known entity associated with increased cardiovascular mortality and morbidity. On the other hand, most of the studies investigating CIMT, point to its relationship with atherosclerosis and endothelial dysfunction as a risk factor. Heart rate recovery (HRR), the decrease in maximum heart rate immediately after ex- ercise is a simple and accurate sign of autonomic status. Impairment in HRR is associated with increased mortality. Carotid bulbus is rich from baroreceptors modulating cardiac autonomic function via parasympathetic activity. Increase in CIMT may be associated with decreased sensitivity of the carotid bulbi. Objectives: The aim of this study is to investigate the association between in CIMT and HRR in patients with low atherosclerotic risk profile. Methods: Patients younger than 55 years without any cardiovascular risk factors have been included in our study. Treadmill exercise stress test was performed in all patients. Carotid intima thickness was measured at the bifurcation level by an expert radiologist. Patients with a positive stress test and/or carotid plaque formation have been excluded from the study. Results: A total of 80 patients were included in our study. The median value of CIMT was 0.80 mm and patients were grouped according to this value. Patients with normal CIMT (42 patients, mean: 0.650.12 mm) was named as Group 1, whereas patients with increased CIMT (38 patients, mean: 1.030.12 mm) was named as Group 2. Heart rate recovery values were significantly impaired in Group 2 patients in the first (10.99.5 vs 16.810.9 beats; p¼0.011) and second minutes (36.613.7 vs 42.913.8 beats; p¼0.044). In the logistic regression analysis, CIMT was significantly associated with impaired first minute HRR (OR: 14.7 [7.3-275, 95% CI], p¼0.001). Conclusion: Increase in CIMT seems to be associated with impaired HRR, a sign of decreased vagal activity, in patients with low atherosclerotic risk profile. Reduction in the sensitivity of carotid bulbus may be one of the underlying mechanisms. Further and well- developed studies are required for more precise results. Disclosure of Interest: None Declared PM033 Benefits of the Additional Electrodes in Quadripolar Left Ventricular Leads in Providing More Programmable Pacing Options for CRT Programming David O’Donnell* 1 , Bernard Thibault 2 , C. Aldo Rinaldi 3 , Carlo Pappone 4 , Klaus-Jürgen Gutleben 5 , Christopher Leclercq 6 , Hedi Razavi 7 , Kyungmoo Ryu 7 , Avi Fischer 7 , Gery Tomassoni 8 1 Cardiology, Austin Health, Melbourne, Australia, 2 Montreal Heart Institute, Montreal, Canada, 3 Cardiology, Guy’s and St Thomas’ Hospitals, London, United Kingdom, 4 Arrhythmology, Maria Cecilia Hospital, Cotignola, Italy, 5 Herz- und Diabeteszentrum NRW, Bad Oeynhausen, Germany, 6 CHU Pontchaillou, Rennes, France, 7 St. Jude Medical, Sylmar, 8 Baptist Health, Lexington, United States Introduction: Cardiac Resynchronization Therapy (CRT) with a quadripolar left ventric- ular (LV) lead offers more pacing vectors as compared to conventional bipolar LV leads. Objectives: We studied the programmability of quadripolar pacing vectors compared to bipolar and tripolar equivalents to determine any incremental benefits of additional elec- trodes on the quadripolar LV lead. Methods: Capture threshold and presence of phrenic stimulation (PS) for 10 pacing vectors in a quadripolar LV lead (QuartetÔ, St. Jude Medical, Fig1A) were tested at pre-discharge in 330 CRT recipients enrolled in four published clinical trials. We defined programmable pacing vectors (PPVs) as those without PS and with capture threshold 2.5V. Program- mability was evaluated in three different sets of electrodes configurations utilizing Quartet: 1) Quartet with all 4 pacing electrodes (D1, M2, M3, and P4); 2) Quartet with 3 pacing elec- trodes simulating tripolar configurations by sequentially eliminating each of the four elec- trodes; and 3) Quartet with 2 pacing electrodes simulating adjacent-bipolar configurations (Fig1B). The number of PPVs for each patient was then determined in the presence of 2, 3, and 4 pacing electrodes. The distance between the two furthest pacing electrodes among each patient’s PPVs was calculated using Quartet’s inter-electrode spacings (Fig1A). Results: Quartet provided the most PPVs (mean 5.6; median 6; IQR 3-8) as compared to the best tripolar configuration D1-M2-P4 (mean 4.1; median 4; IQR 3-5) and the best bipolar configu- ration D1-M2 (mean 2.2; median 3; IQR 2-3) (Fig 2). In the tripolar configuration, elimination of the M3 electrode (D1-M2-P4) resulted in the greatest number of PPVs (mean 4.1; median 4; IQR 3-5) vs. D1-M2-M3 (mean 3.2; median 3; IQR 2-5), M2-M3-P4 (mean 3.4; median 3; IQR 1-5), and D1-M3-P4 (mean 2.9; median 3; IQR 2-4). In the bipolar configuration, the most distal electrodes (D1-M2) showed the greatest number of PPVs (mean 2.2; median 3; IQR 2-3) vs. M3- M2 (mean 1.7; median 2; IQR 1-3) and M3-P4 (mean 1.4; median 1; IQR 0-2). The average distance between the two furthest programmable pacing electrodes was 25.616.9mm for Quartet and 22.018.0mm for the best tripolar configuration (D1-M2-P4) (p<0.05). Conclusion: Quartet quadripolar LV lead provides more viable programmable pacing vectors and wider spatial coverage than bipolar and tripolar equivalents, potentially facil- itating increased CRT delivery by enabling optimal LV pacing. Disclosure of Interest: D. O’Donnell Grant/research support from: Medtronic, Consul- tancy for: St. Jude Medical, Speakers bureau: St. Jude Medical, Medtronic, B. Thibault: None Declared, C. A. Rinaldi Grant/research support from: St. Jude Medical, Honorarium from: St. Jude Medical, Speakers bureau: St. Jude Medical, C. Pappone: None Declared, K.- J. Gutleben: None Declared, C. Leclercq: None Declared, H. Razavi Shareholder of: St. Jude Medical, Employee from: St. Jude Medical, K. Ryu Shareholder of: St. Jude Medical, Employee from: St. Jude Medical, A. Fischer Shareholder of: St. Jude Medical, Employee from: St. Jude Medical, G. Tomassoni: None Declared PM034 Is there a threshold for increasing electromechanical delays in patients undergoing cardiac resynchronization therapies? Michael D. Flannery* 1 , Andrew Teh 1 , Hariharan Sugumar 1 , Tina Lin 2 , Matthew Swale 3 , David O’Donnell 1 1 Cardiology, Austin Health, Melbourne, Australia, 2 St Georg, Hamburg, Germany, 3 Heartcare Victoria, Melbourne, Australia e68 GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters POSTER ABSTRACTS
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Introduction: The chronotropic response to exercise and the heart rate recovery (HRR)following exercise are non-invasive measures of autonomic function, which are easilymeasured duringmaximal exercise stress testing. Bothmeasures are independent predictors ofsudden cardiac death. Abnormal ventricular repolarization, evidenced clinically by correctedQT interval (QTc) prolongation, may represent the mechanism leading to fatal sequelae.Objectives: The current study aimed to delineate relationships between the resting andpost-exercise QTc with the HRR and chronotropic response during treadmill exercise stresstesting. The study compared these associations in patients with and without diabetes.Methods: Data of 95 patients (34 with diabetes; mean age 61 years) referred for exercisestress testing were analysed retrospectively for QTc interval, chronotropic response andHRR. The QT interval was measured at rest and 30, 120, 210 and 300 s post-exercise, andwas rate corrected using the Bazett, Fridericia, Framingham and Hodges formulae. Nopatients had evidence of cardiac ischaemia.Results: Significant inverse relationships were found between (1) resting Hodges QTcinterval and HRR; (2) post-exercise QTc intervals and HRR at 30, 120, 210 and 300 s; and(3) resting and post-exercise QTc intervals and chronotropic index. Multivariate regressionanalysis using the entire patient group identified an independent association between theBazett QTc interval 120 s and HRR 120 s (r¼-0.40, p<0.001). Diabetic patients showedsignificantly lengthened QTc intervals at rest and post-exercise and both attenuatedchronotropic response and HRR compared to the control group. The strength of associa-tions between the QTc, HRR and chronotropic response were similar in patients with andwithout diabetes.Conclusion: The findings suggest abnormal ventricular repolarisation may be a mecha-nistic link by which blunting of the heart rate recovery and chronotropic response arerelated to sudden cardiac death. The inclusion of these non-invasive autonomic measuresin routine exercise stress testing may provide additional risk stratification.Disclosure of Interest: None Declared
PM031
Carotid intima media thickness is associated with reduced heart rate recovery time inpatients with low cardiovascular risk profile
Caglar E. Cagliyan*1, Ibrahim H. Kurt2, Gokhan Soker3, Serdar Turkmen4, Rabia E. Akıllı5,Halil Aktas5, Onur S. Deveci5, Ali Deniz5, Mehmet Balli2, Mesut Demir5, Ayhan Usal51Cardiology, Cukurova University Faculty of Medicine, 2Adana Numune Training and ResearchHospital, Adana, Turkey, 3Radiology, Adana Numune Training and Research Hospital, Adana,4Cardiology, Sanko University, Gaziantep, 5Cukurova University Faculty of Medicine, Adana,Turkey
Introduction: Carotid intima media thickness (CIMT) is a well-known entity associatedwith increased cardiovascular mortality and morbidity. On the other hand, most of thestudies investigating CIMT, point to its relationship with atherosclerosis and endothelialdysfunction as a risk factor.Heart rate recovery (HRR), the decrease in maximum heart rate immediately after ex-
ercise is a simple and accurate sign of autonomic status. Impairment in HRR is associatedwith increased mortality.Carotid bulbus is rich from baroreceptors modulating cardiac autonomic function via
parasympathetic activity. Increase in CIMT may be associated with decreased sensitivity ofthe carotid bulbi.Objectives: The aim of this study is to investigate the association between in CIMT andHRR in patients with low atherosclerotic risk profile.Methods: Patients younger than 55 years without any cardiovascular risk factors have beenincluded in our study. Treadmill exercise stress test was performed in all patients. Carotidintima thickness was measured at the bifurcation level by an expert radiologist. Patients witha positive stress test and/or carotid plaque formation have been excluded from the study.Results: A total of 80 patients were included in our study. The median value of CIMT was0.80 mm and patients were grouped according to this value. Patients with normal CIMT(42 patients, mean: 0.65�0.12 mm) was named as Group 1, whereas patients withincreased CIMT (38 patients, mean: 1.03�0.12 mm) was named as Group 2. Heart raterecovery values were significantly impaired in Group 2 patients in the first (10.9�9.5 vs16.8�10.9 beats; p¼0.011) and second minutes (36.6�13.7 vs 42.9�13.8 beats;p¼0.044). In the logistic regression analysis, CIMT was significantly associated withimpaired first minute HRR (OR: 14.7 [7.3-275, 95% CI], p¼0.001).Conclusion: Increase in CIMT seems to be associated with impaired HRR, a sign ofdecreased vagal activity, in patients with low atherosclerotic risk profile. Reduction in thesensitivity of carotid bulbus may be one of the underlying mechanisms. Further and well-developed studies are required for more precise results.Disclosure of Interest: None Declared
PM033
Benefits of the Additional Electrodes in Quadripolar Left Ventricular Leads inProviding More Programmable Pacing Options for CRT Programming
David O’Donnell*1, Bernard Thibault2, C. Aldo Rinaldi3, Carlo Pappone4,Klaus-Jürgen Gutleben5, Christopher Leclercq6, Hedi Razavi7, Kyungmoo Ryu7, Avi Fischer7,Gery Tomassoni81Cardiology, Austin Health, Melbourne, Australia, 2Montreal Heart Institute, Montreal, Canada,3Cardiology, Guy’s and St Thomas’ Hospitals, London, United Kingdom, 4Arrhythmology, MariaCecilia Hospital, Cotignola, Italy, 5Herz- und Diabeteszentrum NRW, Bad Oeynhausen,Germany, 6CHU Pontchaillou, Rennes, France, 7St. Jude Medical, Sylmar, 8Baptist Health,Lexington, United States
e68
Introduction: Cardiac Resynchronization Therapy (CRT) with a quadripolar left ventric-ular (LV) lead offers more pacing vectors as compared to conventional bipolar LV leads.Objectives: We studied the programmability of quadripolar pacing vectors compared tobipolar and tripolar equivalents to determine any incremental benefits of additional elec-trodes on the quadripolar LV lead.Methods: Capture threshold and presence of phrenic stimulation (PS) for 10 pacing vectorsin a quadripolar LV lead (Quartet�, St. Jude Medical, Fig1A) were tested at pre-discharge in330 CRT recipients enrolled in four published clinical trials. We defined programmablepacing vectors (PPVs) as those without PS and with capture threshold �2.5V. Program-mability was evaluated in three different sets of electrodes configurations utilizing Quartet: 1)Quartet with all 4 pacing electrodes (D1, M2, M3, and P4); 2) Quartet with 3 pacing elec-trodes simulating tripolar configurations by sequentially eliminating each of the four elec-trodes; and 3) Quartet with 2 pacing electrodes simulating adjacent-bipolar configurations(Fig1B). The number of PPVs for each patient was then determined in the presence of 2, 3,and 4 pacing electrodes. The distance between the two furthest pacing electrodes amongeach patient’s PPVs was calculated using Quartet’s inter-electrode spacings (Fig1A).Results: Quartet provided themostPPVs (mean5.6;median6; IQR3-8) as compared to thebesttripolar configuration D1-M2-P4 (mean 4.1; median 4; IQR 3-5) and the best bipolar configu-rationD1-M2 (mean2.2;median 3; IQR2-3) (Fig 2). In the tripolar configuration, elimination oftheM3 electrode (D1-M2-P4) resulted in the greatest number of PPVs (mean 4.1;median 4; IQR3-5) vs. D1-M2-M3 (mean 3.2; median 3; IQR 2-5), M2-M3-P4 (mean 3.4; median 3; IQR 1-5),and D1-M3-P4 (mean 2.9; median 3; IQR 2-4). In the bipolar configuration, the most distalelectrodes (D1-M2) showed the greatest number of PPVs (mean 2.2;median 3; IQR 2-3) vs. M3-M2 (mean 1.7; median 2; IQR 1-3) and M3-P4 (mean 1.4; median 1; IQR 0-2). The averagedistance between the two furthest programmable pacing electrodes was 25.6�16.9mm forQuartet and 22.0�18.0mm for the best tripolar configuration (D1-M2-P4) (p<0.05).
Conclusion: Quartet quadripolar LV lead provides more viable programmable pacingvectors and wider spatial coverage than bipolar and tripolar equivalents, potentially facil-itating increased CRT delivery by enabling optimal LV pacing.Disclosure of Interest: D. O’Donnell Grant/research support from: Medtronic, Consul-tancy for: St. Jude Medical, Speakers bureau: St. Jude Medical, Medtronic, B. Thibault:None Declared, C. A. Rinaldi Grant/research support from: St. Jude Medical, Honorariumfrom: St. Jude Medical, Speakers bureau: St. Jude Medical, C. Pappone: None Declared, K.-J. Gutleben: None Declared, C. Leclercq: None Declared, H. Razavi Shareholder of: St. JudeMedical, Employee from: St. Jude Medical, K. Ryu Shareholder of: St. Jude Medical,Employee from: St. Jude Medical, A. Fischer Shareholder of: St. Jude Medical, Employeefrom: St. Jude Medical, G. Tomassoni: None Declared
PM034
Is there a threshold for increasing electromechanical delays in patients undergoingcardiac resynchronization therapies?
Michael D. Flannery*1, Andrew Teh1, Hariharan Sugumar1, Tina Lin2, Matthew Swale3,David O’Donnell11Cardiology, Austin Health, Melbourne, Australia, 2St Georg, Hamburg, Germany, 3HeartcareVictoria, Melbourne, Australia
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
