Venice Arrhythmias 2017 15th Edition · and lead to uncertainties in non-invasive arrhythmia...

OCTOBER 2017

VOLUME 3

NUMBER 10

(SUPPLEMENT S)

ELSEVIERISSN 2405-500X

■ www.jacc-electrophysiology.org

Venice Arrhythmias 2017

15th Edition

JACEP_v3_i10_sS_COVER.indd 1JACEP_v3_i10_sS_COVER.indd 1 21-09-2017 14:01:0421-09-2017 14:01:04

Venice Arrhythmias 2017

15th Edition

ABSTRACTS

This Supplement contains the selected Abstracts presented at the Venice Arrhythmias 2017, held October 25–27, 2017,at the Fondazione Giorgio Cini, Venice, Italy.

The abstracts are being reprinted without journal editorial review. The opinions expressed in this supplement are thoseof the panelists and are not attributable to the sponsor or the publisher, editor, or editorial board of JACC: Clinical
Electrophysiology. Clinical judgment must guide each physician in weighing the benefits of treatment against the risk oftoxicity. References made in the articles may indicate uses of drugs at dosages, for periods of time, and in combinationsnot included in the current prescribing information.

J A C C : C L I N I C A L E L E C T R O P H Y S I O L O G Y , V O L . 3 , N O . 1 0 , S U P P L S , 2 0 1 7 S1

ORALS

SYNCOPE MISCELLANEOUS

Session nos: 1.01 to 1.05

073_16968-G2
Non-Cardiac Syncope and All-Cause Mortality in Adults:A Meta-Analysis of Prospective Studies
A. Fedorowski, F. Ricci, S. Palermi, G. Renda, S. Gallina, O. Melander,R. De Caterina, R. SuttonDept. of Cardiology, Skåne University Hospital, Sweden LundUniversity, Malmö, Sweden

INTRODUCTION Cardiac syncope heralds significantly higher mor-tality compared with syncope due to non-cardiac causes or unknownaetiology, which is commonly considered a benign event. Nonethe-less, previous studies have typically investigated the outcome ofsyncope across different aetiological subgroups, rather than comparedmatched group of patients with and without syncope. Therefore, littleis known about prognosis of patients with history of non-cardiacsyncope compared with syncope-free population.PURPOSE To determine whether non-cardiac syncope is associatedwith increased mortality.METHODS We performed a systematic review of the literature bysearching for prospective observational studies reporting multivari-able adjusted hazard ratios (HRs) and 95% confidence intervals (CIs)for all-cause mortality in participants with history of non-cardiacsyncope (regardless of site of presentation, i.e. inpatient or outpa-tient) compared with syncope-free participants. Hazard ratios werepooled in a random-effect, generic inverse variance meta-analysis inorder to compute summary effect size.RESULTS We identified a total of 4 studies, including an overallpopulation of 287,382 individuals (51.6% men; age, 64.5�12.4 years),38,843 with history of non-cardiac syncope and 248,539 without his-tory of syncope. The average follow-up was 2.9 years. Compared withcontrols, history of non-cardiac syncope was associated withincreased all-cause mortality (pooled adjusted HR 1.13; 95%CI 1.05-1.23).

CONCLUSIONS Non-cardiac syncope is associated with higher all-cause mortality in older adults.SEARCH METHODS FOR IDENTIFICATION OF STUDIES Medlineand Embase databases, the Clinical Trials Registry (www. clinicaltrials.gov), as well as abstracts from major cardiological and neurologicalsocieties meetings were searched for potentially relevant articlesusing the search terms ((syncope OR vasovagal OR neuron mediatedOR loss of consciousness OR faint OR lipothymia)) AND ((follow ORcohort OR mortality OR prognosis OR outcome OR death)). We alsosearched reference lists of all identified articles for additionalrelevant studies, including hand-searching reviews and previousmeta-analyses.

073_16756-G1
Brugada Pattern ECG Associated With Vasovagal Syncope
Hanane ZouzouAlgiers University, Alger, Algeria

INTRODUCTION Brugada syndrome is definitively diagnosed whentype 1 ST segment elevation is observed, with one of the following:documented VF, polymorphic VT, a family history of SCD, coved typeECGs in family members, inducibility of VT, syncope, nocturnalagonal respiration but without more precision of the origin ofsyncope.METHODS We followed since 2005, in our consultation seventeenpatients with type 1 Brugada pattern ECG and recurrent syncope, adetailed history and physical examination were in favor of neuro-cardiogenic syncope but face to this ECG pattern, further tests wereperformed: implantable loop recorder, electrophysiological study, tilttable testing.RESULTS Only sinus tachycardia was recoded with Implantable looprecorders, we induced VF in one patient, and positive response to tilttesting in nine patients. Sixteen patients have received Disopyramidemedication, along with appropriate physical manoeuvers; we reporteda significant reduction in the frequency of syncopal events.CONCLUSION Given these observations, benign vasovagal episodescould be encountered in patients with Brugada pattern ECG, Dis-opyramide is more efficient, in combination with education and re-assurance.

073_16211-G2
Syncope Unit Management of Patients With HypertrophicCardiomyopathy and Syncope: Pathophysiologic Interpretationand Clinical Approach
M. Rafanelli, G. Filice, I. Olivotto, N. Marchionni, A. UngarSyncope Unit, Department of Geriatrics, Careggi University Hospital,Florence, Italy

BACKGROUND Prognostic stratification and clinical management ofpatients with hypertrophic cardiomyopathy and syncope are complex.This is a pilot Syncope Unit experience on standardized managementof syncope in hypertrophic cardiomyopathy.METHODS Patients with hypertrophic cardiomyopathy referred forsyncope from the Referral Centre for Cardiomyopathies to the Syn-cope Unit, Careggi University Hospital, Florence between May 2004and May 2016, were retrospectively analyzed. Three presyncope and 3unexplained falls, were included.RESULTS 20 consecutive patients. Mean age 55 � 19 years. The 70%had syncope, 65% presyncope, 15% unexplained falls. Initial diag-nosis: 25% orthostatic hypotension, 20% neurally-mediated syncope,10% cardiac syncope, 35% unexplained. Tilt Test was diagnostic in

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58%, 71% vasodepressive. Orthostatic hypotension was confirmed in50%. A loop recorder was implanted in 5 patients, diagnostic in 60%.Final diagnosis: 50% neurally-mediated syncope-orthostatic hypo-tension, 20% arrhythmic, 10% unexplained. Tailored treatment wasmade.CONCLUSION A standardized management of syncope in hypertro-phic cardiomyopathy reduces unexplained episodes, allowing aproper treatment.

073_16760
Predictors of Syncopal Recurrence after Cardiac Pacing inPatients with Carotid Sinus Syndrome
M. Rafanelli,1 G. Rivasi,1 D. Solari,2 F. Tesi,1 A. Ceccofiglio,1 F.C. Sacco,1

S. Venzo,1 I. Giannini,1 M. Brignole,2 A. Ungar11Syncope Unit, Department of Geriatrics, Careggi Hospital andUniversity of Florence, Italy; 2Arrhythmology Centre, Department ofCardiology, Ospedali del Tigullio, Italy

INTRODUCTION In cardio-inhibitory Carotid Sinus Syndrome (CI-CSS), syncopal recurrence is expected to occur in up to the 20% ofpatients after pacing therapy. The present study analyzes post-im-plantation syncopal recurrence in CI-CSS, to identify predictors ofrecurrence.METHODS We retrieved electronic records concerning 3127 consecu-tive patients who had undergone carotid sinus massage (CSM) in theSyncope Unit of Careggi Hospital, Florence, and Ospedali del Tigullio,Lavagna, in the period 2004-2014.The study population included pa-tients who had received cardiac pacing for CI-CSS. Syncopal recur-rence was investigated during a mean follow-up of 3.8�3.4 years.RESULTS 112 patients were enrolled, the mean age was 77.1�9.7 years.19 patients (17%) experienced syncopal recurrence, with a meannumber of 3.8�3.4 episodes per patient. Patients suffering fromrecurrence had more frequently predisposing situations and pro-dromes preceding syncope; chronic therapy with nitrates was morefrequent, too. At the multivariate analysis, prodromes and predis-posing situations remained independent predictors of recurrence.CONCLUSIONS Prodromal symptoms and predisposing situationsidentify patients at higher risk of post-implantation recurrence; thesepredictors can be easily assessed from clinical history.

ATRIAL TACHYARDIA, ATRIAL FLUTTER AND OTHERATRIAL ARRHYTHMIAS: DIAGNOSIS AND TREATMENT


073_16840-D1
A Novel 2-D Spatial-Temporal ECG Representation UsingMultipolar Esophageal Catheters: A Pilot Study
R.A. Wildhaber,1 S. Mortier,2 A. Haeberlin,3 R. Sweda,3 D. Bruegger,4

T. Niederhauser,4 M. Jacomet,4 J. Goette,4 H. Tanner51Institute for Human Centered Engineering, Bern University of AppliedSciences, Biel, Switzerland Dept. of Information Technology andElectrical Engineering ETH Zurich, Switzerland; 2Faculty of Medicine,University of Bern, Switzerland; 3Department of Cardiology,Inselspital, Bern University Hospital, and University of Bern,Switzerland ARTORG Center for Biomedical Engineering, University ofBern, Switzerland; 4Institute for Human Centered Engineering, BernUniversity of Applied Sciences, Biel, Switzerland; 5Department ofCardiology, Inselspital, Bern University Hospital, and University ofBern, Switzerland

INTRODUCTION P-waves in surface ECGs are often of minor qualityand lead to uncertainties in non-invasive arrhythmia diagnostics. Wetherefore exploited the advantages of esophageal ECGs (eECG) toimprove the diagnosis of atrial arrhythmias.METHODS Esophageal ECGs of 14 patients with supraventriculararrhythmias and 6 healthy subjects were recorded during a pilot studyusing a multipolar naso-esophageal catheter (ESOFLEX-10S, FIAB).We fused multiple beats under consideration of catheter motions andvariations in beat morphology to create a novel 2-D high-resolutioneECG representation, which we name esophageal isopotential map(IPM).RESULTS IPMs visualize electrical cardiac fields measured in theesophagus as isopotential lines in a 2-D view with the abscissaeshowing time and the ordinate showing esophageal depth. IPMs show

epicardial atrial signals with enhanced signal quality and reveal car-diac propagation speed and its direction. Figures 1 and 2 show IPMsfor a healthy subject and a patient with atrial flutter, respectively.

CONCLUSIONS Complementing surface ECGs with IPMs might in-crease the reliability of non-invasive atrial arrhythmia diagnostics. Atrial with intra-cardiac reference measurements for validation is on-going.

073_16289
Prophylactic Pulmonary Vein Isolation During Isthmus AblationFor Atrial Flutter: Three-Year Outcomes Of The Prevent Afl Study
V. Shabanov, J.S. Steinberg, A. Romanov, S. Bayramova, D. Losik,D. Ponomarev, I. Stenin, D. Elesin, I. Mikheenko, E. PokushalovArrhythmia Department and Electrophisiology Laboratory, SiberianBiomedical Research Center Ministry of Health Novosibirsk, RussianFederation, Novosibirsk, Russia

INTRODUCTION The PREVENT AF I study demonstrated that pro-phylactic pulmonary vein isolation (PVI) in patients with typical atrialflutter (AFL) resulted in substantial reduction of new onset atrialfibrillation (AF) during 1-year follow up as assessed by continuousimplantable loop recorder (ILR).OBJECTIVE To assess the 3-year outcome in AF prevention byprophylactic PVI in patients with only typical AFL.

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METHODS Fifty patients with documented AFL were randomized toeither cavo-tricuspid isthmus (CTI) ablation alone (n¼25) or CTI withconcomitant PVI (PVI; n¼25). All patients received an ILR with regularfollow-up for 3 years following initial ablation. The primary endpointof the study was the occurrence of any atrial tachyarrhythmiaincluding AF or AFL after ablation with the monthly burden exceeding0.5% on the ILR.RESULTS At the end of 3 years, 80% of the patients in CTI only groupvs 52% of the patients in PVI+CTI group developed AF/AFl recurrences[hazard ratio (HR) 2.40, 95% confidence interval (CI) 1.18–4.86,P ¼ 0.015] (see Figure). More patients in the CTI only group underwentredo ablation compared to PVI+CTI group, 32% vs 8%, respectively(p ¼ 0.037). The three-year AF burden also favored the combinedablation group compared to the CTI ablation only group: 6.2% vs16.8% (p ¼ 0.038). In CTI only group, 12 (48%) patients were hospi-talized during follow-up compared to 4 (16%) in PVI+CTI group(p¼0.032). Two patients in CTI only group developed stroke with noclinical adverse events in PVI+CTI group.

CONCLUSIONS Prophylactic PVI in patients with only typical AFLresulted in a significant reduction of new onset AF and burden duringlong-term follow-up as assessed by continuous ILR, with consequentreduction in hospitalizations and need to perform repeat ablationfor AF.Clinical Trials Registration: NCT01563848

073_16832-L2
Stability Evaluation of an Irrigated, Flexible Tip Catheter DuringRadiofrequency Ablation of AVNRT
P. Sabbatani,1 A. Corzani,1 D. Saporito,3 L. Sacchetti,2

C. Licciardello,2 G. Piovaccari11Department of Cardiology, Bufalini Hospital, Cesena, Italy; 2AbbottAgrate Brianza MB, Italy; 3Department of Cardiology, Infermi Hospital,Rimini, Italy

INTRODUCTION Atrio-ventricular block (AVB) is a major complicationof atrio-ventricular reentry tachycardia (AVNRT) ablation. Electro-anatomic mapping (EAM) ensures catheter stability, reducing X-rays.Our aim was to assess safety and efficacy of an irrigated, flexible tipcatheter, guided by an EAM system, in AVNRT.METHODS Seven patients (1 male, 14%; age 37�11 years) underwentan ablation, identifying fast and slow pathway locations by EnSite�Velocity�. Standard deviation (SD) of the Flexability� catheter tipposition was studied to check its stability with and without irritatingjunctional rhythm during radiofrequency (RF).RESULTS Acute success rate was 100% without complications. Meanprocedure/fluoroscopy times were 126�35min/148�255s, respectively.Mean RF time was 8.5�8.4 min. In 4/7 cases (57%) fluoroscopy wasentirely avoided. Mean distance between RF applications and fastpathway was 18.3�7.9 mm; catheter position SD during RF was0.7�0.3, 1.2�0.7, 1.1�0.6mm on x-y-z axes respectively.

CONCLUSIONS This initial experience on a small cohort of youngadults shows feasibility, safety and efficacy of EAM-guided AVNRTablation. The associated use of a flexible, irrigated tip ensures catheterstability and accurate slow pathway mapping and ablation.

073_17092p
Effects Of Ensite Navx/Precision� Compared To Carto�3 OnFluoroscopy Exposure And Procedural Duration In AvnrtCatheter Ablation
L. Vitali-Serdoz, D. Bastian, S. Poli, J. Walascheck, M. Brunelli,P. Richter, J. Schwab, H. Rittger, M. Pauschinger, K. GöhlHeart and Lung Department, Electrophysiology Division, KlinikumFürth, Germany

INTRODUCTION Electrophysiology procedures (EP) are traditionallyperformed under fluoroscopic guidance. The use of different three-dimensional electro-anatomical mapping (3D-EAM) systems for right-sided arrhythmia ablation may differently effect procedure durationand radiation exposure.METHODS We evaluated 301 consecutive patients undergoing AVNRTablation at two centers. 242 patients ablated with Carto�3 (BiosenseWebster, Diamond Bar, CA) were compared to 59 patients using EnsiteNavX/Precision� (Abbott, SJM, St Paul, MN).RESULTS Patients characteristics and procedural findings are sum-marized in the Table.Patients undergoing Ensite guided EPs were slightly older (p¼0.03).

The two groups were not significantly different regarding BMI. Therewere significant differences in fluoroscopy time and dose, having theEnsite guided EPs the lowest exposure (p <0.005 and p <0.001,respectively), although a longer procedure duration (p¼0.01). Thenumber of procedures with complete elimination of fluoroscopy wassignificantly higher in Ensite NavX� guided EPs (p<0.001). No majorcomplications occurred.

AVNRT
Carto�
Ensite �
P-value
N
242 59
Male/Female (%)
91/145 (40/60%) 21/38 (36/64%)
Mean age (years)
55.7�17.7 61.6�21.5 0.03
BMI (kg/m2)
26.6�5.8 27.6�5.7 0.31
Procedure duration

(min)

123.4�39.8
105.1�45.6 0.01
Fluoroscopy time

(min)

4.3�8.1
1.1�3.4 0.005
DAP (mGy*m2)
245.5�388.5 34�144 <0.001
No-X-ray procedures,

n (%)

42 (17.4%)
41 (73.2%) <0.001
BMI body mass index, DAP dose area product

CONCLUSION When compared to Carto�3 the use of Ensite NavX� forroutine AVNRT ablation is associated with a significant reduction influoroscopy exposure allowing successful procedures with completeelimination of fluoroscopy in >70%.

073_17093p
Effects Of Different 3D Electro-Anatomic Mapping Systems OnFluoroscopy Exposure And Procedural Duration In Typical AtrialFlutter Ablation
D. Bastian, L. Vitali-Serdoz, S. Poli, J. Walascheck, M. Brunelli,P. Richter, J. Schwab, M. Pauschinger, H. Rittger, K. GöhlHeart and Lung Department, Electrophysiology Division, KlinikumFürth, Germany





INTRODUCTION The use of different three-dimensional electro-anatomical mapping (3D-EAM) systems for right-sided arrhythmiaablation may have a distinct effect on procedure duration and radia-tion exposure.METHODS We evaluated 355 consecutive patients undergoing routinetypical atrial flutter ablation at two centers. 267 patients using Carto

�3

(Biosense Webster, Diamond Bar, CA) were compared to 88 patientsusing Ensite NavX/Precision� (Abbott, SJM, St Paul, MN).RESULTS Patients and procedural characteristics are summarized inthe Table.There were no significant differences in age, BMI and procedure

duration.However, the use of different 3-D-EAM resulted in significant

differences in fluoroscopy exposure. Ensite� guided procedures hadthe lowest X-Ray exposure in term of duration and dose. Thesuccess in obtaining a “zero-fluoroscopy” approach was significantlyhigher in the Ensite� group (p<0.001). Ensite NavX�allowed catheter visualization and anatomy acquisition withoutfluoroscopy beginning directly from the groin. No major complica-tions occurred.

Typical atrial flutter
Carto�
Ensite�
P-value
N
267 88
Male/Female (%)
200/67 (75/25%) 51/37 (58/42%)
Mean age (years)
65.1�12,5 67�14,4 0.23
BMI (kg/m2)
29.8�27 27.3�4.3 0.41
Procedure duration

(min)

95.3�48.3
93.4�42.5 0.75
Fluoroscopy time

(min)

7.1�6.6
0.8�1.9 <0.001
DAP (mGy*m2)
547�777.4 22.9�63.2 <0.001
No-X-ray procedures,

n (%)

46 (17.2%)
56 (65.1%) <0.001
BMI body mass index, DAP dose area product

CONCLUSION The routine use of 3D-EAM for typical flutter ablation isfeasible and effective. The use of Ensite NavX� is associated with asignificant reduction in fluoroscopy and allows a higher percentage ofzero fluoroscopy procedures.

073_16768-H5
Radiofrequency Ablation of Atrial Fibrillation and Ectopic AtrialTachycardia From the Superior Vena Cava
S. Mikhaylichenko, E. Lubkina, A. RevishviliDepartment of endovascular methods of diagnosis and treatment ofarrhythmias, State Main Military Clinical Hospital namedN.N.Burdenko, Moscow, Russia

The aim of study was to reveal features of a current and diagnostics ofectopic atrial tachycardias (AT) and atrial fibrillation (AF) from theoutfall of superior vena cava (SVC) and to estimate results of inter-ventional treatment of these arrhythmias.

METHODS AND RESULTS From 2000 till 2017, 2857 patients wereoperated with AF (1950 males) and 495 patients with AT (225 males).Arrhythmogenic area in SVC was found in 9 patients with AF and in 7patients with AT. The average age was 46.1 � 19.1 years (from 20 till72), 7 males. Paroxysmal AF was defined in 7 patients (44%), persis-tent AF in 2 patients (13%). Inefficient radiofrequency isolation ofpulmonary vein (PVI) was earlier executed in 5 patients (31.3%). 26procedures in total were done (1.63 in 1 patient). Repeated radio-frequency ablation of SVC was made in 1 patient (6.25%) with AT dueto recurrence of arrhythmia.CONCLUSIONS Ectopic AT and AF from the area of SVC are ratherrare, RF applications in this area associated with high efficacy and lowrate of complications.

073_16935-H5
Atrial Fibrillation and Atrial Flutter Ablation in Patients WithChronic Heart Failure With Systolic Dysfunction
O.A. NikolaevaCardiovascular Surgery Department, Russian Cardiological Researchand Production Complex, Moscow, Russia

INTRODUCTION The recent guidelines had low class indications forAF ablation in patients with chronic heart failure (CHF). Nowadayssituation has been slightly improved, but some limitations have beenexisted yet.METHODS 19 patients with impaired left ventricular function(LVEF<45%) and CHF symptoms (I-III NYHA class) with persistentand paroxysmal AF and atrial flutter were included. 12 patients werewith AF, 9 of them with long-standing persistent AF (LSPAF), and allatrial flutter (AFl) cases were persistent. Mean LVEF was 39.4�5.89%,LA-volume 92�31.9 ml. We performed ablation procedure using theEnsite Velocity navigation system (St.Jude Medical, USA) and BlazerOI catheters (Boston Scientific, US). In all cases intracardiac echo 10FAcuNav catheters (Biosense Webster, USA) have been used.RESULTS We restored sinus rhythm during ablation. All patients withAFl restored normal sinus during ablation delivery, and only 1 pts withLSPAF. After 3 months of follow-up we had 3 pts with recurrent AFamong LSPAF patients. Mean LVEF was slightly higher 42.6�3.46%(p¼0.083). After 1 year of follow-up we got 58% (11) of total efficacyafter one procedure. After 2 years we had 68.4% (13) patients withsinus rhythm after 1 or 2 procedures, mean LVEF was 42.73�2.74%(p¼0.061).CONCLUSIONS AF and AFl-ablation leads to improvement of symp-toms and left ventricular systolic function in patients with CHF.

073_16791
Atrial Fibrillation Ablation With Multipolar Therapeutic CatheterAnd Aid Of Intracardiac Echocardiography After PercutaneousClosure Of Atrial Septal Defect
P.A. Costa, E. Sbaraini, R.B. Abt, A. Cardoso, D.A.R. Moreira,K.R. Serafim, C.R. Cunha, F.K. DorfmanDepartment of Electrophysiology Instituto de Cardiologia e Ritmologiado Estado de Sao Paulo / Instituto Dante Pazzanese de Cardiologia, SaoPaulo, Brasil

INTRODUCTION Association between atrial septal defect (ASD) andAF is well known. Currently, percutaneous closure (PC) of ASDwith prosthesis implantation at the interatrial septum is an effectivetherapy. In the latter situation, AF ablation is often not indicated ordelayed, particularly because of the difficulty of obtaining transeptalaccess.OBJECTIVE To describe the case in which AF ablation was performedafter PC ASD using multipolar therapeutic catheter (MTC) andintracardiac echocardiography (ICE).CASE REPORT Patient with PC ASD and ischemic stroke, evolvingwith worsening paroxysmal AF attacks, which became more frequent,lasting and symptomatic, despite AAD. AF ablation was performed8 months after PC ASD, using ICE to view the prosthesis at theinteratrial septum and guide the single transeptal puncture. MTC wasplaced in the left atrium and the electrical isolation of the pulmonaryveins was successfully performed. During a 12-month follow-up, thepatient remains asymptomatic and without new episodes of AF.





CONCLUSIONS AF ablation after PC ASD is feasible, showing a goodevolution. ICE is fundamental to assist in transeptal puncture in thiscircumstance, besides guiding ablation.

ATRIAL FIBRILLATION: EPIDEMIOLOGY ANDANTICOAUGULATION ISSUES


073_16751-H1
Atrial Fibrillation in Hispanics, Blacks and Whites withHeart Failure
E. Shulman, F. Kargoli, A. Mittell, E. Hoch, L. DiBiase, J. Fisher,J. Gross, S. Kim, K.J. Ferrick, A. KrumermanDivision of Cardiology, Department of Medicine, Montefiore MedicalCenter, Bronx, NY, USA

BACKGROUND Heart failure (HF) is a common risk factor for atrialfibrillation (AF). The higher HF burden, but lower prevalence of AFin Blacks compared to Whites is known as the “racial paradox.”However, the contribution of HF for AF in Hispanic minorities isunknown.METHODS We retrospectively analyzed 68,022 persons for presenceof AF for HF. Regression analysis was performed to determine theindependent predictive ability of HF by race/ethnicity to predict AF.Logistic regression controlled for: heart failure, race/ethnicity,gender, age, body mass index, hypertension, and systolic bloodpressure.RESULTS Prevalence of HF and AF varied by race/ethnicity (Table 1).The presence of HF in Hispanics and Blacks was associated withsignificantly lower odds to developed AF than the presence of HF inWhites (Black OR¼0.768, 95% CI: 0.645 -0.916, p¼0.003; HispanicOR¼0.731, 95% CI: 0.613-0.870, p<0.001).

CONCLUSIONS This is the first study to characterize the interaction ofHF and AF in the Hispanic population. Despite having many riskfactors for AF, Hispanic and Black patients, relative to White patientswith HF, had a lower risk to develop AF.

073_16759-H1
How Community Pharmacists Can be Engaged to Deliver PulseRhythm Checks to Identify People With Undiagnosed AF(Atrial Fibrillation)
T.C.A. Lobban, N.E. Breakwell, S. AntoniouArrhythmia Alliance, Chipping Norton, UK Arrhythmia Alliance,Chipping Norton, UK Barts NHS Hospital Trust, London, UK

INTRODUCTION The hypothesis of Arrhythmia Alliance was todetermine if Community Pharmacists, in multiple countries, couldeffectively deliver pulse rhythm checks to the public to help identifypeople with undiagnosed arrhythmias. Global AF Awareness Week isrun on an annual basis by Arrhythmia Alliance and its partner orga-nisation, AF Association, during which a ‘Know Your Pulse campaign’is held in multiple settings where the general public can receive a freemanual pulse rhythm check. Settings have included GP surgeries,Hospital reception areas, Community Pharmacy and public placeswith a high footfall of the general public, such as railway stations andshopping malls. In 2016, this initiative was extended to involve theactive collaboration of community pharmacists. The InternationalPharmacists for Anticoagulation Care Taskforce (iPACT) led theinitiative in the pharmacy world. The joint collaboration of

Arrhythmia Alliance, AF Association and iPACT was held duringGlobal AF Aware Week (21-27 November 2016).OUR AIMS� To raise awareness of AF and the importance of pulse rhythm checks

to the general public across multiple countries� To engage community pharmacists in Global AF Aware Week and

their active participation in delivering manual pulse rhythm checks toidentify people with undiagnosed AF and to raise awareness of AF

� To assess the feasibility of pharmacists implementing pulse checks incommunity pharmacy

METHODS Five member countries of iPACT were engaged. Commu-nity Pharmacy partners were identified to deliver the campaign.Educational and campaign materials were provided, in local language,by Arrhythmia Alliance, and a template for recording results createdtogether with a patient Primary Care referral template.RESULTS 1699 pulse checks were undertaken in 56 pharmacies across5 countries.77 people had an irregular heart rhythm detected and were referred

to their clinical practitioner.CONCLUSIONS This preliminary collaboration project demonstratedthat Community Pharmacists can deliver pulse rhythm checks to thegeneral public to help identify people at risk of AF. The collaborationis expanding the project during Heart Rhythm Week (5-9 June 2017) tocommunity pharmacists in at least twelve countries with a target todeliver pulse rhythm checks to 10,000 people, and to raise awarenessof pulse rhythm to more than 1m people.

073_16748-M3
Detection of Atrial Fibrillation (DETECT-AF Study) after EmbolicStroke of Unknown Source
W.B. Winkler, M. Hasun, C. Neuhold, H. Keller, P. Sommer,E. Fertl, F. Weidinger2 Medical Department KA Rudolfstiftung, Wien, Austria

INTRODUCTION In patients after embolic stroke of unknown source(ESUS) an implantable loop recorder (Reveal LINQ, Medtronic) wasinserted subcutaneously for screening of occult atrial fibrillation (AF).This single center study started in 2015. Follow-up is scheduled all 4months until end of device service. Standard work up of stroke wasperformed in all pts. by neurologists, implantation and managementof the implantable cardiac monitor by cardiologists.CASE An interim analysis was performed after 18 months: 69 pts.were included (mean age: 64 years). Follow-up was 447 þ/- 252 daysafter ESUS. Explantation of the device was performed in 1 pt. due todevice infection. AF was detected in 11 pts ( 16%) and atrial flutter in1 pt. ( 1,5%). In 3 pts. pauses longer than 3 seconds were found. Pts.having periods of paroxysmal AF were on aspirin in 66.7%, clopidogrelin 16.7% and DOAC in 16.7%. CHADSVASc score was 3 or more in 92%of AF pts. HASBLED score of 3 or more was found in 75%.RESULT Our interim results show good performance of the LINQimplantable loop recorder. The detection rate of AF is similar to re-sults of other studies like CRYSTAL-AF, where AF was detected in12.4% after 12 months.

073_16825-F1
Is the First Clinical Episode of Atrial Fibrillation Enough to takea Decision for Long-term Anticoagulation Therapy?
P. Papakonstantinou, E. Simantirakis, E. Kanoupakis, P. VardasDepartment of Cardiology, University Hospital of Heraklion, Heraklion,Crete, Greece

INTRODUCTION Long-term anticoagulation therapy is recommendedfor patients after their first atrial fibrillation (AF) episode if theCHA2DS2-VASc score is 1 or higher. Recent data suggests that only AFepisodes with duration >24hours(h) increase significantly the risk ofischemic stroke. In this study, we observed the recurrence profile ofthe arrhythmia via implantable loop recorders (ILRs).METHODS Thirty consecutive patients (mean age 66.9 � 10 years; 14men) received an ILR (Reveal XT 9529; Medtronic, USA) after theirfirst episode of paroxysmal AF. Follow-up visits were scheduled to beperformed for a period of three years.RESULTS In 3 patients (10%), no AF episode was recorded. Almosthalf of the patients (14/30) had a low recurrence rate of the






arrhythmia (�5 episodes/year), while the majority of patients (19/30) did not suffer from episodes with duration >24h. Eight patientshad low recurrence rate of the arrhythmia along with episodeslasted <24h.CONCLUSIONS A significant percentage of patients (36,6%) did notsuffer any other AF episode or had low recurrence rate along withepisodes <24h. In the era of direct oral anticoagulants (rapid onsetand offset) treatment strategies based upon the recurrence profile ofthe arrhythmia may benefit these patients and further studies shouldbe performed.

073_16970-F1
Is the Long-Term Anticoagulation Management of AtrialFibrillation Beneficial in Non-Selected Frail Elderly Patients?
P.E. Papakonstantinou, N.I. Asimakopoulou, D. Leventis, E. Hoda,G. Metzadonakis, M. Panousieris, S. Panagiotakis, A. GikasDepartment of Internal Medicine, University Hospital of Heraklion,Heraklion, Crete, Greece

INTRODUCTION Age appropriateness of long-term anticoagulation inatrial fibrillation (AF) is still uncertain. We aimed to evaluate the AFanticoagulation therapy in elderly patients.METHODS Single-center, observational study which includedconsecutive elderly patients (>70 years) with known AF, hospitalizedat the internal medicine department of our university hospital from 1st

June 2015 to 1st June 2016. The follow-up period lasted one year afterthe hospital discharge.RESULTS Seventy patients (mean age 83,3þ/-7 years; 32 male) wereincluded. Mean CHA2DS2-VASc was 4,2þ/-1,3, mean HAS-BLED was3.4þ/-1,37, and mean Charlson Score was 6.2þ/-2.59. In 63,2% of pa-tients moderate/severe anemia was observed. Prior to admission, 30%received acenocumarol, 22,8% non-vitamin K antagonists, 17,2% low-molecular heparin and 30% did not receive any anticoagulant. 18,5%had a history of moderate/severe bleeding after the initiation ofanticoagulation therapy. The mean rate of hospital re-admission was1.46 per patient, while all-cause mortality was 57,1% (one-year follow-up period).CONCLUSIONS Elderly frail hospitalized AF patients had highthromboembolic and bleeding risk and present significant high all-cause mortality at one-year follow-up. Anticoagulation therapyshould be personalised in these patients.

073_16784-H2
Increased Platelet Activity in Patients With Paroxysmal AtrialFibrillation
M. Negreva,1 K. Vitlianova21Department of cardiology, Medical University of Varna, Varna,Bulgaria; 2Department of cardiology, Second city clinic of Sofia, Sofia,Bulgaria

INTRODUCTION Platelets play a significant role in hemostasis.AIM To study their activity still in the first twenty-four hours ofparoxysmal atrial fibrillation (PAF).MATERIALS AND METHODS We measured plasma levels of b-thromboglobulin (b-TG) and platelet factor-4 (PF-4), main markersof platelet activity, in 51 non-anticoagulated patients (26 men, 25women; mean age 59.84�1.60) with PAF duration < 24 hours andin 52 controls (26 men, 26 women; mean age 59.50�1.46) matchedby age, gender, concomitant diseases and their treatment. Themarkers were examined once per each participant by chromogenicassays.RESULTS Plasma levels of b-TG were significantly higher in the pa-tient group compared to controls (25.04 � 1.10 IU/mL vs 14.97 � 0.46IU/mL, p<0.001). Compared to controls, patients with PAF had sub-stantially higher levels of PF-4 (8.07 � 0.44 IU/mL vs 3.99 � 0.27 IU/mL, p<0.001).CONCLUSION Platelet activity is significantly increased in the firsttwenty-four hours of PAF clinical manifestation that is a predisposi-tion to the development of hypercoagulable state still in that veryearly stage of the disease.

AF ABLATION: MAPPING AND IMAGING ISSUES


073_16284-H5
Visualization of Left Atrial Sympathetic Innervation Activity andthe Effect of Catheter Ablation on Activity Patterns in PatientsWith Atrial Fibrillation
V. Shabanov, A. Romanov, S. Minin, C. Breault, N. Nikitin, J. Stirrup,I. Mikheenko, D. Losik, I. Stenin, E. PokushalovArrhythmia Department and Electrophisiology Laboratory, SiberianBiomedical Research Center Ministry of Health Novosibirsk, RussianFederation

INTRODUCTION A novel cardiac gamma camera utilises the radio-pharmaceutical Iodine-123 Meta-iodobenzylguanidine (123I –mIBG) tovisualise cardiac sympathetic innervation. Physiologic uptake of123I –mIBG provides anatomical quantification of autonomic nervoussystem (ANS) structures, with discrete uptake areas (DUA) locatedin the left atrium (LA) corresponding to main ganglionatedplexi (GP) clusters that have previously not been able to bevisualised.PURPOSE The purpose of this study is to visualise cardiac sympa-thetic innervation patterns in AF patients and to assess the influenceof radiofrequency (RF) ablation on DUA sites in the LA.METHODS Twelve AF patients (7 non-paroxysmal; 6 male, mean age56�11) underwent cardiac computed tomography (CT) and 123I –mIBGnuclear imaging after isotope injection. Nuclear datasets were mergedwith the pre-acquired CT to generate a detailed anatomical map ofcardiac sympathetic activity. The processed maps were imported to a3D electroanatomical mapping system. High frequency stimulation(HFS) was performed using current recommended output settings atDUA sites indicating GP location and followed by targeted RF ablation.Additionally, HFS was performed in the expected anatomical GPareas. Circumferential pulmonary vein (PV) isolation with exit andentrance block confirmation was performed in all patients after DUAablation. Follow up nuclear imaging was acquired after 5 – 7 days postablation.RESULTS A total of 40 DUA in the LA were identified in 12 patients,3.3 � 1.49 per patient, (16 corresponding to left-sided PVs, 17 to right-sided PVs and 7 to the roof of the LA). Positive HFS response at DUAsites was achieved in 8 (67%) patients. There was no response to HFSin additional sites of the LA outside DUA locations before ablation.5.75�4.55 RF applications per each DUA were performed with positivevagal response during ablation in 5 patients. After ablation there wasno HFS response at DUA sites. On follow up images 3 DUA sites inthe LA were identified (0.25� 0.62 per patient; p< 0.001 vs baseline).In 10 patients (83%) DUA were not visualized compared to baselineimages.CONCLUSION The cardiac sympathetic innervation patterns of the LAcan be visualised by physiological localized uptake of 123I –mIBG. RFcatheter ablation can precisely and effectively target the identifiedsympathetic innervation structures in AF patients.

073_16731-A1
Visualisation of Left Atrial Sympathetic Activity Distribution andIts Physiological Variation Over Time in Healthy Individuals
A. Romanov, S. Minin, C. Breault, N. Nikitin, J. Stirrup,V. Shabanov, I. Mikheenko, D. Losik, I. Stenin, E. PokushalovArrhythmology department, Siberian Federal Biomedical Researchinstitution, Novosibirsk, Russian Federation

INTRODUCTION A novel cardiac gamma camera utilises physiologicuptake of Iodine-123 Meta-iodobenzylguanidine (123I –mIBG) tovisualise cardiac sympathetic innervation. Physiologic uptake of123I –mIBG provides anatomical quantification of autonomic nervoussystem (ANS) structures with discrete uptake areas (DUA) located inthe left atrium (LA) corresponding to main ganglionated plexi (GP)clusters, that have previously not been able to be visualised in healthysubject.






PURPOSE Understanding patterns of left atrial sympathetic activityin healthy individuals and their variation over time.METHODS Ten healthy individuals (4 male, mean age 37.8�14) un-derwent cardiac computed tomography and 123I –mIBG isotope nuclearimaging. The two image datasets were merged to generate a detailedanatomical map of cardiac sympathetic innervation. Specific activity(corrected for volume) from each DUA was measured, as well as themediastinal specific activity (corrected for volume), to describe theratio between DUA and the mediastinum. Nuclear imaging wasrepeated after 5-7 days, with no apparent change in the subject’s con-dition, and compared with baseline imaging. The study was approvedby local Ethics Committee and all participants signed informedconsent.RESULTS A total of 10 DUA in the LA were identified in 10 patients, 1�0.8 per patient. The mean activity ratio between DUA and the medi-astinum was 6.8�4.5. No DUA were identified in 3 (33%) subjects. Onfollow up images 13 DUA in the LA were visualized (1.3� 0.9 per pa-tient; p¼0.82 vs baseline) with mean activity ratio of 5.2�2.8 (p¼0.15vs baseline). In 7 (70%) subjects the locations of DUA were the same ascompared to baseline images. One additional DUA was visualized in 3(30%) subjects on FU images.CONCLUSION In the majority of healthy individuals the areas of leftatrial sympathetic activity can be visualized and are reproducible. Thedifference in activity of localized discrete uptake areas of 123I –mIBGbetween healthy subjects and patients with arrhythmias deservefurther investigation and may play an important role in developmentand management of atrial fibrillation.

073_16195-H2
Computer Modelling of Paroxysmal and Persistent AtrialFibrillation Mechanisms and Ablation Approaches. ExtrapolationMathematical Data to Clinical Results
E. Zhelyakov, A. Ardashev, M. Mazurov, V. FinkoDepart of Electrophysiology, MV Lomonosov State University, Moscow,Russia

AIM 1) to estimate theoretical probability of 4- and 6-waves re-entryto eliminate as a results of linear ablation simulation in 2D-mathe-matical modeling of left atrium (LA); 2) to extrapolate mathematicalmodeling data to clinical results of linear ablation in patients withparoxysmal and persistent AF.MATERIAL AND METHODS Study was conducted on 40 pts withparoxysmal and persistent AF. First group (paroxysmal) included 20pts (6 women, 51.4�13.6 years of age) with paroxysmal AF, who weredivided into 2 age-sex-arrhythmia duration subgroups (A and B). Thesubgroup A consisted of 10 pts in whom ablation strategy consisted ofPVI using LASSO approach. The subgroup B concluded of 10 pts inwhom ablation strategy consisted of antral isolation of PVs added byroof and mitral isthmus lines. Second group (persistent) concluded 20pts (6 women, 58.2�10.6 years of age, duration of arrhythmia – 7.1�1.1years) with persistent AF who underwent index circumferentialablation combined with roof and mitral isthmus lines. We evaluatedAF CL into the CS during procedure. The numeric reconstruction ofthe autowave process and the simulation of 4- and 6-wave re-entry AFwas performed using Fitzhugh-Nagumo equation. A special scanningmethod was used for calculating characteristics of autowave processesin 2D mathematical model of LA. Then simulation of circular (corre-sponding to LASSO approach) and linear ablation (corresponding tolinear approach) were performed.RESULTS In the first group 7 pts of the subgroup A vs 4 pts of thesubgroup B had early recurrences of arrhythmia. AAD free effective-ness in the A/B subgroups was 80%/20% at 12 months respectively(p¼0,003). In the second group organization of AF cycle length (from112�24 to 204�35 ms) was verified in 12 of 20 pts during ablation.There was no elimination of 4-waves re-entry around the PV andvortex waves caused by them in a distributed 2D medium while cir-cular LASSO-like ablation pattern was used. In contrast, linear abla-tion patterns suppressed arrhythmias caused by 4-waves re-entry.Ablation formatting (corresponding to linear ablation) transformed 6-wave reentry to 4 wave re-entry.CONCLUSION For paroxysmal AF mathematical ablation formatingsuppressed 4-waves re-entry more effectively comparing to LASSOapproach only. Mathematical modeling of 6-wave reentry and linear

ablation formatting may simulate persistent AF and subsequent AForganization result of antral and linear ablation. Our clinical resultsare consistent with ablation modeling data.

073_16988-H2
Electrogram Signature of Specific Activation Patterns: Analysisof Atrial Arrhythmias at High-Density Endocardial Mapping
A. Frontera, M. Takigawa, R. Martin, N. Thompson, G. Cheniti,G. Massouille, J. Duchateau, T. Kitamura, M. Wolf, N. Al-Jefairi,K. Vlachos, S. Yamashita, A. Denis, M. Hocini, H. Cochet, F. Sacher,P. Jaïs, N. Derval, M. HaïssaguerreHopital Haut Leveque, Bordeaux, France

BACKGROUND The significance of fractionated electrograms is objectof debate with multiple mechanisms described.OBJECTIVE Using Rhythmia�, a high-density mapping system, wesought to investigate the relationship between specific electrophysi-ological phenomena and EGM characteristics at those sites.METHODS 25 consecutive patients underwent HD atrial mappingduring AT. Bipolar EGMs were recorded with the Orion� catheter, a64-electrode basket. The following atrial phenomena were identified:slow conduction(SC) areas, lines of block(LB), wave front colli-sions(WFC), pivot sites(PS) and gaps. EGMs collected at these pre-defined areas were analyzed in terms of amplitude, duration, andmorphology.RESULTS 25 atrial maps with 195 sites of interest (1755 EGMs) wereobject of our analysis. 35% were sites of SC: fractionation had lowamplitude (0.16 �0.07 mV) and long duration (87.8 �10.7 ms); WFCwas seen in 38% of sites with EGMs shorter in duration (46.5 �4.5 ms)and of higher voltage (0.58 �0.13mV); 17% were LB, never responsiblefor fractionation (0.13� 0.05 mV, 122.4 ms �24.8ms); 9% were PS withhigh degree of fractionation (0.55 �0.15 mV; 85.8 �7.9ms). Two gapswere identified (1%) with low degree of fractionation.CONCLUSIONS Specific EGM characteristics can be reproduciblylinked to electrophysiological mechanisms. High voltage and shortduration EGMs are associated with collision and pivot sites which areunlikely to form critical sites for ablation; long duration, low voltage,EGMs are associated with slow conduction. However, not all slowconduction regions will lie within the critical circuit and identificationby only EGM characteristics cannot guide ablation.

073_16987-H2
EGM Fractionation in Apparently Healthy Tissue:Time to Redefine the Voltage Threshold for Diseased Atrium?
A. Frontera, R. Martin, M. Takigawa, G. Cheniti, C. Dallet, T. Kitamura,N. Thompson, M. Wolf, G. Massoullie, K. Vlachos, A. Denis, M. Hocini,H. Cochet, F. Sacher, P. Jaïs, N. Derval, M. HaïssaguerreHopital Haut Leveque, Bordeaux, France

INTRODUCTION EGM fractionation is associated with diseased atrialtissue, however above the established threshold of 0.5 mV, mecha-nisms of fractionation are poorly understood.OBEJCTIVE To investigate the mechanism underlying EGM fraction-ation on healthy tissue using high density mapping during atrialtachycardia.METHODS We mapped 40 consecutive post AF ablation ATs withRhythmia. Only healthy EGMs (> 0.5 mV) were considered for anal-ysis. When fractionation (>40 ms and > 2 deflections) was detected,we characterized the mechanism as slow conduction, wave-frontcollision, or pivot points. In the case of slow conduction, we measuredconduction velocity. Each EGM was characterized in terms of frac-tionation, duration and amplitude.RESULTS On 36 left and 4 (10%) right atrium maps, 115 sites of EGMfragmentation on healthy tissue were identified. There was no fraction-ation in 3 atrial maps (7.5%). In the others, the most frequent mechanismwas slow conduction (velocity 0.3 m/s� 0.2) (73%). EGM voltage was 0.98� 0.05 mV with duration 59,6 � 13.1 ms. Wavefront collision was thesecond most frequent (18%), characterized by higher voltage (1.8 � 0.7mV) and shorter duration (44.4� 7.1 ms). Pivot point (13%) was associatedwith the highest degree of fractionation with 62.5 � 10.4 ms and 1.1 � 0.1mV. In six sites, fractionation was unexplained. The EGM duration wassignificantly different among the 3 mechanisms (p¼ 0.0351).





CONCLUSION EGM fractionation occurs with normal voltage but islikely to be related to underlying structural disease. Voltage criteriamay not be sufficient to define healthy myocardium.

073_16800
Comparison Of The Rhythmia� And Confidense� MappingSystem For The Assessment Of Pulmonary Vein ConductionRecovery
M. Gwechenberger, R. Wurm, C. Schukro, H. GössingerMedical University of Vienna, Vienna, Austria

BACKGROUND Pulmonary vein (PV) isolation (PVI) is the corner stonein the ablation of atrial fibrillation. However recurrence of PV con-duction occurs quite frequently. The study aim was to evaluatewhether the assessment of PVI reconnection is dependent on theapplied mapping modality.METHODS A total of 12 patients aged 62.3 �14.9 (50% male) under-going a repeat ablation procedure because of recurrence of atrialfibrillation were examined. The recovery of pulmonary vein conduc-tion was assessed using 2 different mapping systems (RHYTHMIA�Mapping System, Boston Scientific, Inc, Cambridge, MA and CARTO� 3System CONFIDENSE� Module, Biosense Webster, Diamond Bar CA).The result was considered concordant if both system demonstratedreconnection (or isolation) of the PV and discordant if this was onlypresent in one system. In addition the morphology of the veins wasassessed (Diameter, Area, Branching).RESULTS The PVs were more frequently considered non isolated withthe RHYTHMIA� system when compared to the CONFIDENSE� Sys-tem and a reconnection was present in at least one pulmonary vein in91.6% of the patients. The amount of discordant results was depen-dant on the location of the pulmonary vein: left superior and inferiorpulmonary vein in 12,5% each, right superior vein 18.8% and rightinferior in 25%. With respect to the morphology of the vein only asmaller diameter in the left inferior vein was predictive for discor-dance, all the other parameter remained not significant for all veins.CONCLUSION The assessment of reconnection after PVI is dependenton the applied mapping modality and is more often seen with theRHYTHMIA� system when compared to the CONFIDENSE� .

073_16739-L5
Transseptal Imaging of the Left Atrium With CartosoundIntracardiac Ultrasound
B. Antoli�c, M. Jan, D. Iek, L. Klemen, A. Pernat, M. InkovecDepartment of Cardiology, University Medical Centre Ljubljana,Ljubljana, Slovenia

INTRODUCTION Reconstructing left atrium (LA) anatomy for atrialfibrillation (AF) ablation with CARTOSound intracardiac ultrasound(ICE) is usually done from the right heart chambers. However, asvisibility of LA structures with this method is frequently suboptimaladditional point-by-point or fast anatomical mapping is needed.Therefore, our aim in this case series was to present our experiencewith transseptal LA imaging with CARTOSound ICE.METHODS After initial imaging and LA anatomy reconstruction from theright heart chambers, LA access with ICE was achieved by navigating theICE probe along the wire placed through the transseptal puncture or

through the long sheath placed transseptally. With the ICE placed trans-septally all LA structures relevant to PVI could be imaged in great detail.RESULTS We performed PVI in 15 patients with AF (13 paroxysmal, 2persistent). All PVIs were successfully achieved with irrigated contact-force sensing catheter. Median procedure time was 150 min (inter-quartile range: 130 - 160 min) without the use of fluoroscopy.

CONCLUSIONS Transseptal CARTOSound imaging allowed us tomake the relevant anatomy for succesfull PVI without flouroscopy oradditional contact mapping.

TRANSCATHETER ABLATION AND SURGICAL ABLATIONOF AF: CLINICAL RESULTS


073_16225-H5
Fibrosis Marker Soluble ST2 for Prediction of Atrial FibrillationRecurrence After Cryoballoon Catheter Ablation
S. Okar, O. Kaypakli, D.Y. Sahin, M. KocHealth Sciences University, Adana Health Practices and ResearchHospital. Cardiology Department

INTRODUCTION We aimed to investigate the relationship betweenthe recurrence of AF and fibrosis marker sST2 in patients with non-valvular PAF.METHODS We prospectively included 100 consecutive patients withPAF diagnosis and scheduled for cryoballoon catheter ablation foratrial fibrillation (47 male, 53 female; mean age 55,1�10,8 years). sST2plasma levels were determined using the ASPECT-PLUS assay onASPECT Reader device (Critical Diagnostics, San Diego, CA, USA). Themeasurement range of these measurements was 12.5-250 ng / mL.Patients had regular follow-up visits with 12-lead ECG, medical historyand clinical evaluation. 24 h Holter ECG monitoring had been recor-ded 12 months after ablation.RESULTS AF recurrence was detected in 22 patients after 1 year. Pa-tients were divided into two groups according to the AF recurrence.All parameters were compared between the two groups. Age, smokinghistory, DM, HT frequency, ACEI-ARB use, CHA2DS2VASc and HAS-BLEED score, serum sST2 level, LA end-diastolic diameter, LA volumeand LA volume index were related to AF recurrence. In binary logisticregression analysis, sST2 was found to be only independent parameterfor predicting AF recurrence (OR¼1.085) (p¼0.001). The cut-off valueof sST2 obtained by ROC curve analysis was 30,6 ng/mL for prediction





of AF recurrence (sensitivity: 77.3%, specificity: 79.5%). The area un-der the curve (AUC) was 0.831 (p<0.001).CONCLUSIONS Soluble ST2, which is associated with atrial fibrosis,can be thought to be a useful marker for detection of patients withhigh-grade fibrosis who will get less benefit from cryoablation.

073_16936-H5
The Comparison of Efficacy of PVI and Rotors Ablation inPatients with Persistent and Long-Standing Persistent AtrialFibrillation. Mid-Term Results
O.V. Sapelnikov, D.I. Cherkashin, N.B. Shlevkov, A.A. Zhambeev,H.F. Salami, D.F. Ardus, O.A. Nikolaeva, T.M. Uskach, A.S. Partigulova,N.A. Buldakova, A.V. Chapurnikh, R.S. AkchurinCardiovascular Surgery Department, Russian Cardiology Research andProduction Complex, Moscow, Russia

INTRODUCTION The CONFIRM trial showed excellent results inFIRM-guided ablation in patients with persistent atrial fibrillation.Authors demonstrated the sinus rhythm restoration during rotorsablation and described its properties and localization. But thecomplicated method and high cost of tools limited the reproducibilityof these results. In our study we compared the efficacy of the pro-cedure of pulmonary vein isolation and FIRM-guided ablation.METHODS 80 patients with persistent and long-standing persistentAF were included. 23 patients had non-invasive rotor mapping usingAMYCARD-system (AMYCARD,Russia) and the ablation procedure –usingthe Ensite Velocity navigation (St.Jude Medical, USA) and Blazer OpenIrrigated catheters (Boston Scientific, US). We isolated PVs and performedclosing lines through rotor’s epicenters to anatomical structures(PVs, valves etc.). In all cases 10F AcuNav ICE-catheters (Siemens) havebeen used. For an objective evaluation of the results monitor RevealXT (Medtronic, USA) was implanted. For 57 patients, who did not havenon-invasive rotor mapping, we performed PVs isolation.RESULTS After 6 months of follow-up 3 atrial fibrillation recurrencesand 1 atrial flutter were registered in FIRM-guided ablation group. 19patients remained in normal sinus rhythm. In 2 patients we observedthe restoration of the sinus rhythm through the transformation of AFto the left atrial flutter, which was mapped and ablated. In PVsisolation group we observed 16 patients with atrial fibrillation recur-rence and 3 patients with atrial flutter. During the procedure only onepatient had the restoration of the sinus rhythm. As the result the ef-ficacy of PVs isolation and FIRM-guided ablation was 82.6% versusPVs isolation – 66.7%. Nevertheless, this difference was not statisti-cally significant (p ¼ 0.153).CONCLUSIONS Additional ablation of rotors leads to changes ofelectrical activation of the atria in some patients. According to our data,FIRM-guided ablation precedes PVs isolation in several features. Possiblerestoration of the sinus rhythm and electrical changes in the atria areassociated with the stability of rotors in patients with chronic AF.

073_16725-H5
Our First Outcome Pulmonary Vein Isolation Using II Generation28 MM Cryo Balloon
A. Baimbetov, K. Yergeshov, K. Bizhanov, I. Yakupova,K. AbzalievDepartment Interventional Cradiology and Arrhythmology, Syzganov’National Scientific centre of Surgery Almaty, Kazakhstan

AIM AND OBJECTIVE to demonstrate our primary results after pul-monary vein cryoisolation using 2nd generation in patients withparoxysmal and persistent atrial fibrillation. Long term outcomes isnot yet avialable.MATERIALS AND METHODS From 2014, in our electrophysiologicallaboratory, more than 200 ablation procedures of pulmonary veinisolation were carried our using 2nd generation cryoballoon in pa-tients with different forms of atrial fibrillation. In selecting patientsfor cryoablation procedure patients with paroxysmal and persistentform of atrial fibrillation are taken with a condition of size of the leftatrium is not more than 4.5 cm and not previously received anytreatment. All patients received standard anticoagulation therapywith a target INR of (2.0-2.5). Before procedure, all the patients un-derwent transesophageal echocardiography (TEE) in order to excludepresence of thrombus in the left atrial appendage. Also, all the pa-tients conducted computed tomography (CT) with reconstruction ofthe anatomy of the left atrium and pulmonary veins with their size

measurement. In order to avoid impairment of phrenic nerve, pacingthrough superior vena cava was carried out with a frequency of 5pulses per minute. At the end of isolation of each vein spiral mappingcatheter was used to confirm the degree of isolation. The resultshowed that it is possible to achieve 95 % of complete isolation in allthe veins and 5 % of incomplete isolation which is due to the anatomyof the left atrium and pulmonary veins.RESULTS During the procedure, significant complications were notobserved. However, there was phrenic nerve palsy in 18 patientswhich evolved during isolation of right superior pulmonary vein. In 2patients, the phrenic nerve palsy was maintained for 6 months, therest went on their own within 1 month. In addition to that, return ofAF was observed in 30 patient who again underwent a RFA procedureusing the navigation system with the construction of three-dimen-sional map of the left atrium.

CONCLUSION The method of pulmonary vein isolation using cry-oballoon of 2nd generation is considered as highly effective and safeprocedure in treatment of paroxysmal atrial fibrillation with anatomicnon-dilated left atrium. This technique can be recommended not onlyfor patients with paroxysmal, but also for persistent atrial fibrillationwith careful patient selection.

073_16772-H5
First Long-Term Redo Experiences With Cryo After CryoballoonAblation for Atrial Fibrillation: A Two-Year Follow-Up Registry
S.W. Westra, S.P.G. van Vugt, S. Sezer, R. Evertz, R.J. Beukema,M.E.W. Hemels, J.L.R.M. Smeets, G.B. Chierchia, M.A. BrouwerRadboud University Medical Center, Nijmegen, the Netherlands HeartRhythm Management Center, University Hospital Brussels, Brussels,Belgium

INTRODUCTION The ideal energy source and strategy for repeatablation procedures of atrial fibrillation (AF) has to be established.Data on redo procedures using cryoballoon technique are limited. Wereport long-term follow-up on cryoballoon redo procedures after aninitial successful cryoballoon ablation.METHODS The cohort consists of AF patients who underwent a repeatablation for recurrent AF with the same cryoballoon technique (n¼67).By local protocol, all patients were followed with four 6-day Holterregistrations during the first year, and 2-year clinical follow-up wassystematically collected with 3-month intervals. We report rates of AFrecurrences after a 90-day blanking period.RESULTS Baseline characteristics are displayed in table 1. First yearAF recurrence was observed in 30% of patients (n¼20), with the ma-jority of recurrences detected with clinical follow-up. Two year clin-ical follow-up resulted in AF recurrence in 37% (n¼25) patients.





CONCLUSION Cryoballoon redo procedures after a first cryoballoonablation have acceptable long-term success rates. Additional studieswith systematic clinical follow-up in addition to protocol drivenHolter monitoring are warranted to compare the efficacy of cryo redoprocedures with radiofrequency ablation.

073_16735-H5
Reverse Electrical Remodeling Induced by Sinus Rhythm andCalcium Channel Blockers May Play a Role for Better Long-TermFollow-Up Results in Patients With Long Standing PersistentAtrial Fibrillation and Treated With Cryo-Balloon Ablation
J.M. Paylos, C. Ferrero, O. Rodríguez, J.R. Conesa, R. Ramírez, L. Lacal,E.J. Heim, Y.H. Abdou, F. Valencia, C. MartínezArrhythmia Unit and Electrophysiology Lab. Moncloa HLA UniversityHospital. European University of Madrid, Madrid, Spain

INTRODUCTION The electrical disconnection of the pulmonary veins(PV) from the left atrium (LA) by cryo-balloon ablation (CB), hasproven effective to treat patients (pts) with atrial fibrillation (AF).However the results significantly differ from paroxysmal to persistent,and several factors related with the atrial remodeling process play animportant role on this. AF causes electrical remodeling, and chronicAF led to shortening of the atrial effective refractory period (AERP),and to loss of its physiological rate adaptation, which could make atriamore vulnerable to fibrillation. Human and experimental studies havedemonstrated that electrophysiological changes are influenced byintracellular calcium overload, and verapamil (VP), but not otherantiarrhythmic drugs (ADD) could markedly attenuate this effect.According with the aforementioned, we sought to achieve electricalatrial stabilization with VP after cardioversion (CV) 3 months beforeCB-PV ablation in patients with long standing persistent atrial fibril-lation (LSPAF).METHODS Sixty nine pts, 56 male (61�10 mean age) were treated forLSPAF, 54 with the second generation CB and PV isolation demon-strated. The mean time duration of stable arrhythmia was 5�5 years(2-24). All previously treated with AAD. Mean LA size: 42�6 mm. AfterCV, electrophysiological evaluation pre and post 0.15 mgr/Kg bodyweight of VP was done and the AERP at 500 ms pacing CL measured.Criteria of exclusion for CB-PV ablation included: left atrial size �50mm, and failed CV to reverse AF. After 3 months blanking period onAAD, PV complete electrical isolation was achieved with CB, and amean period follow-up duration of 42.6 months (4�2 years), analyzed.RESULTS Mean AERP increased from 205�16 to 237�16 ms (p�0.05)after VP. Forty six pts (66%) maintain SR without AAD after asingle procedure. AF recurred in 23 pts (33%) who were givenAAD: 9 pts refused a second procedure (REDO) and remain in AF. Inthe remaining 14, sinus rhythm (SR) was restored with AAD andwere REDO. In a mean REDO follow-up of 30�20 months, all 14

REDO pts remain in SR (4 on AAD). After REDO, 60 pts (87%) remainin SR.CONCLUSIONS Reverse atrial electrical remodeling induced by SR þVP 3 months before CB-PV ablation can select LSPAF pts for CB-PVisolation with better long term outcomes.

073_16230
Recurrence Of Atrial Fibrillation After Cryoablation During TheBlanking Period Is A Strong Predictor For Long Term Recurrence
T. Rambhatla, E. Levine, K. Bhasin, N. Skipitaris, N. Bernstein,S. MountantonakisHeart Rhythm Center, Lenox Hill Hospital, New York, NY, USA

INTRODUCTION The term blanking period refers the initial 3 monthspost radiofrequency ablation (RFA) when early recurrence (ER) ofatrial tachyarrhythmias can be ascribed to the temporary inflamma-tory and proarrhythmic changes that occur in the atrium post pro-cedure and do not necessarily predict late recurrence (LR) of atrialarrhythmias. The 2007 expert consensus statement endorses imple-menting a blanking period for the first 3 months after RFA for atrialfibrillation (AF). A few studies have shown that ER post cryoablationmay be predictive of LR but it is not generally accepted. We hypoth-esized that the use of cryoenergy is far less proarrhythmic than radi-ofrequency energy such that the initial temporary blanking period of 3months post procedure does not apply to cryoablation and ER duringthis period may be a strong predictor of LR.METHODS We retrospectively analyzed outcomes of 115 patients thatunderwent cryoablation at our institution since 2014 (paroxysmaln¼68; persistent n ¼ 47). All patients had circumferential ablation ofall four pulmonary veins with isolation demonstrated by entrance andexit block. Patient were followed post procedure with a 12 lead ECG at1-,3-,6-,12- month intervals, regular phone call assessment for symp-tom recurrence, and a 24 hour Holter monitor, 3 week event monitor,or internal loop recorder obtained on an individual need basis. ER wasdefined as any atrial tachyarrhythmia observed lasting > 30 secondsduring the initial 3 months post procedure.RESULTS After a median follow up period of 16 months: 31/115patients were found to have ER; of those patients, 19 (63%) devel-oped LR; and 12 patients (38%) developed LR without ER. Individualcharacteristics (history of CHF, EF < 50%, dilated left atrium,CHADs-VASc score > 2, persistent AF) did not meet statisticalsignificance for predicting LR by Chi-square and regression analysis.The only predictor of LR was the presence of ER as determined byboth regression analysis and univariate analysis (p¼.030; p ¼ 0.00).Of the 19 patients that had both ER and LR, 5 had repeat procedures,and 4 out of the 5 cases (80%) had reconnection of one or more ofthe pulmonary veins.CONCLUSION In our study, ER after cryoablation for atrial fibrillationwas show to be an independent strong predictor of LR. These datasuggest that the presence of ER after cryoablation is not a temporaryphenomenon due to the proarrhythmic state post procedure but mayin fact be due to a more permanent factor and possibly, reconnectionof a pulmonary vein.

073_16741-Q1
Successful Management of Atrio-Esophageal Fistula (AEF) ThatCould Not be Detected by Conventional Imaging Methods AfterCatheter Ablation for Atrial Fibrillation
E. Güler,1 Ö. Arıcı Düz,2 G. Babur Güler,1 G.G. Demir,1 A. Akçevin,3

F. Kılıçaslan1

1Istanbul Medipol University, Cardiology Department; 2IstanbulMedipol University, Neurology; 3Istanbul Medipol University,Cardiovascular Surgery Department, Istanbul, Turkey

INTRODUCTION Atrio-esophageal fistula (AEF) development aftercatheter ablation for atrial fibrillation is a major complication which ishard to recognize and presents with fever and neurological symptoms.When clinical symptoms raise concerns about AEF, demonstration ofthe fistula by imaging methods followed with surgical therapy isrecommended. However, it is challenging to choose treatment strat-egy when conventional imaging methods fail to detect AEF. Here wepresent a case of AEF after catheter ablation for atrial fibrillation thatwas successfuly treated surgically and the treatment strategy was





chosen based on highly clinical suspicion although the fistula couldnot be visualized.CASE A 57 year-old male patient with no remarkable history otherthan hypertension presented to our outpatient clinic for palpitationsymptoms despite medical therapy. The patient had atrial fibrillationin his admission electrocardiogram with a heart rate of 95 beats perminute. Left atrium and pulmonary veins anatomy were recon-structed by CARTO electroanatomic mapping method after transseptalpuncture. Ostia of pulmonary veins were circumferentially ablatedpoint-by-point via Lasso catheter (Lasso; Biosense Webster, DiamondBar, CA,USA). The patient presented with fever 20 days after theprocedure and was followed by the infectious disease specialist withthe preliminary diagnosis of infective endocarditis. Blood culturetests were positive for Enterococcus species and appropriate anti-biotic therapy was initiated. Initial computed tomography (BT) inorder to rule out AEF did not show any signs of AEF so antibioticregimen was continued. Five days after admission the patient suf-fered significant impairment in reading and writing skills and diffusemagnetic resonance imaging (MRI) revealed ischemic area in lefttemporal cortical area with simultaneous hemorrhagic foci. The con-dition of the patient was evaluated by the Heart Team and urgentsurgery was scheduled despite failure to show AEF. Left atriotomywas performed following sternotomy. Ostium of the fistula in 2.5 mmsize was detected adjacent to left inferior pulmonary vein in the leftatrium. The fistula was sutured with pericardial support. Left atriumwas closed and the heart was examined posteriorly, purse-stringsuture with autologous pericardial support was performed in thearea adjacent to left inferior pulmonary vein through the estimatedfistula line. The patient continued to receive antibiotic therapy for4 weeks after the operation and esophagoscopy revealed no signs offistula. Control diffuse MRI showed no remarkable lesion but stablehemorrhagic foci and the follow-up is uneventful under warfarintherapy.

073_16292-H6
Effect of Left Atrial Appendage Excision on Procedure Outcomein Patients With Persistent Atrial Fibrillation UndergoingSurgical Ablation
E. Pokushalov, A. Romanov, D. Elesin, A. Bogachev-Prokophiev,D. Ponomarev, D. Losik, S. Bairamova, O. Pidanov, E. Ivanickii,A. Karaskov, J.S. SteinbergState Research Institute of Circulation Pathology, Novosibirsk, Russia

INTRODUCTION Catheter ablation is less successful for persistentatrial fibrillation (Pers AF) than for paroxysmal atrial fibrillation. Somestudies suggest that left atrial appendage (LAA) isolation in additionto pulmonary vein isolation (PVI) is required in persistent atrialfibrillation.METHODS AND RESULTS We randomly assigned 176 patients withPers AF to video-assisted thoracoscopic surgical ablation with PVIalone (88 patients), or PVI plus additional LAA excision (88 patients).The duration of follow-up was 18 months. The primary end pointwas freedom from any documented recurrence of atrial fibrillationlasting longer than 30 seconds after a single ablation procedure. After18 months, 87% of patients assigned to PVI alone were free fromrecurrent atrial fibrillation, as compared with 90% of patientsassigned to PVI plus LAA excision (P ¼ 0.61). There were also no sig-nificant differences among the two groups for the secondary endpoints, including freedom from atrial fibrillation after two ablationprocedures and freedom from any atrial arrhythmia. AF burden wassignificantly reduced post-ablation by all strategies (p<0.001) and theburden was not significantly different between groups. There were nosignificant differences between groups. Five patients required con-version to median sternotomy for bleeding. Other serious adverseevents included death (one event), transient ischemic attack or stroke(6 events), pneumothorax (14 events), hematothorax or hydrothorax(17 events).CONCLUSION Among patients with persistent atrial fibrillation, wefound no reduction in the rate of recurrent atrial fibrillation when leftatrial appendage excision was performed in addition to pulmonaryvein isolation.

SUDDEN CARDIAC DEATH RISK IN HEREDITARYARRHYTHMOGENIC DISEASE AND ATHLETES


073_16729-B2
Co-Inheritance of Mutations Associated With ArrhythmogenicCardiomyopathy and Hypertrophic Cardiomyopathy
M. De Bortoli,1 C. Calore,2 A. Lorenzon,1 M. Calore,1 G. Poloni,1

E. Mazzotti,2 I. Rigato,2 M. Perazzolo Marra,2 P. Melacini,2 S. Iliceto,2

G. Thiene,2 C. Basso,2 L. Daliento,2 D. Corrado,2 B. Bauce,2

A. Rampazzo1

1Department of Biology, University of Padua, Padua, Italy; 2Departmentof Cardiac, Thoracic, and Vascular Sciences, University of Padua,Padua, Italy

INTRODUCTION Arrhythmogenic cardiomyopathy (ACM) and Hyper-trophic cardiomyopathy (HCM) are genetically and phenotypicallydistinct disorders of the myocardium.METHODS The population of the study included 2 families with recur-rence of ACM and HCM. ACM and HCM were diagnosed according to therevised 2010 Task Force criteria and the 2011 ACCF/AHA HCM guidelines.The genetic analysis was carried out by denaturing high-performanceliquid chromatography, sanger and next generation sequencing.RESULTS In Family A, 5 patients resulted to be carriers of two mu-tations, in DSP and MYBPC3 genes (Figure 1). Two of them werediagnosed with ACM, two with HCM and one declined clinical eval-uation. In Family B, patient II-7 resulted to carry two mutations inCTTNA3 and MYH7 genes (Figure 1), but he does not fulfill the currentdiagnostic criteria neither for ACM nor for HCM.

CONCLUSIONS This report describes for the first time patients withdifferent cardiac phenotypes showing a co-inheritance of mutations ingenes associated with ACM or HCM. These patients do not exhibit a moresevere form of the disease compared with single mutation carriers.

073_16776-B2
Unexpectedly High Incidence of T309I Mutation in KCNQ1 GeneAmong Czech Families With Long QT Syndrome
T. Novotny,1 I. Synkova,2 I. Andrsova,1 R. Gaillyova,2

I. Valaskova,2 P. Vit,3 T. Chlupova,1 M. Bebarova,4 O. Svecova,4

J. Hosek,5 J. Spinar11Department of Internal Medicine and Cardiology, University Hospital Brnoand Faculty of Medicine, Masaryk University, Brno, Czech Republic;2Department of Medical Genetics, University Hospital Brno and Faculty ofMedicine, Masaryk University, Brno, Czech Republic; 3Department ofPaediatrics, University Hospital Brno and Faculty of Medicine, MasarykUniversity, Brno, Czech Republic; 4Department of Physiology, Faculty ofMedicine, Masaryk University, Brno, Czech Republic; 5Department ofMolecularBiologyandPharmaceutical Biotechnology,FacultyofPharmacy,Veterinary and Pharmaceutical University Brno, Brno, Czech Republic

INTRODUCTION Mutations in up to 15 genes have been associatedwithlong QT syndrome (LQTS), most encoding for subunits of cardiac ionicchannels. In majority of cases, each family has its “own” mutation.





METHODS Individuals with suspected LQTS are regularly investigated inUniversity Hospital Brno, all of them undergo clinical examinationincluding bicycle ergometry and genetic consult. In patients with clini-cally confirmeddiagnosis of LQTS,mutation analysis of LQT-related genes(mostly KCNQ1, KCNH2, SCN5A) is performed. Previously, single strandconformational polymorphism methods and automatic sequencing wereutilized, recently, we have started to use next generation sequencing.RESULTS KCNQ1 gene mutations were found in 30 unrelated families(88 individuals, 52 mutation-carriers) with clinical diagnosis of LQTSduring years 2000-2016. In 5 families (16%) the same T309I variant wasthe causativemutation segregating with pathological LQTS phenotype.According to preliminary biophysical data, the mutation seems togenerate non-functional channels.CONCLUSIONS High incidence of T309I mutation in KCNQ1 genesupports a hypothesis that this might be a founder mutation in ourregion. Further pedigree extension and geographic localization ofancestor origin is ongoing.

073_16793-Q1
Iatrogenic Electrical Storm in Brugada Syndrome
P.A. Costa, E. Sbaraini, R.B. Abt, A. Cardoso, D.A.R. Moreira,K.R. Serafim, C.R. Cunha, F.K. DorfmanDepartment of Electrophysiology Instituto de Cardiologia e Ritmologiado Estado de Sao Paulo / Instituto Dante Pazzanese de Cardiologia, SaoPaulo, Brazil

INTRODUCTION Brugada syndrome (BS) is a disease that occurs withcompromised cardiac sodium channels. It is associated with polymorphicventricular tachycardia (VT) and sudden death. In the presence of sus-pected ECG, a pharmacological test can be performed with antiarrhythmicdrugs, such as propafenone, in order to induce the typical type 1 pattern.CASE REPORT A 32-year-old male with a diagnosis of SB and animplantable cardioverter-defibrillator (ICD). During a 3-year follow-up, presented 4 appropriate shocks. Because of this, his doctor haschosen to start propafenone. After the 5th dose, he started to presentseveral shocks by the ICD, looking for emergency service. His ECGshowed Brugada type 1 pattern and presented several episodes ofunsustained VT with cardioscopy. The ICD assessment showed 17appropriate therapies, being 15 shocks in approximately 45 minutes.Propafenone was discontinued and treatment with intravenousIsoproterenol was initiated, with resolution of the tachyarrhythmia.CONCLUSIONS 1) Knowledge of BS is fundamental for its adequatetreatment; 2) propafenone can trigger malignant arrhythmic events;And 3) Isoproterenol is effective drug in the treatment of electricalstorm in these patients.

073_16836-Q1
Night Time Cardiac Arrest in Type Three Malignant EarlyRepolarization Syndrome: A Case Report
P. Cheema,1 C. Perzanowski21Department of Graduate Medical Education, Brandon RegionalHospital, Brandon, FL, USA; 2Department of Electrophysiology, Bay AreaCardiology and Vascular; Brandon Regional Hospital; Brandon, USA

Malignant early repolarization syndrome (MERS) has recently beenrecognized as a rare arryhthmogenic entity for sudden cardiac death.

Once considered a benign finding on ECG, recent studies establish alink between the presence of early repolarization and idiopathicventricular fibrillation (VF). This report describes a nocturnal pre-sentation and subsequent treatment of MERS.A seventy-year-old woman suffered VF arrest overnight. Adequatelyanticoagulated, her cardiac biomarkers, catheterization and echocar-diography were unremarkable. The EKG revealed a J-wave elevationin five inferior-lateral leads(Figure 1), consistent with Type-3 MERS.The patient underwent implantation of a cardioverter defibrillator andwas started on Ito-blockade with disopyramide. At two year follow up,there have been no recurrent episodes of VF and J-waves remainabsent on ECG.MERS is an uncommon cause of VF arrest. Although the literaturesuggests dynamic fluctuations in J-waves, night-time arrest is not acommon association. This case suggests that the presence of the J-waves in multiple leads may be associated with a more ominousprognosis. MERS should be contemplated as the cause of unexplainedVF arrest when other, more common etiologies have been excluded.

CATHETER ABLATION OF VENTRICULAR ARRHYTHMIAS


073_16938-C4
Contiguous Low Impedance Areas are Associated with OutflowTract and Non-Outflow Tract PVCs
A.M. Greenspan, K.P. Joshi, I. Khurram, S.K. MainigiEinstein Medical Center, Philadelpphia Section of ElectrophysiologyDepartment of Medicine Philadelphia, Pennsylvania, USA

INTRODUCTION Contact tissue impedance mapping (CTIM) candifferentiate focal atrial tachycardia (AT) from macro-reentry e.g.atrial flutter, and localized reentry e.g. AVNRT, by identifying acontiguous low impedance area (CLIA) only in AT. We suspect that theCLIA is related to triggered activity as suggested by its presence onlyin AT associated with sharp, short duration electrograms at the site oforigin. We hypothesized that if the CLIA reflected a region of triggeredactivity (TA) due to after-depolarizations it should be present in pre-mature ventricular complexes (PVC) that are mainly due to TA. Toexpand the utility of CTIM in analysis of arrhythmia mechanisms, weapplied CTIM in patients with PVCs to determine if CLIA’s are presentand help localize their ablation site.

METHODS Forty-one consecutive patients with 53 different PVCs,28male (68%),19 with CHF(46%) ,with mean LVEF of42�16% weremapped via local activation time (LAT) and CTIM utilizing the Carto 3and XP mapping systems, and a 4-mm tip ablation catheter. Mapswere created by moving the catheter to approximately150 points inthe ventricle. Pace mapping was used adjunctively to select theablation site. Low impedance (Z) was defined as � Z min þ 10%x(Zmax-Zmin). Normal Z was defined as � Zmin þ 20%x(Zmax-Zmin).

RESULTS The origin of the 53 PVCs were outflow tract (OT) -25, mitralannulus -9, LV papillary muscles (PAP) - 4, LV lateral wall - 4, tricuspidannulus- 3 , RV septum- 2, LV apex - 1 and 1 in aorto-mitral continuity.





Forty-nine (93%) of the 53 PVCs had a CLIA and all had sharp normalvoltage (>1.5 mV) narrow(<55ms) electrograms at the ablation site. In19 (76%) of 25 OT PVC and in 17 (71%) of the 24 Non-OT PVCs the CLIAcontained the ablation site, and in remaining 15 PVCs (29%) the CLIAwere within 1.3�0.6cm (1.2�0.6 for OT PVC and 1.5�0.6 for non-OTPVC) of the ablation site. The mean distance of CLIA to the ablation sitewas 0.4�0.7cm and the average surface area of the CLIA was6.1�3.5cm2. The size of the CLIA was directly proportional to its dis-tance from the ablation site when it did not contain the ablation site.Four patients 2 with PAP PVC and 2 with mitral annular PVC had noCLIA, but all had highly fractionated, long duration (97-145 ms) lowamplitude(<0.5mV) electrograms at the ablation site.CONCLUSION Most PVCs have associated CLIAs in the CTIM withoutfractionated long duration electrograms at the site of origin. TheCLIAs either contain the successful ablation site or are in close prox-imity to it. It appears that the CLIA phenomenon seen in focal ATs isalso seen in ventricular arrhythmias related to TA and can be utilizedto localize the origin of PVCs.

073_17038P-C4
Characterization of the Electroanatomic Substrate in CardiacSarcoidosis and its Correlation with Imaging Findings of Scarand Inflammation
D. Muser, P. Santangeli, J.J. Liang, S.A. Castro, T. Hayashi, S. Magnani,D. Frankel, S. Dixit, E. Zado, B. Desjardins, D.J. Callans, A. Alavi,F.E. MarchlinskiCardiac Electrophysiology, Hospital of the University of Pennsylvania,Philadelphia, PA, USA, and Cardiovascular division, University Hospitalof Triest, Italy

BACKGROUND Cardiac sarcoidosis (CS) is characterized by varyingdegree of active inflammation and replacement fibrosis. The elec-troanatomic (EAM) substrate features in patients with CS andventricular tachycardia (VT) and the relationship with imagingfindings of inflammation and fibrosis have not been previouslyinvestigated.OBJECTIVES We sought to characterize the EAM substrate in patientswith CS and VT and the relationship with imaging findings ofinflammation and fibrosis.METHODS We studied 42 patients with CS based upon HRS criteriaand VT who underwent high-density EAM. Abnormal EGMs werecollected and independently classified as multicomponent fraction-ated, late and split according to standard criteria and regardless of thepeak-to-peak bipolar/unipolar voltage. A total of 29 (69%) patientsunderwent pre-procedural MRI and PET/CT scan. The distribution ofEAM substrate based on abnormal electrograms was correlated withregions of late gadolinium enhancement (LGE) on MRI and increasedFDG uptake on PET/CT.RESULTS 4073 out of 21451 (19%) bipolar and unipolar EGMs wereclassified as abnormal with a predominant distribution in the basal per-ivalvular segments and interventricular septum. Using the standard bi-polar (<1.5 mV) and unipolar (<8.3 mV for LV <5.5 mV for the RV) voltagecut-off values, 40% of abnormal bipolar and 22% of the abnormal EGMswere located outside the EAM low voltage areas, respectively. LGE waspresent in 26/29 (90%) and abnormal FDG uptake in 14/29 (48%) patientswith imaging. Segments with abnormal EGMs had LGE evident higherscar transmurality [24 (4-40) vs. 5 (0-15)%; p<0.001] and a lower meta-bolic activity [20 (14-30) vs. 29 (18-39) g glucose; p<0.001]. Overall, theagreement between the presence of abnormal EGMs was higher with thepresence of LGE (k¼0.51; p<0.001) than with the presence of activeinflammation (k¼ -0.12; p¼0.003).CONCLUSIONS In patients with CS and VT, pre-procedural imagingwith MRI and PET/CT can be useful in detecting EAM abnormalitiesthat are potential targets for substrate ablation. Abnormal EGMs weremore likely located in segments with higher scar LGE transmurality atMRI and a lower degree of inflammation on PET.

073_16945-L4
Severity of Heart Failure and Outcomes of Catheter Ablation ofVentricular Tachycardia in Nonischemic DilatedCardiomyopathy
D. Muser, J.J. Liang, T. Hayashi, S. Castro, R.K. Pathak, S. Magnani,J.E. Rame, E. Zado, F. Garcia, D. Frankel, S. Dixit, D.J. Callans, E. Zado,G. Sinagra, F.E. Marchlinski, P. SantangeliCardiac Electrophysiology, Hospital of the University of Pennsylvania,Philadelphia, PA, USA, and Cardiovascular division, University Hospitalof Triest, Italy

BACKGROUND In patients with nonischemic dilated cardiomyopathy(NIDCM), presentation with recurrent ventricular tachycardia (VT)may represent a marker of worsening heart failure (HF) status. TheSeattle Heart Failure Model (SHFM) is an established tool to assess theseverity of HF and predict prognosis. We evaluated the utility of theSHFM to predict the outcomes of CA of VT in NIDCM.METHODS We examined 282 consecutive patients (age 59�15 years,80% males, LVEF 36�13%) with NIDCM who underwent a total of 442CA procedures (median 1; range 1-8 procedures per patient). Outcomesare reported after the last procedure.RESULTS The mean SHFM score was 0.2�1.1 (range -2 to þ4). At theend of the last procedure, acute procedural success (non inducibilityof any VT with cycle length >250 ms) was achieved in 216/262 (82%)patients. After a median follow-up of 48 (19-67) months, 58 (21%)patients experienced VT recurrence. At 60-months follow-up, thecumulative VT-free and death/transplant-free survival were of 69%and 76%, respectively. At multivariable analysis, baseline SHFMscore was the only independent predictor of VT recurrence (HR 2.1,95%CI 1.4-3.0, p<0.001) and mortality/transplant (HR 3.4, 95%CI2.2-5.4, p<0.001). Patients with a SHFM score >0.45 (2nd tertile) hada 6-fold higher risk of VT recurrence over follow-up (HR 5.82, 95%CI 3.34-10.13; p<0.001), with a cumulative VT-free survival of 39% at3 years.

CONCLUSIONS In patients with NIDCM the severity of the underlyingHF indexed by the SHFM score is a powerful predictor of recurrentVT and death/transplant over follow-up. In particular, a SHFM score of>0.45 identifies patients at particularly high risk of adverse outcomes.

073_16808-L5
Analysis of VT Substrate in Chagas Disease Patients Using3D-LGE MRI and Automatic Detection Arrhythmia Substrate(ADAS) Software
M. Scanavacca, C. Pisani, T. Lima, C. Hardy, S. Lara, F. Darrieux,D. Hachul, J. Parga, C. Rochitte, C. NomuraIncor - Heart Institute - USP, São Paulo, Brazil

BACKGROUND The use of cardiac MRI has been an interesting tool tosubstrate identification and ablation planning. ADAS software hasbeen developed to identify conducting channels using 3D LGE MRI.Chagas disease is an infectious disease that lead to specific abnor-malities that are substrate to scar related VT.OBJECTIVE The objective of this study is to evaluate the use of ADASsoftware in patients with Chagas disease.RESULTS We performed 3D LGE cardiac MRI in 6 patients with Chagasdisease without ICD with an age of 64�8.3 years-old, LV ejection





fraction on echocardiogram of 41�5.7% and on MRI of 30�17.5%. EPstudy was performed in 4 patients, in one there was no VT induction, inother VT was successfully ablated and on other 2 patients VT wasinduced being decided to implant an ICD. On the other 2 patients whereEP study was not performed ICD was implanted. There was a median of1.5 (Q1: 0,25; Q3: 2,75) morphologies induced. All patients were usingamiodarone in a median dose of 400mg. The mean tissue thresholds ofthe maximum pixel signal intensity (PSI) of the myocardium in MRIdefining border-zone tissue were 36.5�9.5% and 54.5�10.2%, respec-tively. There was a median of 3.5 (Q1: 2.5; Q3: 7,75) channels identifiedper patient. The mean mass of LV on ADAS reconstruction was 169�40grams and scar mass was 45�19grams. The proportion of scar was27�14%, border zone 20�10% and core 6�4%. The segment 4 and 5(infero latero basal) of the bull-eye was the most common site of scar,presented in 5 of the 6 patients. In one patient ablation was performedwith EAM (Figure) with good correlation of the scar and border zone.Late potentials were identified in the border zone.

CONCLUSION Software analysis of 3D LGE MRI could help to identifyscar and conducting channels in Chagas disease patients.

073_16807-L4
Prospective and Randomized Study of Efficacy and Safety ofEpicardial Ablation of Ventricular Tachycardia in Patients withChagas Disease
M. Scanavacca, C. Pisani, S. Lara, C. Hardy, M. Chokr, F. Darrieux,D. Hachul, T. Wu, L. SacilotoIncor - Heart Institute - USP, São Paulo, Brazil

INTRODUCTION Epicardial mapping and ablation is frequentlynecessary for non-ischemic cardiomyopathy, especially Chagas Dis-ease patients. Although, there is no randomized study proving itssuperiority compared to endocardial only ablation.METHODS We selected 27 patients with Chagas disease referred forVT ablation that were randomized to (G1) endocardial only group(n¼14) or (G2) epi/endo group (n¼13). In the epi/endo group ablationwas performed in the surface of optimal signals during VT or substratemapping. In the endo only group, ablation was performed initiallyonly in the endo, if there was no scar or clinical VT remained inducedablation continued with epicardial mapping. The endpoint was safetymeasured by the rate of complications and efficacy, measured by VTinducibility after ablation.RESULTS Most of the patients were male (8 in G1 and 9 in G2), themedian age was 65 (Q1: 58, Q3: 69) and 58 (Q1: 43,5, Q3:65,5; P¼0,1)years-old and LVEF was 30�9% and 32�10% (P¼0,5), in G1 and G2respectively. In the endo only group (G1) ablation failed in eightpatients (57.1%), partial success was obtained in three (21.4%) andcomplete success was also obtained in three (21.4%) patients. In theendo/epi group (G2) ablation failed in two (15.4%), partial successwas obtained in seven (53.8%) and complete success in 4 (30.8%).There was significantly more failure in the endo only (G1) group(P¼0,04). In eight patients of G1 ablation continued to epicardialmapping due to clinical VT reinduction in five patients and absenceof endocardial scar in three. After ablation continuation usingepicardial mapping in the endo only group (G1), failure occurred inone (12.5%), partial success in four (50%) and complete success inthree (37.5%). RF applications were performed in epicardial surfacein all patients in G2. There was three accidental RV puncture (25%)in the G2 and four (50%) in the G1 patients that ablation continued(P¼0,35). Additionally, there was no difference on the amount ofblood drained after RV puncture (P¼0,77) as well as number of pa-tients that drain was maintained (P¼1). Two patients died beforedischarge in each group in a median of 32.5 (Q1: 14.2 Q3: 55.5) daysafter ablation.

CONCLUSIONS In this randomized trial of epicardial and endocardialVT ablation in Chagas Disease there was less failure of ablation whencombined endo/epi approach was used. Both approached were safe.

PACING: CLINICAL ISSUES


073_16788-P1
Cost as a Barrier to Installation of Permanent Pacemaker inPakistan
K.A. Zaidi, M. Zahid, S.Z. JamalZiauddin University Hospital, Karachi, Pakistan

INTRODUCTION To establish cost as a barrier in installation of apermanent pacemaker (PM) based on the number of days spent ontemporary pacemaker (TPM) before the installation of a permanentpacemaker (PPM).METHODOLOGY This was a retrospective cross-sectional study from2008-2012 conducted at National Institute of Cardiovascular diseasesin Karachi, Pakistan. Data was obtained for 858 patients who were puton a TPM till their finances were approved for a PPM.RESULTS The average number of days patients had to be put onTPM was 11.2 � 10.4 days. The mean in 2008 was 10.2 � 7.6 dayswhich improved to 8.8 � 5.9 days in 2012. In 2008, vvi pacemakerwas installed in 79.0% of the patients with ddd in the remaining21.0%, however in 2012, vvi and ddd were installed in 50% each(p-value¼0.011). VVI was the more commonly used PPM in 71.7%of the sample. Majority of the patients (81.7%) in the private wardhad the procedure done in less than the average number ofdays as opposed to only 62% of those in the general ward(p-value¼0.001).

CONCLUSION A major barrier to installation of a permanent pace-maker in our country is the cost of the procedure. The reduction inwaiting days and the increased use of dual chamber PMs are




promising results. If these rising trends are maintained, the compli-cations due to prolonged use of TPMs such as DVT and infections canbe decreased. In a low to middle income country like Pakistan, thishas been achieved by the efforts of the government.

073_16730-J3
Predictors of Cardiac Permanent Pacing in Patients WithPotential Reversible Causes for Bradycardia: A RetrospectiveAnalysis
L. Marques, A. Castro, R. Santos, H. Guedes, D. Seabra, R. Sousa,P. PintoServiço de Cardiologia; Centro Hospitalar do Tâmega e Sousa, EPE,Guilhufe, Portugal

INTRODUCTION Slow heart rate is a common cause for hospitalreferral and cardiologist evaluation in the emergency department. Inmany patients (pts), a potential reversible cause for bradycardia caneasily be identified, and permanent pacing should be delayed until thecorrection of these underlying conditions. Medications and electro-lyte disturbances are among the major reversible causes for conduc-tion system disturbances. Still, many of these pts may haveunderlying conduction system disease, with a potential need to apermanent cardiac pacemaker (PM) implantation at a long-term. Theidentification of this subgroup of pts remains a challenge.PURPOSE To characterize a cohort of pts admitted to a cardiologyward with a diagnosis of bradycardia in the context of negativechronotropic medication intake and/or electrolyte disturbances, andto identify prognostic features that may be associated with permanentPM implantation.METHODS We retrospectively analysed a group of pts admitted toa cardiology department with an initial diagnosis of bradycardia inthe context of medication intake and/or electrolyte disturbances,between 1/2012 and 9/2016. Clinical characteristics [age, sex], con-duction disorder on first medical contact [sinus node disfunction(SND), atrioventricular block (AVB), atrial fibrillation/flutter withlow ventricular rate (AF/AFL with LVR)], outpatient medication[beta blockers, digoxin, beta blockers with digoxin, amiodarone,others], electrolytic disturbances [hyperkalemia] and evidence ofstructural heart disease [coronary disease; native heart valve dis-ease; heart valve prothesis; dilated cardiomyopathy; hypertensiveheart disease] were analysed. The primary end point was perma-nent PM implantation, in hospitalization or after discharge. Per-centage of atrial and ventricular pacing was analysed at 1, 8 and 24weeks of follow-up.RESULTS A total of 121 pts were included (41.3% male; mean age79.9�8.3 years). On first medical contact, SND was diagnosed in 8(6.6%), AF/AFL with LVR in 34 (28.1%) and AVB in 79 (65.4%) pts.Regarding the reversible causes of bradycardia, drug intake wasidentified in 113 (93.4%) and hyperkalemia in 8 (6.6%); amongmedications, beta blockers were the most common (77; 68.1%), fol-lowed by digoxin (15; 13.3%), beta blockers in association withdigoxin (10; 8.8%), amiodarone (4; 3.5%) and other agents (7; 6.2%;including ivabradine, flecainide, propafenone, diltiazem, verapamil).Drug discontinuation or potassium correction reversed the conduc-tion disturbance in 16 (13.2%) pts; permanent PM was needed in 105(86.8%), with implantation occurring during hospital admission in98 (93.3%) and after discharge in 7 (6.7%), after a mean follow-up of9.7 months. Patients without need of permanent PM were morefrequently woman (87.5% vs. 12.5%, p¼0.012) and had higherprevalence of AF/AFL (81.3% vs 18.8%, p¼0.005), with no significantdifferences on age (p¼0.085), conduction disturbance on first med-ical contact (p¼0.081), evidence of structural heart disease(p¼0.874), outpatient medication or electrolyte disturbances(p¼0.068), need for temporary transvenous PM (p¼0.775), nor betablockers dosage on admission (p¼0.893 for bisoprolol; p¼0.217 forcarvedilol); although, a lower dosage of digoxin intake on admissionpredicted the need for permanent PM placement (0.21�0.06 vs.0.16�0.06mg, p¼0.029).CONCLUSION(S) AVB was the most frequent conduction disturbanceidentified in this cohort and beta-blockers were the most commonreversible cause for bradycardia. Even with the identification andcorrection of a reversible cause, many pts kept indication for perma-nent PM, which globally defines these pts as a group of risk whodeserve further follow-up for conduction disturbances. The presenceof AF/AFL predicted a lower need for permanent PM, as well as theintake of higher dosages of oral digoxin as precipitating factor.Further studies, with larger cohorts and longer follow-up are needed,in order to define better predictors for early PM implantation.

073_16795-J1
Cost-Effectiveness Analysis of MRI-Conditional PacemakerImplantation in the Current Era: Observations from aMulti-Center US Experience
R. Gopinathannair, P.L. Mar, G. Chen, G. Gandhi, A. Leiserowitz,A. Tripuraneni, E. Kreps, L. Botting, D. Lakkireddy, J.E. GranatoUniversity of Louisville, Louisville, KY, Vanderbilt University,Nashville, TN, Bethesda North Hospital, Cincinnati, OH, Iowa HeartCenter, West Des Moines, IA, Oregon Health Science University,Portland, OR, University of Kansas Medical Center, KS

BACKGROUND MRI-conditional pacemakers (MPM) have beendeveloped to reduce the risk of adverse events from MRI scanning.However, MPM are more expensive than non-MRI-conditional pace-makers (NMPM), and as not all individuals who receive a MPM willeventually have a MRI performed, it is unclear if implanting a MPM iscost-effective.OBJECTIVE To determine whether or not implantation of an MPM is acost-effective strategy after accounting for post-implantation MRIusage data from a multicenter MPM cohort.METHODS We evaluated 908 patients who received an MPM from2011-2015 across 4 centers in the Catholic Health Initiatives network todetermine MRI scan utilization during follow-up. We performed a full-text search for cost-effectiveness studies involving MRI’s through11/2016 from the Medline database. Our search strategy termsincluded: MRI, quality adjusted life years (QALY), and cost-effectiveness. Inclusion criteria were empirical studies published inany language that reported the results of economic evaluations interms of QALY. An incremental composite QALY for overall benefit ofperforming a MRI was calculated by averaging the QALY from all theincluded studies obtained from the literature search. Cost-effective-ness was defined as an incremental cost-effectiveness ratio (ICER) ofless than $100,000 / 1 QALY.RESULTS Of 908 patients with an MPM, 48 (5.3%) underwent an MRIduring a 20-month median follow-up period. The average cost dif-ference between implanting a MPM vs. a NMPM over this time framewas $1500. Out of a total of 127 potential studies identified on Med-line, only 14 were included in review. The incremental compositeQALY for overall benefit of performing a MRI was 0.086 QALY. Thecalculated ICER for our multi-center experience was $348,432 / QALYover a 20 month follow-up period.CONCLUSION Given our limited follow-up data of 20 months andonly 5.3% of patients having received a MRI thus far, implanting anMPM does not appear to be cost-effective as the ICER is > than$100,000 / QALY ($348,432 / QALY). However, implanting an MPMwill become cost-effective once MRI usage within the MPM populationexceeds > 17.4% over the lifetime of the device.

073_16737-J1
Performance of a Leadless Transcatheter Pacemaker SystemCompared to a Conventional Transvenous Pacing System:Perioperative Complications and Shortterm Follow-Up
R. Zbinden, T. Rizzo, C. Franzini, R. Dillier, A. Müller, N. HolmDepartement of Cardiology, Stadtspital Triemli, Zürich, Switzerland

INTRODUCTION The Medtronic MICRA transcatheter pacing system(MICRA TPS) is a recently introduced leadless single-chamber pacingsystem. We compared the safety and performance of the MICRA TPSwith conventional transvenous single chamber pacemakers (conven-tional VVI) implanted at our centre.METHODS This retrospective, observational single center study included30 consecutive patients receiving a MICRA TPS and 33 historical controlpatients receiving a conventional VVI system at our centre.RESULTS Average procedure time was 41.2 � 14 minutes for theMICRA TPS group and 34.3 � 19.5 minutes for the conventional VVIgroup (p¼NS). Fluoroscopy time was significantly longer in the MICRATPS group compared to the conventional VVI group (10.3�6.8min vs4.8�2.5min; p¼0.01). There were significantly more periinterven-tional complications in the MICRA TPS group compared to the con-ventional VVI group (20% vs 3%; p¼0.03). Mean follow up time was 95� 26 days. There were 3 adverse events in the MICRA TPS groupcompared to 1 in the conventional VVI group (p¼NS).CONCLUSION The new MICRA TPS is an alternative to conventionalVVI pacingwith comparable short termperformance. There is a learningcurve with more periprocedural complications in the first cases. Radi-ation times are significantly higher with the MICRA TPS system.





073_16794-J1
Cardiac Implantable Electrical Device related Procedures andAssociated Complications in Continuous flow LVAD Recipients:A Multicenter Experience
R. Gopinathannair, R. Dhawan, J. Trivedi, H. Roukoz, A. Bhan,M.M. Ahmed, G. Bhat, J. Cowger, M.S. Slaughter, A. RavichandranUniversity of Louisville, Louisville, KY, University of Minnesota,Minneapolis, MN, Advocate Christ Medical Center, Chicago, IL,University of Florida, Division of Cardiovascular Medicine, Gainesville,FL, St. Vincent Hospital, Indianapolis, IN, USA

BACKGROUND Patients with continuous flow Left Ventricular AssistDevices (LVAD) and concomitant Cardiac Implantable Electrical De-vices (CIED) are prone for device and lead-related complicationsrequiring intervention.OBJECTIVE We sought to describe the incidence and characteristicsof CIED-related procedures and complications and their associationwith survival in a multicenter LVAD cohort.METHODS We retrospectively reviewed data on 480 LVADpatients with a CIED from 5 centers. Of the 480, 235 patients hadaccurate long-term CIED follow-up data were used for this analysis.Kaplan Meier analysis was used to assess survival differencesbetween patients with CIED-related complications versus those whodid not.RESULTS Of 235 patients with an LVAD and a CIED (Age 58�13,80% male), 130 had a CRT-D and 105 had ICD only. During a me-dian LVAD follow-up of 692 days, 103 patients required a CIEDgenerator replacement with CRT-D patients having a significantlyhigher rate of generator replacement compared to the ICD onlygroup (68[52%] vs 35[33%], p¼0.003). A CIED or lead-relatedcomplication occurred in 36 (28%) of CRT-D patients and 16 (15%)of the ICD patients (p¼0.06). 20 (15%) patients in the CRT-D groupand 14 (13%) in the ICD group underwent lead removal or extrac-tion during follow-up (p¼0.5). Both the CRT-D and ICD groups hadcomparable incidences of pocket hematoma (8% vs 5%), pocketand/or lead infection (9% vs 4%), and lead malfunction (8% vs 9%).Kaplan Meier analysis showed no significant survival differencebetween those who had a CIED-related complication versus thosewho did not (log rank p¼ 0.7).CONCLUSIONS CIED related procedures are common in LVADpatients. Compared to ICD only, continued CRT-D post-LVADresulted in a significantly higher number of generator changes andshowed a trend towards higher device or lead related complica-tions. CIED-related complications were not associated with reducedsurvival.

073_17041p
Hisian Pacing With Apical Back-Up On Demand Is SafeAnd Effective
L. Marcantoni, G. Giau, G. Boaretto, P. Raffagnato, A. Tiribello,G. Pastore, E. Baracca, A. Barbetta, F. Di Gregorio, L. Roncon, F. ZanonCardiology COU, S. Maria della Misericordia Hospital, Rovigo, Italy

INTRODUCTION Hisian pacing might entail a higher thresholdthan conventional pacing methods. Back-up stimulation on de-mand allows managing the risk of capture loss with the lowestenergy cost.METHODS His-bundle and apical back-up leads were connected,respectively, to the V1 and V2 channels of a suitable three-chamberstimulator (Helios or Hera, Medico). When Hisian pacing waseffective, apical sensing occurred within the VV delay and preventedback-up stimulation (1st and 2nd cycles in the figure). In case of pacingfailure, a back-up pulse was delivered at VV delay end (120 ms,3rd and 4th cycles). False-inhibition was avoided by careful program-ming of post-spike blanking and haemodynamic surveillance bytransvalvular impedance (TVI), which confirmed ejection occurrenceat every beat.RESULTS The demand back-up system was enabled in 16 implants.All were properly inhibited by apical sensing, occurring 96�13 msafter His-bundle stimulation. At the last follow-up check (21�18months), pacer diagnostics reported <1% back-up pacing prevalencein all cases but one, where V1-V2 stimulation was applied in 10% ofcycles.

CONCLUSIONS Demand back-up stimulation is effective andstrengthens Hisian pacing reliability.

073_16824
The Relationship Between Indication For ImplantableCardioverter Defibrillator Therapy And The Prognosis OfPatients With Acute Decompensated Heart Failure WithReduced Ejection Fraction
R. Hata, H. Tasaka, M. Ozaki, M. Ozaki, M. Yoshino, N. Ohashi,Y. Kawase, T. Tada, S. Fujii, K. KadotaDepartment of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan

INTRODUCTION We aimed to evaluate the relationship between in-dications for implantable cardioverter defibrillator (ICD) therapy andthe prognosis of acute decompensated heart failure (ADHF) patientswith reduced left ventricular ejection fraction (LVEF).METHODS We retrospectively analysed 851 consecutive patientshospitalised for ADHF and divided them into two groups based on theLVEF values, excluding 24 patients undergoing ICD therapy: 227 pa-tients with LVEF �35% and 600 patients with LVEF >35%. Arrhythmiaevents (AE) were defined as a composite of sudden death and life-threatening arrhythmia. A subanalysis for AE stratification was con-ducted by classifying the ICD group into two groups.RESULTS Between ICD indication and non-ICD indication groups, the240-day cumulative rate was significantly different in AE (7.0% versus1.1%, p¼0.02). Cox proportional hazards model showed that thepresence of non-sustained ventricular tachycardia (NSVT) duringadmission (hazard ratio, 22.6; p<0.01) was an independent predictorof AE.CONCLUSIONS Indication for ICD was related to poor prognosis ofarrhythmia events in ADHF patients. The presence of NSVT duringadmission was a strong predictor of arrhythmia events in ADHF pa-tients indicated for ICD therapy.

073_16782
Safety of Anticoagulation With Uninterrupted NOAC (U-NOAC)vs Interrupted NOAC (I-NOAC) in Patients Requiring anImplantable Cardiac Device (CIEDs)
V. Calabrese, I. Colaiori, A. Creta, A. Nenna, G. Di SciascioCardiology Unit, Campus Biomedico University of Rome, Italy

AIMS the safety and efficacy of novel oral anticoagulants (NOAC) inpatients with atrial fibrillation undergoing pacemaker or implantablecardioverter-defibrillator interventions have not been clearly defined.Therefore, we compared the incidence of bleeding and thrombo-embolic complications following cardiac rhythm device (CRD) im-plantations under NOAC interrupted (I-NOAC) vs uninterrupted NOAC(U-NOAC).METHODS AND RESULTS we prospectly randomized 101 consecutivepatients to interrupt NOAC 24 or 48 hours before procedure andrestart 24 hours after surgery according to renal function (51 patients)or to be operated in NOAC (50 patients). Post-operative bleedingcomplications and thrombo-embolic events occurring within 30 dayswere compared. There were no significant differences in baselinecharacteristics between patients in the two groups. Moreover the twogroups were well matched for CHA2DS2VASC score, and NOACS type.Most of the patients in both the groups received dual chamber orcardiac resynchronization devices (75 vs.78%) as opposed to single-chamber systems (25 vs. 22%). In the I-NOAC group, two (4.0 %)bleeding complications (two pocket haematomas) were observed in






comparison with two (3.9 %) pocket haematomas in the U-NOAC. Noischemic complications occurred in both groups.CONCLUSION bleeding and thrombo-embolic complications in pa-tients treated with uninterrupted NOACS are rare. Further and largerstudies are warranted to define the optimal anticoagulation manage-ment in patients with a need for oral anticoagulation and CRD in-terventions.

CARDIAC IMPLANTABLE ELECTRONIC DEVICES:DIFFERENT ISSUES


073_16965-Q1
Temporary Complete Heart Block in a 78-Year-Old-Patient Dueto Biliary Colic
P.E. Papakonstantinou,1 N.I. Asimakopoulou,1 E. Kanoupakis,2

S. Maragkoudakis,2 S. Panagiotakis,1 A. Gikas11Department of Internal Medicine, University Hospital ofHeraklion,Heraklion, Crete, Greece; 2Department of Cardiology,University Hospital of Heraklion, Heraklion, Crete, Greece

INTRODUCTION Acute cholecystitis and biliary colic may have signsand symptoms similar to those of acute coronary syndromes. Chole-cystitis and/or biliary colic have both been reported as trigger factorsfor bradyarrhythmia in the literature.CASE REPORT A78-year-oldmalepatientwasadmitted toouremergencydepartment due to acute abdominal pain. The ECG on admission showedsinus bradycardia (40 bpm) without signs of acute ischemia and a smallperiod (7 sec) of complete atrioventricular (AV) block. He was initiallytreated with analgesics. After the remission of the pain, a new ECG wasperformed which showed sinus rhythm of 55 bpm. The AV block termi-nated one hour after the patient’s admission. The patient remained he-modynamically stable during the episode. He underwent an ultrasound oftheabdomenwhich revealedmudandone stone in thegallbladderwithoutsigns of inflammation. D-dimer and troponin were negative, while thecoronaryangiographyshowedcoronaryvesselswithout significant lesions.CONCLUSIONS Biliary colic can cause severe reversible reflex brady-cardia (Cope’s Sign), even complete heart block. Pain relief is veryimportant in the management of such cases.

073_16969-Q1
Total Atrioventricular Block Due to Leptospirosis
J.W. MarthaDepartment of Cardiology and Vascular Medicine, PadjadjaranBandung, Indonesia

INTRODUCTION A 24 year old factory worker male was admitted toEmergency Department Hasan Sadikin Hospital/Padjadjaran Univer-sity, Bandung, Indonesia because of syncope approximately 10 mi-nutes duration. There was no residual neurological deficit atpresentation. History taking after the patient regained consciousnessrevealed that he complained of high fever over the last 7 days,accompanied by nausea, vomiting, severe muscle pain. There was noicterus and urination abnormalities. Two weeks prior to admission, hecleaned sewer in front of his house on bare foot.CASE Vital signs were normal except for pulses of 25-30 bpm. Phys-ical exams demonstrated no cardiac abnormality, but marked hepa-tomegaly. Laboratory revealed leukocytosis 21.600/mm3, SGOT/SGPT248/352 U/l, Ureum/Creatinin 67/1,72 mg/dl, Troponin T >2,0 ng/ml.Chest X-ray showed no cardiomegaly or pulmonary disease. Totalatrioventricular block was noted at the ECG. Further laboratoriumresults were as follows: IgM anti Dengue negative, IgM anti Leptospira13,3 units. Normal cardiac chambers and normal ejection fraction wasfound on Echocardiogram. The patient was put on TPM (apex RV,treshold 0,75mA, output 1 mA, 70 bpm), and antibiotic course ofAzithromycin 1x500mg po and Cefotaxime 3x1 gr IV. On 5th day ofhospitalization, the rhythm became sinus with HR 75 bpm, thus TPMwas turned off, subsequently removed, and the patient was dis-charged. At follow up outpatient visit, the microscopic agglutinationtest was 1:1400, but blood culture was negative. Therapy wascontinued with Doxycycline 2x200mg po. Leptospirosis is a bacterial

infection caused by Leptospira genus, usually transmitted by animalurine or by water or soil containing animal urine coming into contactwith breaks in the skin. Prior observational studies described cardiacinvolvement was discovered in 52% patients with serologically-positive leptospirosis and myocarditis was demonstrated in 8.1% ofpatients. In other studies, ECG abnormalities was found in 59% ofpatients, with first-degree AV block and atrial fibrillation were themost frequent findings. This was a rare case of myocarditis due toleptospirosis complicated by total atrioventricular block.

073_16213-J4
Perioperative Complication Rates in Patients With De NovoImplantation of a Cardiac Device: Is There an AssociationBetween Complication Rates and the Day of Implantation(Friday versus Monday-Thursday)
Z. Yildirim-OeguetCardiology, Klinikum Ingolstadt, Ingolstadt, Germany

BACKGROUND Until now there is no data available concerning thecomplication rate for implantation of cardiac devices (pacemaker(PM), implantable cardioverter-defibrillator (ICD)) in association withthe day of the week, the implantation takes place.PURPOSE In this retrospective study we aimed to analyse the corre-lation of perioperative and early postoperative complications after PMand ICD Implantation from day of surgery.METHODS We analyzed data from a total of seven hundred andthirty-two consecutive patients between January 2011 and December2014, who underwent either a new ICD or a new SM Implantation inour hospital (mean age: 73 �12). 22,5% (n:165) were ICDs and 77,5%(n:567) PMs. Cardiac resynchronization therapy (CRT) was excluded.We analyzed the day by day occurrence of complication, and wedivided the patients in two groups (group 1 implantation took placebetween Monday to Thursday, group 2 implantation took place onFriday).RESULTS One hundred and seventy-five patients (23,9%) wereoperated on a Friday and five hundred and fifty-seven patients(76,1%) on other weekdays. The total complication rate was 4,5% (n:33) (for ICDs 3%, for PMs 4,9%). The complication rate on a Friday was4% and on the other days was 4,7%. We found no statistical relevanceof the complication rate and the day the operation carried out(p> 0,05). Day to day variation of complication rate was not signifi-cantly different.CONCLUSION Cardiac device (PM, ICD) implantations will be carriedout just as safely and effectively on Fridays without resulting in anincreased complication rate compared with the other days.

073_16746-J4
Incidence and Predictors of Moderate to Severe TricuspidRegurgitation After Permanent Pacemaker Implantation;Clinical Implications of Atrial Fibrillation on Its Progression
K-J. ChoiHeart Institute, Asan Medical Center, Seoul, Republic of Korea

BACKGROUND Incidence and predictors of tricuspid regurgitation(TR) after permanent pacemaker (PM) implantation were not welldefined to date.OBJECTIVE We sought to find out these predictors, especiallyfocused on the influence of atrial fibrillation (AF).METHODS A data of 578 patients underwent pacemaker implantationwithout significant TR (moderate or severe degree) in the baselineechocardiography were evaluated. The major outcomes were inci-dence of overall and isolated TR of moderate to severe degree in thefollow-up echocardiography.RESULTS During a follow-up period of 7.3 years, overall TRwere developed in the 95 patients (16.4%). The 48 patients (51%)had concomitant structural heart diseases (54.2% heart failure, 40.7%valvular disease), and 47 patients (49%) were presented as isolatedTR. Multivariable analysis showed independent predictors of overalland isolated TR (table). Development of persistent/permanent AF(PeAF) was independent predictor of both overall and isolated TR.Patients with PeAF showed higher 7-year incidence of overall andisolated TR compared to PAF or those without AF (figure).






Table. Predictors of TR progression

Univariable analysis
Multivariable analysis
Variables
HR 95% CI P-value HR 95% CI P-value
Overall TR progression

DM
2.29 1.50-3.48 <0.001 2.16 1.36-3.42 0.001
CHF
2.14 1.39-3.28 0.001 1.52 0.96-2.42 0.074
PAD
2.45 1.54-3.90 <0.001 1.57 0.93-2.66 0.091
COPD
2.26 1.09-4.66 0.028 1.94 0.92-4.06 0.081
Pre-existing mild TR
2.17 1.18-3.98 0.013 2.31 1.24-4.27 0.008
Significant AR
4.06 1.48-11.13 0.007 3.29 1.13-9.54 0.029
Significant MR
3.52 1.63-7.61 0.001 2.67 1.12-6.38 0.027
RA-RV PG (1mmHg)
1.04 1.02-1.05 <0.001 1.02 1.00-1.03 0.121
Paroxysmal AF*
1.49 0.84-2.64 0.170 0.89 0.48-1.67 0.723
Persistent/permanent AF*
4.14 2.60-6.60 <0.001 2.55 1.49-4.35 <0.001
Isolated TR progression

Stroke/TIA
2.49 1.24-5.02 0.011 2.21 1.07-4.58 0.033
Pre-existing mild TR
3.12 1.12-8.73 0.030 3.02 1.07-8.55 0.037
Paroxysmal AF*
2.39 0.97-5.89 0.058 1.41 0.60-3.32 0.431
Persistent/permanent AF*
7.51 3.54-15.93 <0.001 3.83 1.85-7.92 <0.001
*Time-dependent covariates for extended Cox-proportional hazard model.

Figure.

CONCLUSION Patients with PeAF were at the higher risk of significantTR after PM implantation.

073_16227-J2
Externalized Conductors-Can a Shock Now Predicts a FailureLater?
R. CorbisieroElectrophysiology Deborah Heart & Lung, Browns Mills, NJ, USA;St Jude Medical Sylmar, CA, USA

INTRODUCTION Leads which exhibit externalized conductors (EC)may or may not require replacement at generator change. Techniquesto identify potential electrical malfunction (EM) vary based on prac-tice and include assessment of bipolar imp. (BIU), non-invasiveimpedance (NIU) high voltage test shock (HVSU).METHODS Patient data (N¼28) was analyzed comparing patients withHVSU (N¼19) vs. NIU (N¼9) to predict EM. BI U was also tracked inboth groups. Implant data at the time of generator change and futurefollow-up data were included to determine electrical changes. Ourendpoint was measurements indicating EM obtained during the post-surgery follow-up.RESULTS N¼28 patients age 72þ/12.4 consisting of 18M:10F wereincluded. The HVSU group(N¼19) had mean f/u of 9.23þ/-2.4yrs. The NIUgroup(N¼9) had mean f/u of 10.3þ/-1.8yrs. Additional data in Table 1.

Table 1.

CONCLUSIONS Both groups demonstrated similar characteristicsincluding BI, NI, and RV threshold. HVS showed no benefit inpredicting EM or revisions. Associated risks from anesthesia mayoutweigh predictive benefit of a test shock. Further analysis ina larger cohort may prove we alter practices when dealing withpatients with EC.

073_16752
Cardiac Resynchronisation Therapy With Or WithoutDefibrillator In Non-Ischaemic Cardiomyopathy
R. Baggen-Santos, I. Silveira, M. Trêpa, B. Brochado, M.J. Sousa,C. Roque, A. Pinheiro-Vieira, V. Lagarto, A. Luz, A. Hipólito-Reis,S. TorresCardiology Department, Centro Hospitalar do Porto, Porto, Portugal

INTRODUCTION CRT improved outcomes in patients with advancedheart failure. A reduction in mortality would be expected witha defibrillator, but recent data challenge this premise in patientswith non-ischemic cardiomyopathy(NICM). The aim of this studywas to compare the prognosis of patients with NICM with CRT-P/CRT-D.METHODS Retrospective study of NICM patients who underwent CRTbetween 2002-2016.RESULTS We studied 177 patients (mean follow-up time 53.7�40.8months). 52.5% had a CRT-P. CRT-P patients were less frequentlymale, were older, had more atrial fibrillation and lower baseline LVejection fraction (LVEF). After CRT, 53% of patients in both groupshad an LVEF>35%. Sustained ventricular arrhythmias were found in2.8% of CRT-P patients and in 22.9% of CRT-D. In CRT-D groupinappropriate shocks were reported in 4.8% and appropriated thera-pies in 7.3% (with only one patient having LVEF>35% after device).We didn’t find differences on survival rates at 5 years (73.0%vs88.2%p¼0.522).CONCLUSION We found no significant differences between deviceson survival rate. Due to LVEF improvement after CRT, half of ourcohort no longer had indication for a defibrillator for primary pre-vention.

073_16780
Influence Of Permanent Atrial Fibrillation On Crt Response AndLong-Term Prognosis
R. Baggen-Santos, M. Trepa, I. Silveira, M.J. Sousa, B. Brochado,C. Roque, A. Pinheiro Vieira, V. Lagarto, H. Reis, A. Albuquerque,S. TorresCardiology Department, Centro Hospitalar do Porto, Porto, Portugal

INTRODUCTION/AIM To evaluate CRT response of patients withpreviously known permanent atrial fibrillation (PAF), as well as theirlong-term prognosis.METHODS Retrospective analysis of 316 patients who underwentbiventricular device placement (CRT-D or CRT-P), between January2002 and March 2016.RESULTS In the studied population, PAF prior to CRT was present in32% of patients. These patients were older, more frequently male andhad a higher NYHA class at presentation. There were no significantdifferences between groups concerning cardiovascular risk factors,chronic kidney disease (CKD) or left ventricular ejection fraction(LVEF) before CRT.In the PAF group, heart rate control was achieved with drug ther-

apy, and only 8 patients underwent atrioventricular nodal ablation.These patients had a lower biventricular pacing percentage (92% vs97%, p<0,001). They did improve after CRT, both by clinical andechocardiographic criteria and there were no significant differencesbetween groups concerning NYHA class reduction and LVEFimprovement. However, they had a higher rate of both appropriate(1,8 � 2,8 vs 0,73 � 1,8; p¼ 0,019) and inappropriate shocks (1,0 � 2,8vs 0,35 � 1,3; p¼0,006), and a worse long-term prognosis, with acomposite outcome of global mortality and HF hospitalizations of 48%vs 33% (p¼0,02) (mean follow-up of 48 � 38 months). After adjustingfor age, gender, CKD and final LVEF, PAF was not an independentpredictor of prognosis.CONCLUSION Patients with previously known permanent atrialfibrillation had similar clinical and echocardiographic responses toresynchronization therapy than those in sinus rhythm. However, they





experienced a higher percentage of appropriate and inappropriateshocks and had a worse long-term prognosis. This may be explainedby their less favorable baseline characteristics, since atrial fibrillationwas not an independent predictor of prognosis.

073_16789
Predictors Of Global Response To Cardiac ResynchronizationTherapy: Beyond The Classic
R. Baggen-Santos, M. Trêpa, I. Silveira, B. Brochado, M.J. Sousa,C. Roque, A.P. Vieira, V. Lagarto, V.A. Dias, H. Reis, S. TorresPorto Hospital Center, Cardiology Department, Porto, Portugal

BACKGROUND Cardiac resynchronization therapy (CRT) has becomeincreasingly important in the treatment of advanced heart failure(HF). However, variable responses have been observed between pa-tients who meet ESC criteria for CRT implantation. We aimed toassess the predictors of clinical and echocardiographic responseto CRT.METHODS Unicentric retrospective study including 316 patientswith advanced heart failure who underwent cardiac resynchroniza-tion therapy (CRT) between 2002 and 2016. Clinical, laboratory,electrocardiographic and echocardiographic variables were included.We defined response as obtaining both clinical and echocardiographicimprovement: global response. Clinical response was defined asimprovement in �1 NYHA class and echocardiographic responseas � 5% increase in left ventricular ejection fraction (LVEF) observed6-12 months after device implantation. Only variables with p<0.1 inunivariate regression analysis were included in the multivariatemodel.RESULTS The study population had a mean age of 69�10 years, 65%of patients were male and 67% had HF of non-ischemic etiology.Previously to CRT implantation, most patients (77%) were in NYHAclass III, 18% in class II and 6% in class IV. The mean LVEF was 27�6%and mean QRS duration was 160�24ms. We observed clinical responsein 211 patients (73%) and echocardiographic response in 177 (56%).50% of patients obtained global response.Compared to the non-responder group, global responders were

more likely to be women (44 vs 31%, p¼ 0.024), have non ischemicetiology (69% vs 51%, p¼0.002). Previously to CRT implantion, globalresponders were more frequently in sinus rhythm (SR) (71% vs 58%,p¼0.018), had more often left bundle block pattern (81 vs 67%,p¼0.013) and longer QRS duration (QRS>140 ms: 75 vs 91%, p¼0.005).There were no significant differences between the groups regardingage, lead placement in coronary sinus, type of lead or previous pres-ence of another device (pacemaker or implantable cardioverter-defibrillator).In multivariate analysis, non-ischemic etiology (OR 2.5; p¼0.013),

QRS>140 ms (OR 3.0; p¼0.04) and SR (OR 2.4; p¼0.04) were inde-pendent predictors of global response.CONCLUSIONS In this study, non ischemic etiology, QRS durationand sinus rhythm previously to implantation were strongly associatedwith joint clinical and echocardiographic response to CRT. Combiningthis data with the classical criteria for CRT implantation may helppredicting which patients derive greater benefit from resynchroniza-tion.

CARDIAC RESYNCHRONIZATION THERAPY:TECHNICAL ASPECTS


073_16719-A1
Evaluation of Right Atrial-Coronary Sinus Pressure Gradients inPatients With LV Dysfunction Referred for ICD Implantation.Description of the Phenomenon of Coronary Sinus FlowReversal and Its Incidence
Su. Verma, Sa. Verma, J. Wiley, K. LeeHeart Rhythm Center- Baptist Health Care St Jude Medical CRMD,Sylmar, CA University of Miami, Coral Gables, FL

INTRODUCTION We have described coronary sinus (CS) flow reversal(FR) during non-occlusive venography during CRT-D implantation.The incidence and effects of this phenomenon is unknown. This likelyoccurs due to dynamic changes in the Right Atrial pressure (RAp) andCoronary Sinus pressure (CSp) during the cardiac and respiratorycycle.METHODS 44 pts undergoing ICD implant (single, dual chamber orCRT) were enrolled. During implantation, Pulmonary Artery pres-sure (PAp), CSp and RAp were recorded simultaneously duringinspiration and expiration. Pts were categorized in high PAp andlow PAp groups (> 45 or � 45 mm Hg Systolic). % time CS reversal(RAp >CSp) was obtained in 29/44 pts (66%) by measuring the timethat RAp was greater than CSp divided by the respiratory cyclelength.RESULTS We observed a trend towards increased CSp in pts with highPAp. CS Flow reversal was observed (RAp> CSp) during in 24/29 (83%)pts ranging from 3% to 100%.

PA pressure £ 45

mmHg (n[24)

PA pressure > 45

mmHg (n[20)
P value
Gender
8 % Female 40 % Female 0.01
Systolic Pressure
117.5 � 17.9 mmHg 126.9 � 21.5 mmHg 0.1
Diastolic Pressure
70.3 � 10.2 mmHg 71.1 � 13.1 mmHg 0.8
Ischemic history
54 % 55 % 0.9
HF history
88 % 75 % 0.3
RA Pressure
14.1 10.4 mmHg 19.8 � 8.1 mmHg 0.05
RV Pressure
34.6 � 12.1 mmHg 60.1 � 11.9 mmHg <0.001
Aortic Pressure
98.3 � 41.7 mmHg 121.6 � 21.6 mmHg 0.03
CS Pressure
16.6 � 7.8 mmHg 22.2 � 9.1 mmHg 0.04
CS Flow Reversal
22.24% � 28.1 %
(n¼14)

36.11% � 37.1 %

(n¼15)

0.27

LVEF %
28�1.2 27�1.8 0.52
CONCLUSIONS CS-FR is common in heart failure patients undergoingICD implantation. This may be a possible mechanism for interven-tricular interdependence and LV diastolic dysfunction in PHT.

073_16815-K2
Serial Assessment of Peak Oxygen Consumption in PatientsWith Heart Failure Undergoing Cardiac ResynchronizationTherapy: Predicting and Tracking Level of EchocardiographicImprovement
N. Kumar, S. Chaudhry, A. Bagai, N. Kumar, D. Popovic, R. ArenaWhitby CardioVascular Institute Met-Test Atlanta St Mike’s HospitalUniversity of Toronto University of Illinois, Chicago, IL

INTRODUCTION Cardiac resynchronization therapy (CRT) is a valu-able approach to improving clinical status in patients with heart fail-ure (HF). Given the changes in cardiac function and geometry, parallelimprovements in cardiorespiratory fitness (CRF) can also be expected.The current analysis assesses: 1) Improvement in peak oxygen con-sumption (VO2); 2) the ability of peak oxygen consumption (VO2) topredict and correlate with echocardiographic improvements in HFpatients who underwent CRT.METHODS Twelve subjects (age ¼ 64.3 �13.1 years, 10 male/2 fe-male) diagnosed with HF underwent cardiopulmonary exercisetesting (CPET) on a cycle ergometer and Doppler echocardiographyprior to and following CRT. Mean time between assessments was6.5 �4.1 months. Peak VO2 and peak respiratory exchange ratio(RER) were the primary endpoints for CPET while left ventricularejection fraction (LVEF), left atrial (LA) size and right ventricularsystolic pressure (RVSP) were primary endpoints for Dopplerechocardiography.RESULTS Following CRT, there were statistically significant(p<0.05) improvements in: 1) peak VO2 (12.2 �3.0 vs. 15.5 �2.5mlO2$kg-1$min-1); 2) LVEF (28.3 �6.0 vs. 40.0 �7.1%); 3) LA size(38.4 �19.6 vs. 34.1 �15.6 mm); and RSVP (31.3 �15.5 vs. 25.2 �11.9mmHg). Peak RER was not significantly different between CPETs(1.01 �0.10 vs. 1.04 �0.10), indicating similar effort between tests.


There was a significant negative correlation between baseline peakVO2 and both with change in LA size (r¼-0.72) and change in RSVP(r¼-0.63) post CRT. Change in peak VO2 post CRT significantlycorrelated with change in LVEF (r¼0.60) and LA size (r¼0.82).Peak VO2 at baseline significantly correlated with change in peakVO2 (r¼-0.59) post CRT.CONCLUSION CRF has recently been proposed as a vital sign. Theresults of the current study indicate peak VO2 holds value in pre-dicting the magnitude of echocardiographic improvement in patientswith HF undergoing CRT. Patients with a lower peak VO2 at baselineappear to derive greater benefit. Assessment of peak VO2 in patientsbeing considered for CRT may provide beneficial clinical informationwith respect to likelihood of therapeutic impact.

073_16962-A1
In Vivo Interventricular Conduction Times AnisotropyAssessment in Heart Failure Patients
D. Pospsil, M. Sepsi, M. FelsöciInternal Cardiology Department, University Hospital Brno, Brno, CzechRepublic

INTRODUCTION We performed measurements of interventricularconduction times in 62 consecutive patients who signed consentforms and underwent CRT device implant. We acquired very inter-esting data for both ischemic and dilated cardiomyopathy HF etiologypatients with the use of in-vivo measurements on newly introducedright and left ventricular pacing leads.METHODS We used Biotronik Renamic PSA module for performingrate and voltage dependent pacing protocol (from threshold up to 10V, from intrinsic rate up to 140 BPM). Every available pacing vectorbetween leads was tested to determine its conduction time in bothdirections, that means pacing in the right ventricle, signal acquisitionin the left ventricle, then vice-versa.

RESULTS We found major directional dependency of conductiontime – anisotropy phenomenon in 2 of 24 (8,3%) patients withischemic HF etiology and rapidly more – 17 of 38 (44,7%) in patientswith dilated cardiomyopathy.

CONCLUSIONS Dilated cardiomyopathy patients have significantlyfrequent occurrence of interventricular anisotropy which should be

taken into consideration while setting of CRT device. Obtained dataare being used for CRT optimization and further research at our de-partment.

073_16806-K1
Use of Dynamic Coronary Roadmap for Positioning LeftVentricular Lead : First Case Report
A. Rajappan, R. Varma, S. Shivdas, M. Shaik, K. ZuurmondAster Medcity, Kochi, Kerala, India & Philips Healthcare, Netherlands

AIM Dynamic Coronary Roadmap (DCR) is a navigation supportpackage that allows the users to see a roadmap of the coronaryanatomy displayed on live fluoroscopy. By comparing moving struc-tures that are present in both the angiogram and the live fluoroscopyimages, with image registration techniques, DCR provides a preciseoverlay of the coronary vessel tree on top of the live fluoroscopymoving exactly with the cardiac and breathing motion. This sametechnique can also be used for imaging the coronary venous anatomyfor guiding left ventricular lead placement.METHODS A 70 year old man with dilated cardiomyopathy, LBBB andsevere left ventricular dysfunction was taken up for triple chamberpacing. The DCR was used to create a mask of the coronary venousanatomy during the initial coronary sinus venogram. Subsequently,the wiring of the lateral vein and positioning the left ventricular leadwas done with the guidance of the DCR.RESULTS Thus, dynamic coronary roadmap can be usefully adaptedfor assisting left ventricular lead placement in triple chamber pacing.This will reduce the procedure time and radiation involved in cardiacresynchronization.

073_16762-K3
Minimally Invasive Thoracoscopic Technique for LV LeadImplantation IN CRT: Long-Term Outcome
S. Quintarelli, M. Marini, S. Branzoli, C. Pederzolli, A. Graffigna,A. Coser, F. Guarracini, P. Moggio, R. Bonmassari, A. Droghetti,S. Valsecchi, M.C. BottoliLaboratorio di Cardiologia Interventistica, S. Chiara Hospital, Trento, Italy

INTRODUCTION In our center we developed a minimally invasivethoracoscopic technique for epicardial placement of the LV lead forCRT.METHODS The procedure requires general anaesthesia, oro-trachealintubation, right-sided ventilation, 2 thoracoscopic 5-mm and 1 15-mmports. After pericardiotomy, pacing measurements are performed anda screw electrode is anchored at the final site. The electrode istunnelled to the pocket and connected to the device.RESULTS 87 patients were referred for epicardial LV lead implanta-tion. Four patients were excluded because of conditions precludingsurgery. The remaining 83 patients underwent the procedure. Ofthem, 56 had undergone an unsuccessful lead implantation and 5were unsuitable for transvenous implantation for their venous anat-omy (Group 1). In the remaining 22 patients CRT was discontinued dueto lead dislodgment (Group 2). The implantation was successful in allpatients (pacing threshold 1.0�0.5Volt, no phrenic nerve stimulation).No complications were reported, except for 1 pericardial effusion and2 induced ventricular fibrillations (no sequelae). The procedure timewas 75�29min. After 19[7-37] months, 14 patients died (comparablerate between Groups, p¼0.581) and 5 patients of Group 1 underwentpocket revision for erosion/infection.CONCLUSION The approach proved to be safe and effective afterfailed transvenous implantation and in case of LV lead dislodgment.


073_17036P-K3
MPP Reduces the Ventricular Arrhythmias Burden Compared toStandard BIV in CRT Patients
F. Zanon,1 L. Marcantoni,1 E. Baracca,1 G. Pastore,1 L. Roncon,1

S. Aggio,1 C. Picariello,1 D. Lanza,1 S. Giatti,1 F. Noventa11Arrhythmia and EP Unit, Cardiology Department, Santa Maria DellaMisericordia Hospital, Rovigo, Italy. Department of MolecularMedicine, University of Padua, Italy

INTRODUCTION Multipoint pacing (MPP) in CRT produces a moreuniform ventricular depolarization and could reduce the arrhythmicburden in patients implanted with an ICD. Aim of the study was tocompare the ventricular arrhythmic burden in a long term follow up intwo homogeneous group of CRT patient, the first implanted with bi-polar LV pacing lead and the latter with MPP.METHODS We retrospectively evaluated the incidence of ventriculararrhythmias in 100 patients implanted with CRT-Defibrillator (46 withMPP, 54 with standard biventricular pacing) over a mean follow up of23�14 months. We considered the first ventricular event requiring ICDintervention.RESULTS No significant differences in clinical characteristics betweenthe two groups were found. 7 pts in MPP group (15%) and 23 pts innon-MPP (43%) group experienced ventricular arrhythmias treatedwith ATPs or shocks. The time of the first event on average was 410days in MPP group vs 498 in non-MPP group.

Tot
MPP Non MPP p
# pts
100 46 54
Male
84 38 46 0.72
Secondary prevention
14 4 10 0.16
Ischemic CMP
56 24 31 0.71
AF at implant
32 17 15 0.29
VT during follow up
30 7 23 0.004
ATP
22 4 18 0.003
Shock
20 3 17 0.02
Inappropriated shock
10 2 8 0.09
CONCLUSIONS In our series of CRT patients MPP reduced the ven-tricular arrhythmias compared to standard bipolar pacing.

073_16781-K3
NYHA Functional Class or Left Ventricle Ejection Fraction: WhoShould we Rely on to Predict Mortality in CardiacResynchronization Therapy?
R. Baggen Santos, R. Baggen Santos, M. Trepa, I. Silveira, M.J. Sousa,B. Brochado, C. Roque, A. Pinheiro Vieira, V. Lagarto, H. Reis,A. Albuquerque, S. TorresCardiology department, Centro Hospitalar do Porto, Porto, Portugal

INTRODUCTION Despite the indisputable role of cardiac resynchro-nization therapy (CRT) in heart failure, the prognostic significance ofclinical or echocardiographic responses to CRT are less well defined.We aimed to evaluate the impact of either clinical or echocardio-graphic response to CRT on long-term prognosis of heart failurepatients.METHODS We retrospectively analyzed 316 patients who underwentbiventricular device placement (CRT-P or CRT-D) between January2002 and March 2016. Echocardiographic (echo) responders weredefined as those with a �5% improvement in left ventricular ejectionfraction (LVEF) 6-12 months after CRT. Clinical responders weredefined as those with an improvement of at least 1 NYHA functionalclass 6-12 months after CRT assessed by chart review. Cox propor-tional hazards models were used to study the relationship betweenecho and clinical response and all-cause death at follow-up. Multi-variable models were adjusted for age, sex, cardiomyopathy etiologyand chronic renal insufficiency.RESULTS The studied population had a median age of 69 � 10 yearsand 65% were male. Of all biventricular devices implanted, 171 (54%)were CRT-D and 145 (46%) were CRT-P. 57% had a non-ischemiccardiomyopathy. Baseline median LVEF was 28�6%. The distributionacross NYHA functional class II, III and IV were 18%, 77% and 6%,respectively. At a mean follow-up of 48�38 months, 33% of patientshad died. Of all patients, 73% were considered clinical responders and56% echo responders. The two groups of responders had a signifi-cantly lower hospitalization rate than non-responders (p<0,001).Clinical and echo responses to CRT were both significantly related toall-cause death on univariable analysis. However, on multivariableCox-regression analysis only echo response to CRT predicted asignificant reduction in death risk (HR: 0.36; 95% CI: 0.19-0.67;P ¼ 0.001).CONCLUSION Echocardiographic response, but not clinical one,measured by NYHA functional class improvement, had an indepen-dent prognostic value in heart failure patients that underwentbiventricular resynchronization.


POSTERS

ATRIAL FIBRILLATION AND PHARMACOLOGIC THERAPY


073_16253-B1
A2A-Adenosine Receptor Overexpression Leads to Arrhythmias
J. Neumann, U. Gergs, P. Kirchhof, L. Fabritz, F.U. Müller,K. Drzewiecki, P. BoknikInstitute for pharmacology and toxicology, Medical School, Münster,Germany

INTRODUCTION Although adenosine A2A-receptors (A2A-AR) are alsopresent in the human heart, their role in arrhythmias is poorlyunderstood.

METHODS We generated transgenic mice that overexpress A2A-AR incardiac myocytes (TG) and compared them to littermate controls(WT).

RESULTS In isolated cardiomyocytes from these hearts, the A2A-ARagonist CSG21680 led to a cAMP-increase and enhanced phosphory-lation of regulatory proteins like phospholamban. In isolated rightatrial preparations, we noted arrhythmias in 15 from 53 samples in WTbut 27 from 57 samples of TG (c2-test, p<0.05,). Moreover, in threefrom five isolated perfused hearts, we noted atrial arrhythmias but innone of eight perfused WT (c2-test, p<0.05), consistent withenhanced atrial diameter in echocardiography of TG (n¼9-12, p<0.05).

CONCLUSIONS It is tempting to speculate that activation of A2A-ARmight explain atrial fibrillation in some patients.

073_16934-X
The Role of Atrial Fibrillation on Vasodilators Treatment inPatients with Acute Decompensated Heart Failure with ReduceSystolic Function
O.A. Nikolaeva, S.N. Tereschenko, I.V. Zhirov, O.V. Sapelnikov,D.F. Ardus, T.M. UskachCardiovascular surgery department, Russian Cardiological Researchand Production Complex, Moscow, Russia

BACKGROUND Assess effect of vasodilators infusion on the clinicalimplications and BNP dynamics in acute decompensated heart failurepatients with reduce systolic function with atrial fibrillation (AF) vssinus rhythm.

MATERIALS AND METHODS We studied 40 patients with acutedecompensated heart failure with reduced left ventricular systolicfunction (left ventricular ejection fraction < 40%). All patients hadIII-IV functional class(FC) by NYHA. The average age of the patientswas 62,45 (56,54-68,36) years. 17 patients had a history of long-termpersistent atrial fibrillation. The duration of AF was 5.06 (1,73-8,46)years. In addition to standard HF therapy, were performed periph-eral vasodilator infusion. Assessment AF influence at clinical statuscarried out before and after treatment including vasodilatorinfusion.RESULTS Patients with HF and AF had significant left atrium dilata-tion -148 (� 45.2) ml compared with patients with sinus rhythm -108(� 28.5) ml (P <0.05). It was significant correlation of AF with theperiod of hospitalization (r ¼ 0,578*; p ¼ 0,03). Length of hospital stayof patients with AF was significantly higher than patients with sinusrhythm (13,94 � 1,67 vs 12,33 � 2,79 days; p ¼ 0,027). More over, inpatients with sinus rhythm during the treatment had greaterdecreasing BNP level (D¼ -765,91 vs D¼ -369,01 pg/ml; p ¼ 0,046). Alsoat the time of discharge FC was slightly higher in patients with sinusrhythm: 2,35 (1,89-2,56) vs 1,89 (1,54-2,25); p ¼ 0,061.CONCLUSION Patients with atrial fibrillation compared to patientswith sinus rhythm worse respond to treatment of acute decom-pensated heart failure. In order to improve the drug therapy response

in patients with HF and AF should be considered a rhythm controlstrategy.

073_16777-H4
Cardioversion of Symptomatic Persistent Atrial Fibrillation inPatients With Severe Left Atrium Dilatation: How Far ShouldWe Go?
C. VacarescuTimisoara Institute of Cardiovascular Diseases; Victor Babes UniversityOf Medicine and Pharmacy Timisoara, Cardiology Department,Timisoara, Romania

INTRODUCTION to assess the outcome of direct current cardioversion(DCCV) in patients with symptomatic persistent atrial fibrillation(PAF) and severe LA dilatation.METHODS We analyzed 84 pts (49 male) aged 64.6�9.8 y.o, withPAF<1 year, EHRA class>2 and LAVI>40 ml/m2. Echocardiographicparameters: ejection fraction (EF), LA diameter (LAD), LA area (LAA),LA volume (LAV) and LA volume index (LAVI). Follow-up intervals: 1-3-6-12 months; maximum 3 conversion/year admitted.RESULTS All pts received proper anticoagulation (36 pts dabigatran, 5pts apixaban, 43 pts acenocumarol) and antiarrhythmic treatment:amiodarone (57 pts), propafenone (4 pts), flecainide (13 pts), sotalol (3pt), amiodaroneþflecainide (7 pts). All 84 pts underwent uncompli-cated DCCV. The mean CHA2DS2-VASc score: 3.02 � 1.28. DCCV wassuccessful in restoring SR in 79 pts (94 %). Total follow-up: 22�9months; 25 pts (30%) needed reconversion after 9�4 months; 13 pts(15%) were left in permanent AF at the end of the study.

Table 3. Main echocardiographic parameters.

Echocardiographic

parameters

All patients (baseline) (N[84)

SR group (end

of the study)

(n[66)

Permanent

AF group

(end of the

study)

(n[18)

P value
Mean ± SD Range Mean ± SD Mean ± SD
EF (%)
48.4 � 7.8 20 - 60 49.6 � 6.6 45 � 7.2 0.021
LVEDV (ml)
120 � 47.8 70 - 330 115 � 41 126.7 � 41.8 0.299
LAd (cm)
4.6 � 0.6 3.3 – 6.7 4.6 � 6.6 4.8 � 0.4 0.807
LAA (cm2)
30.1 � 4.8 20 - 46 29.8 � 4.7 32.3 � 2.7 0.005
LAV (ml)
114.9 � 29.5 60 - 220 112.3 � 28.9 127.9 � 16.6 0.004
LAVI (ml/m2)
52.37 � 8.9 87.18-40.21 46.7 � 4.3 53.4 � 9.2 0.007
*P values for comparisons between SR and permanent AF groups

CONCLUSION Electrocardioversion of PAF in severe LA dilatationshowed a positive outcome, even if multiple DCCV and adaptedstrategy in all pts is needed.

073_16802-P1
Elevated CHADS2 and CHA2DS2VASc Scores are AssociatedWith Echocardiographic Changes in Patients With CoronaryArtery Disease in Sinus Rhythm
P.A. Costa, D.A.R. Moreira, R.B.M. Barretto, D. Le Bihan, J.E. Assef,G.M. Mohallem, K.R. Serafim, R.G. HabibDepartment of Electrophysiology Instituto Dante Pazzanese deCardiologia Sao Paulo, Brazil

INTRODUCTION Patients (P) with CAD and elevated CHADS2 andCHA2DS2VASc scores have been shown to be at increased risk ofsystemic thromboembolism (ST) independent of the documentationof AF. The addition of echocardiographic (ECHO) changes to thescores may increase its accuracy for risk stratification for ST.OBJECTIVES To evaluate if P-CAD in sinus rhythm (SR) present ECHOalterations proportional to the CHADS2 and CHA2DS2VASc scores; andto evaluate the effect of each component of these scores on ECHOvariables.METHODS 111 P-CAD in SR were stratified into two groups(CHADS2 <2 vs � 2 and CHA2DS2VASc <3 vs �3) and submitted to TT-ECHO and TE-ECHO, with left atrial volume index (LAVi), left ven-tricular mass (LVMi), LVEF, presence of left ventricular diastolicdysfunction and left atrial appendage flow velocity (LAAFV).


POSTERS
RESULTS These are presented in the tables below. The component“heart failure” is associated with a 30-fold higher risk of ECHOchanges.
ECHO parameters vs

CHADS2 ‡ 2
Odds ratio 95 % CI p
LAVi increased
5,1 2,2 – 12,2 < 0,001
LAAVF reduced
3,4 1,2 – 10,2 0,027
LVMi increased
2,8 1,2 – 6,8 0,019
LVEF reduced
18,9 2,4 – 149,2 0,005
Diastolic dysfunction
3,2 1,5 – 7,0 0,003
ECHO parameters vs

CHA2DS2VASc ‡ 3
Odds ratio 95 % CI p
LAVi increased
7,7 2,2 – 27,3 0,002
LAAVF reduced
8,6 1,1 – 67,3 0,041
LVMi increased
3,3 1,04 -10,4 0,042
CONCLUSIONS P-CAD with elevated scores have ECHO abnormalities,indicating a higher risk for ST, even in the absence of AF; “Heartfailure” is the major determinant of ECHO changes.

073_16773-H1
Early Markers of Coagulation Activity Prothrombin Fragments1þ2 and Fibrinopeptide A are Significantly Increased in Patientswith Paroxysmal Atrial Fibrillation
M. Negreva,1 K. Vitlianov,2 R. Tasheva11Medical University of Varna, Varna, Bulgaria; 2Second MHAT, Sofia,Bulgaria

BACKGROUND Prothrombin fragments 1þ2 (F1þ2) and fibrinopeptideA (FpA) are early markers for blood coagulation abnormalities and inthis sense their study is of research and clinical interest in paroxysmalatrial fibrillation (PAF).PURPOSE To study F1 þ 2 and FpA plasma levels in patients withclinical manifestation of PAF episodes <24 hours.MATERIALS AND METHODS We studied 51 non-anticoagulated pa-tients (26 men, 25 women; mean age 59.84 � 1.60 years) with PAFduration<24 hours, and 52 controls (26 men, 26 women; mean age59.50 � 1.46 years). Plasma levels of F1þ2 and FpA were examinedonce per each participant by enzyme-linked immunoassays.RESULTS Plasma levels of F1þ2 were significantly higher in the pa-tient group compared to controls (183.40 pmol/L � 8.38 pmol/L vs292.61 pmol/L�14.03 pmol/L; p <0.001). Compared to controls, pa-tients with PAF had substantially higher levels of FpA (3.09mcg.mL�0.15 mcg/mL vs 4.47 mcg/mL � 0.25 mcg/mL, p <0.001).CONCLUSION The results give us grounds to assume that bloodcoagulation is significantly activated and there is a tendency for hy-percoagulability even during the first twenty-four hours of PAF.

073_16950-F1
The New Oral Anticoagulants vs Warfarin in Patients with AtrialFibrillation and Diabetes: A Meta-Analysis of Pioneer Trials ofCurrently Used New Oral Anticoagulants
S. Cay, O. Ozeke, F. Ozcan, D. Aras, S. TopalogluDepartment of Cardiology, Division of Arrhythmia andElectrophysiology, Yuksek Ihtisas Heart-Education and ResearchHospital, Ankara, Turkey

INTRODUCTION The aim of the current study was to compare the neworal anticoagulants with warfarin in patients with atrial fibrillationand diabetes.METHODS Four large randomized trials of the new oral anticoagu-lants (n ¼ 18086) were included in this meta-analysis (Apixaban 5 mg,Rivaroxaban 20 mg, Dabigatran 150 mg, and Edoxaban 60 mg). Sub-group analysis of diabetic patients with atrial fibrillation wasperformed.RESULTS In patients with atrial fibrillation and diabetes, there was astatistically significant reduction in the primary outcome of stroke orsystemic embolism with the new oral anticoagulants (RR ¼ 0.80 [95%CI (0.66 - 0.96)], p ¼ 0.019) compared to warfarin by the fixed effect

model (Figure 1). The P value for Egger’s test is 0.57. Therefore noapparent bias exists in the studies included in the meta-analysis(Figure 2).

Figure 1

Figure 2

CONCLUSION The new oral anticoagulants were effective in reducingstroke or systemic embolism in patients with atrial fibrillation anddiabetes.

AF CATHETER AND SURGICAL ABLATION


073_16743-Q1
Management of Atypical Atrial Flutter in a Patient WithDextrocardia, Inferior Vena Cava Interruption, and AzygosContinuation
B. Candemir, V.K. Vurgun, A.T. Altin, O. AkyurekCardiology Department, Ankara University School of Medicine, Ankara,Turkey

A 44-year-old man had dextrocardia, IVC interruption with azygoscontinuation and had surgical repair of two ostium secundum ASD,referred to our center for ablation of atrial flutter. Femoral approachwas achieved and three long sheaths were introduced and parked atthe azygos vein-SVC-RA junction in order to stabilize the catheters(Figure 1A). A decapolar coronary sinus(CS) catheter and duo-decapolar halo catheter were stationed at the CS and RA(Figure 1B and1C). An activation and voltage map of the RA were performed usingCarto-3, and an irrigated RF ablation catheter. Two scar areas weredefined, close to each other on the interatriaal septum (Figure 1D and1E). The entrainment was performed at the hepatic vein-tricuspidisthmus, which revealed a PPI>50ms excluding a peritricuspid typicalatrial flutter. The pacing entrainment, local activation time andpropagation maps suggested that the tachycardia was spreading be-tween those two scars. We then went for a superior ablation lineconnecting the anterior narrow isthmus which gradually slowed down


OSTERS
and eventually terminated the tachycardia (Figure 1F and 1G). Therewas no tachycardia induced with rapid or programmed extrastimuluspacing under isoproterenol infusion. He had no recurrence arrhyth-mias at 1-year follow-up.
Figure 1. Antero-posterior view of three long sheats(A), left anterior oblique(B) and right anterioroblique(C) views of catheters, voltage mapping of RA anterior view (D) and posterior view (E), ablationline (F) and termination of tachycardia(G).

073_16754
Creating A Conduction Block On Beating Atrial Free WallEpicardially Using An Infrared Coagulator
H. Tsuchiya, H. Kubota, H. Endo, H. Ishii, K. TerakawaCardiovascular Surgery, Kyorin University, Tokyo, Japan

INTRODUCTION Various ablation devices have been developed forthe treatment of arrhythmia at present. We developed a new ablationdevice using infrared radiation and electrophysiologically and histo-pathologically investigated its efficacy.METHODS Coagulation method; Five courses (30 seconds), eachconsisting of infrared irradiation for 4 seconds and an interval for 2seconds, were given to the right atrium on beating heart. Evaluationmethods; 1. EPS; A-1; Measurement of delay in impulse conduction. A-2; The predicted rate of conduction delay after irradiation calculatedfrom conduction distance was compared with the measured rate ofconduction delay. B; The root of the right atrium was irradiated underoverdrive pacing. 2. Pathological findings.RESULTS 1. A; Impulse conduction time: Before: during: after irradi-ation¼7.0: 11.0: 10.0 msec(Fig 1). The rate of conduction delay (pre-dicted rate: measured rate during irradiation: measured rate afterirradiation) ¼ 1.55:1.57:1.43(Fig 2). B; Reversible block converted toirreversible block during irradiation. 2. Some regions showed trans-mural coagulation and some did not.

Fig 1

Fig 2

CONCLUSIONS Creation of electrical block in the atrial free wall onbeating heart by infrared irradiation was clinically confirmed.

073_16203-H5
Complex Arrhythmia Ablation Therapy in a Referring Center:Indications, Management and Arrhythmia Recurrence
E. Abela, M.A. SammutDepartment of Cardiology & Department of Medicine, Mater DeiHospital, Malta

INTRODUCTION A total of 54 referrals, mainly atrial fibrillation (33patients) and ventricular tachycardia (11 patients), were referred forcomplex arrhythmia ablation therapy abroad. We aim to assessarrhythmia recurrence post-arrhythmia ablation and the treatmentprescribed, with recurrence on or off antiarrhythmic treatment with orwithout referral for re-do ablation and recurrence free rates.METHOD The types of ablations; namely AF (Atrial Fibrillation)ablation with PVI (Pulmonary Venous Isolation)/ PVI with substratemodification and VT (Ventricular tachycardia) ablation, the anti-arrhythmic treatment prescribed, repeat ablations and recurrence freerates despite or off anti-arrhythmic treatment – were noted.RESULTS Pharmacological treatment and arrhythmia recurrence.Note: Class refers to the class of the antiarrhythmic, Rx: treatment


POSTERS

CONCLUSIONS Arrhythmia recurrence rates in the patients referredabroad for ablative therapy during the period between 2010-2015 arerelatively high. The Maltese cohort had comparatively more advanceddisease with RF ablation being generally considered only as a finalattempt in the management strategy. This supports the implementa-tion of a local catheter ablation programme for complex arrhythmias.

073_16783-H4
Utility and Safety of A New Internal Cardioversion Systemduring Catheter Ablation of Atrial Fibrillation
M. Kaneko, S. Maeda, Y. Enomoto, S. Shiohira, Y. Shirai, A. Yagishita,T. Sasaki, Y. Takahashi, M. Kawabata, M. Goya, K. HiraoHeart Rhythm Center, Tokyo Medical and Dental University, Tokyo,Japan

INTRODUCTION It is reported internal cardioversion (IC) via subcla-vian (upper) approach is effective for termination of atrial fibrillation(AF) during catheter ablation (CA) for AF. We sought to evaluate theutility and safety of a new IC system by adopting the femoral approach.METHODS This study included 159 consecutive patients (75 and 84 viaupper and femoral approach respectively) during CA for AF. We usedthe BeeAT

�catheter and dedicated defibrillator (A,B). Cardioversion is

performed between distal and middle sets of electrodes.RESULTS AF was terminated successfully in 98.7% via upperapproach (C). In contrast, sinus rhythm was restored in 71.0% withdirect coronary sinus cannulation via femoral approach (D). However,success rates improved to 93.3% when IC catheter formed an a-loop inthe RA (E). Of note, there were no complications in the femoralapproach, whereas pneumothoraxes occurred in upper approach.

CONCLUSIONS Femoral approach was comparable regarding AF termi-nation to upper approach when IC catheter adopted an a-loop in the RA.

073_16764-Q1
Successful Cryoballoon Ablation in a Case With ParoxysmalAtrial Fibrillation Who Had Unusual Geometry
T. Tokano, Y. Nakazato, T. Shiozawa, Y. Kimura, F. Odagiri,H. Tabuchi, H. Hayashi, G. Sekita, M. Sumiyoshi, H. DaidaCardiology, Juntendo University Urayasu Hospital, Urayasu, Japan

INTRODUCTION Cryoballoon ablation (CBA) is sometimes difficultdue to geometry of the left atrium (LA) and pulmonary veins (PV).CASE The present case is a 43 year-old female with paroxysmal atrialfibrillation. LA diameter was 38mm in an echocardiography, however, theLA geometry was very unusual as shown in the figure. CBAwas performedin this case, however, we did not feel any difficulty in the placement of aFlex Cath AdvanceTM and the manipulation of an AchieveTM guide wireand a cryoballoon, Arctic Front AdvanceTM in the LA and PV. PV isolationwas completed with 3 times applications in the each left PV and 1 timeapplication in the each right PV with total procedure time of 120 minutes.PV isolation using CBA was successfully completed in the present casealthough the geometry of LA was very unusual like lacking the LA pos-terior wall.

CONCLUSION CBA can be applied safely in cases with a usual geom-etry of LA if the size of PV is adequate.

073_16809-H5
LA Roof-Dependent Atrial Flutter after Cryoballoon Ablation ofPulmonary Vein Isolation in a Patient with Paroxysmal AtrialFibrillation
J. Morii, M. Ogawa, Y. Idemoto, T. Komaki, Y. Nagata, S. Imaizumi,K. Saku, S. MiuraDepartment of Cardiology, Fukuoka University Hospital, Fukuoka,Japan

INTRODUCTION Cryoballoon ablation is known to be safe and effec-tive to treat drug-refractory atrial fibrillation. Although conventionalcatheter ablation for LA substrate modification occasionally makemacro-reentrant substrate such as gap-related, there are few reportsof LA macro-reentrant atrial tachyarrhythmia after pulmonary veinisolation (PVI) using cryoballoon ablation.METHODS N/ARESULTS A 67 year old male was referred to our hospital fortreatment heart failure due to paroxysmal atrial fibrillation. PVIusing cryoballoon technique was successfully performed and cavo-tricuspid isthmus linear ablation using irrigated ablation catheterwas additionally performed at first session. Several days after firstsession, atypical atrial flutter (AFL) was documented. At secondsession, Electrical and three-dimensional mapping during atypicalAFL identified macro-reentrant circuit went through from LAanterior wall to posterior wall via LA roof gap between two scarareas (<0.05mV) which are detected in the vicinity of bilateral


OSTERS
pulmonary vein antrums. Concealed entrainment during tachy-cardia was confirmed on the circuit of LA roof. These finding ledus to perform linear ablation at LA roof. Atypical AFL terminatedduring irrigated radiofrequency application and subsequentlycompleted linear lesion at LA roof by point by point application.During follow-up of 13 months, no recurrences of AF/AFL wereobserved.CONCLUSIONS Emerge of LA roof-dependent atrial flutter might beaffected by relatively narrowed LA area between two scars after cry-oballoon ablation of PVI. The remaining non-ablated LA area aftercryoballoon PVI might rarely, but occasionally make macro-reentrantsubstrate, which might partially indicate the meaning of LA roofblockline in substrate modification procedure.
073_16973-H5
Comparison of Ablation Technologies of Paroxysmal AtrialFibrillation. Our 2 Year Follow-Up Experience
A. Baimbetov, K. Bizhanov, K. Ergeshov, I. Yakupova, T. Bozshagulov,E. Abilkhanov, M. Kuzhukeev, K. AbzaliyevInterventional Cardiology and Arrhythmology Department, A.N.Syzganov’s National Scientific Center of Surgery, Almaty,Kazakhstan

INTRODUCTION Cryoballoon pulmonary vein isolation (PVI) hasbeen developed as a alternative technology for ablation of atrialfibrillation (AF). Our objective is to compare Cryo-PVI and PVIusing radiofrequency energy (RF-PVI) results during 1 year follow-up.METHODS Cryo-PVI was performed in 155 patients using a 28-mmcryoballoon ablation catheter (Arctic Front Advance, MDT). 145patients undergoing RF-PVI using irrigated RF ablation catheter andnavigation mapping system (Carto 3, BW) served as a control group.The procedural endpoint was PVI confirmed by a circumferentialmapping catheter. Follow-up was performed 6, 9, 12, 18 and24 month after the procedure, using by 24-Hour ECG HolterMonitor.

RESULTS This study included 200 patients with paroxysmal atrialfibrillation (age 56�13 years, left atrial size 40�4 mm). After singleprocedure and during 1 year follow-up 112 patients (72,3%) were freefrom AF without antiarrhythmic drugs (AAD) in the Cryo-PVI group. Inthe RF-PVI group 102 patients (70,3%) had sinus rhythm without AAD.Significantly differences were procedure and fluoroscopy duration –

112�27 and 19,5�5,7 in the Cryo-PVI group versus 154�42 and 32�9,3in the RF-PVI group (p<0,001). When including repeat procedureswith a mean of 1,5�0,5 procedures per patient, 39 of 155 patients(25,2%) in the Cryo-PVI group and 37 of 145 patients (25,5%) in the RF-PVI group (1,4�0,6 procedures per patient) remained in stable sinusrhythm without AAD.

CONCLUSION Single procedure efficacy of PVI is approximately 71%during 2 year follow-up and this is independent of the energy sourceused, but significantly difference of approaches were procedure andfluoroscopy durations (p<0,001). When including repeat proceduresin 25% of patients, outcomes is increased to approximately 85%.

073_16740-H5
Impact of Extensive Encircling of Pulmonary Vein IsolationGuided by Complex Fractionated Atrial Electrograms(CFAE-guided EEPVI) for Persistent Atrial Fibrillation
A. Yoshida, K. Takami, S. Yamada, M. Nakagawa, K. Yamawaki,M. Hiraishi, T. Tagashira, K. AwanoDepartment of Cardiology, Kita-Harima Medical Center, Ono, Japan

In patients with persistent atrial fibrillation(PeAF), complex frac-tionated atrial electrograms(CFAE) ablation after pulmonary veinisolation(PVI) could not reduce the rate of recurrence.

METHODS AND RESULTS In 57 of 91 patients with PeAF, extensiveencircling PVI including CFAE area mapped before ablation(CFAE-guided EEPVI) was performed and compared with conventional PVIin 34 patients. There was not significant difference of baselinecharacteristics of age, duration of AF, LAD, and EF between twogroups. After multiple procedure, one year freedom rate from anyatrial arrhythmia was significantly improved in CFAE group(85%)compared with conventional group(64%) (log-rank test;p<0.05,figure).

CONCLUSION CFAE-guided EEPVI was more effective in patientswith PeAF compared with conventional EEPVI.

073_16387-H5
Role of Right Atrial for Effective Radiofrequency Ablation forParoxysmal and Persistent Atrial Fibrillation
E.A. Artyukhina, A.S.h. Revishvili, V.A. Vaskovsky, M.V. YashkovA.V. Vishnevsky Institute of Surgery, Depatment of the arrhythmia,Moscow, Russia

INTRODUCTION In a number of cases with catheter treatment of atrialfibrillation (AF) despite the performed protocol of radiofrequency ef-fects (isolation of pulmonary veins and linear lesions in the leftatrium), sinus rhythm is not restored. In some cases radiofrequencyablation (RFA) in the right atrium leads to the restoration of the sinusrhythm in patients with paroxysmal and persistent AF. Aim: to eval-uate the role and effectiveness of elimination of the right-of-ferentialfactor in the catheter elimination in patients with paroxysmal andpersistent AF.METHODS Retrospectively were evaluated intraoperative and remoteresults of 72 patients: 38 women and 4 men with a mean age of 61 �8.2 year, 37.5% (27) patients with the paroxysmal AF and 62.5% (45)patients with persistent AF. The duration of the arrhythmia in pa-tients with the persistent AF was not to exceed 4 � 2.1 months. Inpatients with paroxysmal AF, RFA was performed on sinus rhythmafter the isolation of pulmonary veins, induction of arrhythmia wasperformed in all cases. Further the linear effects were performed inthe left atrium, the area of the ganglionic plexus, low-amplitudefragmented activity zones. Electrophysiological diagnostics andvolumetric reconstruction of the right and the left atrium were per-formed by «Astrocard» navigation system (Russia).RESULTS In 8.3% (7) patients, 5 with paroxysmal AF and 2 withpersistent AF the zones of continuous fragmented activity are verifiedin the right atrium (vena cava superior-1, coronary sinus mouth - 2,the lower part of the right atrium - 3). The implementation of RFA inthese areas have led to restoration of sinus rhythm. Total time of RFAwas 58 � 11 minutes, the time of RFA in the right atrium was 5 � 3 min,at the temperature of 35�3 � C and 42�2 W. The observation periodwas 6 � 3.5 months with persistent sinus rhythm remaining.CONCLUSION Undoubtedly the right atrium plays an important rolein maintaining of AF. Verification of continuous fragmented activityin right atrium using volumetric reconstruction allows to eliminateatrial fibrillation in patients with paroxysmal and persistent AF.

073_16192-H1
The Quality of Life After Ablative Therapy in Patients with AtrialFibrillation In Korea
W.J. Park,1 H. Kim,2 S. Lee,2 K. Park31Dongkang medical center, Ulsan, Korea; 2Semyoung Medical Center,Pohang, Korea; 3Veteran hospital, Daegu, Korea

INTRODUCTION We sought to evaluate the influence of ablativetherapy on QOL in patients with atrial fibrillation at 3 months afterablation.


POSTERS
METHODOLOGY From January 2010 to August 2013, eighty-sevenpatients who underwent first catheter ablation for paroxysmal orpersistent atrial fibrillation were enrolled in Yeungnam UniversityMedical Center. Both pulmonary veins isolation was done in all pa-tients. Additional linear ablation or electrogram-guided ablationdepended on operator’s decision. Before and after ablative therapy at3 months, patients received a questionnaire for QOL assessment.Heath-related QoL was assessed with the Medical Outcomes StudyShort Form-36(SF-36). The SF-36 contains 8 individual scales, scoredfrom 0 (worst health) to 100 (best health). Physical component sum-mary (PCS) and mental component summary (MCS) scores includingsubscales analysis were assessed.RESULT After ablative therapy, the physical component summaryscores of the Medical Outcomes Study Short Form 36 increased from67.9�21.6 to 75.1�16.6 (p¼0.001). In subscales of physical component,physical functioning increased from 73.6�23.0 to 79.6�18.8(p¼0.006), role-physical increased from 70.2�32.7 to 79.7�30.0(p¼0.008), and body pain increased from 77.2�27.2 to 88.7�19.0(p<0.001). However, there was no difference in general health beforeand after ablative therapy (50.8�19.6 vs. 52.2�18.2, p¼0.455). Afterablative therapy, the mental component summary scores of the ShortForm 36 increased from 65.2�19.5 to 69.8�17.0 (p¼0.021). In subscalesof mental component, only social functioning increased from 80.9�25.5 to 92.2� 17.8 (p<0.001). There was no difference in role-emotional (74.4�32.4 vs. 77.6�30.6, p¼0.331), vitality (48.3�20.6 vs.47.6�21.3, p¼0.751) and mental health (57.2�20.0 vs. 61.5�21.4,p¼0.062).CONCLUSION Ablative therapy improved the quality of life in pa-tients with AF at 3 months in not only physical component but alsomental component.
073_16212
Gender-Related Clinical Outcomes Of Catheter Ablation ForParoxysmal Atrial Fibrillation
K. Ando, M. Nagashima, T. Iseda, S. Tohoku, J. Morita,M. Fukunaga, K. HiroshimaCardiology, Kokura Memorial Hospital, Kitakyushu, Japan

INTRODUCTION Catheter ablation (CA) is an effective and widelyused treatment strategy for paroxysmal atrial fibrillation (PAF). Ac-cording to some papers, PAF is associated with distinct mechanisticand prognostic criteria in different patient subgroups. Compared withmen, women with PAF have greater thromboembolic risk and tend tobe more symptomatic. However gender-related differences associatedwith PAF ablation remain unclear. The purpose of this study was toinvestigate retrospectively gender differences in real-world outcomesafter CA for PAF.METHODS From August 2009 to March 2015, a total of 1191 PAF pa-tients received the first stepwise CA. In our series, 380 patients(31.9%) were female and 811 patients (68.1%) were male. We analyzedperiprocedural parameters, procedural complications and Kaplan-Meier analysis about recurrence of AF was performed to compare theefficacy of CA. All procedure-related adverse events requiring thera-peutic intervention were recorded as complications.RESULTS Women were older at the time of ablation (women: 65.9years; men: 61.9 years; p<0.0001) and lower BMI (women: 23.07 kg／m2; men: 23.85 kg／m2; p¼0.0002). In addition, they were less oftenaffected by cardiovascular disease (women: 3.16%; men: 7.03%;p¼0.005), whereas sick sinus syndrome (women: 16.32%; men:8.51%; p<0.0001) and the rates of pacemaker implantation (women:2.89%; men: 1.11%; p¼0.0318) were more frequent in femalepatients. There was no statistical difference in CHADS2 score(women: 1.04pt; men: 0.93pt; p¼0.0709). Following the procedure,women did not more often received AADs (women: 49.2%; men:46.6%; p¼0.4021). During median follow up (interquartile range:15.1-74.8) 52.3months, they experienced 26.8% of AF recurrenceswithin the first year (vs men 21.5%; p¼ 0.0369), 35.2% within 2 years(vs men 30.2%; p¼ 0.0819), 47.1% within 3 years (vs men 37.0%;p¼0.0218) and 50.7% within 4 years (vs men 46.2%; p¼0.0405). Onthe other hand, there was no significant difference in the incidenceof procedure-related complications among two groups (women:5.00%; men: 5.55%; p¼0.6937).CONCLUSIONS CA for PAF was effective in both groups. Consideringthat women were significantly older and tended to have sick sinussyndrome, they experienced higher AF recurrence rates. However, in

terms of similar complications rate, PAF ablation for women could besafely performed.

073_16734-H5
The Impact of Ablation on Clinical Outcomes in Acute HeartFailure syndrome with Atrial Fibrillation
M. Manita, M. Nakata, N. Higa, T. Asahi, K. TabataDepartment of Cardiology, Naha City Hospital, Okinawa, Japan

BACKGROUND The prognosis of acute heart failure syndrome (AHFS)with atrial fibrillation (AF) is very poor, partly because many elderlypatients are involved. There have been reports that AF ablation canlead better outcomes in relatively young patients with chronic heartfailure. Therefore, the aim of this study was to investigate the impactof AF ablation on clinical outcomes in patients with AHFS includingthe elderly patients.METHODS AND RESULTS A total of 21 patients with persistent AF(mean age; 73 years, range from 56 to 89 years) admitted to ourhospital for AHFS underwent AF ablation after the treatment ofAHFS. All patients successfully underwent pulmonary vein antrumisolation using contact force sensing catheter. One patient (5%)needed a second session for recurrence. Eighteen patients (86%)maintained sinus rhythm and had no event during the meanobservation period of 9 months. Three out of 9 patients aged 80 orover developed readmission due to heart failure. There was a sig-nificant improvement in left ventricular ejection fraction (from36.6�15.8 to 59.3�10.4 %, p<0.01) and a significant reduction inserum BNP (from 744�472 to 119�106 pg/ml, p<0.05) in these 18patients.CONCLUSIONS AF ablation for AHFS, even if it includes the elderly,would become an important therapeutic option.

073_16242-H5
Relationship between Epicardial Adipose Tissue and Recurrenceof Atrial Fibrillation in Paroxysmal Atrial Fibrillation Ablation
K. Kumagai, K. Minami, Y. Sugai, Y. Otsuka, H. Motoda, Y. Take,T. Sasaki, K. Nakamura, S. Naito, S. OshimaDivision of Cardiology, Gunma Prefectural Cardiovascular Center,Maebashi, Japan

INTRODUCTIONS Epicardial adipose tissue (EAT) is mainly locatedadjacent to antra of the pulmonary vein (PV). The relationship of AFrecurrence with overlap between EAT and circumferential PV isola-tion line is unclear in paroxysmal AF.METHODS Seventy-seven PAF patients underwent circumferentialPVI. After the PVI, EAT images on MDCT were merged with geometrycreated on the NavX. The patients were divided into an AF-free group(n¼67) and AF-recurrent group (n¼10).RESULTS The AF freedom off antiarrhythmic drugs in PAF patientswas 87% over a 12-month follow-up period. There were not signif-icant differences of body mass index, CHA2DS2-VASc score,left atrial (LA) dimeter, total cholesterol, triglyceride, brain natri-uretic peptide and C-reactive protein between both groups. In theLA, the overlap between EAT located at roof and left PVI line, andEAT located at inferior septum and right PVI line was greater in theAF-recurrent group than in the AF-free group (P¼0.036 andP¼0.025).CONCLUSIONS EAT located at roof and septum in LA may be relatedwith atrial substrate, which influence on ablation lesion creationduring circumferential PVI and AF prognosis.

073_16757-H5
Early Recurrence of Atrial Fibrillation Did Not Predict theLong-Term Outcome in Patients Who Underwent CryoballoonAblation
T. Tokano, Y. Nakazato, T. Shiozawa, Y. Kimura, F. Odagiri, H. Tabuchi,H. Hayashi, G. Sekita, M. Sumiyoshi, H. DaidaCardiology, Juntendo University Urayasu Hospital, Urayasu, Japan

INTRODUCTION Transient AF is frequently observed just after cry-oballoon ablation (CBA). We tested whether early recurrence of AFafter CBA predict the outcome in the long-term follow-up.


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METHODS The subjects were 38 patients with AF (mean 59 year-old,27 were males) who underwent CBA. The frequencies of induced AFduring CBA procedure and AF <1 month after CBA were noted, and therecurrence of AF >3 months after CBA were compared between pa-tients with and without these early recurrences of AF.RESULTS Sustained AF was induced in 10 patients (26%) during CBAprocedure. Transient AF <1 month after was observed in 13 (34%)patients. AF recurrence >3 months after CBA was noted in only 1patient with transient AF <1 month after CBA and was not observed inpatients with induced AF and without AF <1 month after CBA. Thereis no statistically significant difference.CONCLUSION Early recurrence of AF such as induced AF during CBAprocedure and transient AF <1 month after CBA did not predict thelong-term outcome in patients who underwent CBA.
073_16957-H5
Association of the P/PR Segment in Lead DII (Macruz Index) andthe Terminal Segment of the P Wave in Lead V1 (Morris Index)With Recurrence in Patients Underwent Paroxysmal AtrialFibrillation Ablation Using Cryoballoon
S. Cay, O. Ozeke, M. Kara, F. Ozcan, D. Aras, S. TopalogluDepartment of Cardiology, Division of Arrhythmia andElectrophysiology, University of Health Sciences, Yuksek IhtisasHeart-Education and Research Hospital, Ankara, Turkey

INTRODUCTION The aim of the study was to investigate whether theP/PR segment in lead DII (Macruz index) and the P wave terminalsegment in lead V1 (Morris index) were predictors of AFib recurrencein patients underwent paroxysmal AFib ablation using cryoballoon.METHODS Overall 246 patients (123 male; the mean age, 55.8�11.2years) were included. ECG recordings of all patients prior to the pro-cedure were investigated.RESULTS All 941 PVs (38 left common, 9 right common, 4 rightaccessory) were successfully isolated. Temporary phrenic nervepalsy was observed in 6 patients. The mean follow-up duration was21.0 � 15.8 months. All patients received anti-arrhythmic treatmentthroughout the first three months. During follow-up, recurrencedeveloped in 36 patients. The mean P wave duration was104.6�15.0 msec and 102.2�12.8 msec in patients with and withoutrecurrence, respectively (p¼0.314). The mean Macruz index was1.63�0.22 and 1.51�0.26 (p¼0.014) and the mean Morris index was0.036 � 0.006 and 0.031 � 0.005 (p <0.001) in patients with andwithout recurrence, respectively. In addition, in multivariableregression analysis, the only parameter was found to be significantpredictor of recurrence was the Morris index (OR¼1.094, 95% CI1.063-1.125, p<0.001).CONCLUSION The Morris index can be an independent predictor ofrecurrence in patients underwent paroxysmal AFib ablation usingcryoballoon.

073_16742-H5
Evaluation of Acute Brain Injury With Serum Neuron-SpecificEnolase Levels in Patients Undergoing Catheter Ablation forAtrial Fibrillation
A.T. Altin,1 V.K. Vurgun,1 A. Acibuca,1 M. Kilickap,1 C. Isikay,2

O. Akyurek,1 B. Candemir,1 I.S. Gul,2 D.M. Gerede,1 C. Erol11Cardiology Department, Ankara University School of Medicine,Ankara, Turkey; 2Neurology Department, Ankara University School ofMedicine, Ankara, Turkey

INTRODUCTION Catheter ablation of atrial fibrillation (AF) is relatedwith tromboembolic complications. We aimed to measure periproce-dural serum neuron-specific enolase (NSE) levels, which is known asbiomarker of neuronal injury.METHOD Forty three patients with paroxysmal AF underwent pul-monary vein isolation performed with irrigated radiofrequencycatheter. A neurological examination was performed pre- and post-ablation period. Serum NSE levels was determined before and at theand of the ablation, as well as 2hours, 24hours and 48hours after theprocedure.RESULTS None of the patients developed new neurological defi-cits. But NSE levels increased after ablation above the upperreference limit of 17ng/ml in 14 patients. No clinical parameters

such as age, hypertension, previous history of stroke, diabetesmellitus, CHA2DS2VASc score and atherosclerotic heart diseaseshowed significant correlation with increased NSE. Proceduralparameters such as activated clotting time value, total proceduretime, electrical cardioversion didn’t correlated with an increasedlevel of NSE (Table 1). Patients with increased NSE levels hadlarger left atrium.

Table 1. Clinical, procedural and echocardiographic features of the patients.

Increase of NSE

p value
- +
CHA2DS2VASc�2
18 (69.2%) 8 (30.8%) 0,757
minACT�250
16 (59.3%) 11 (40.7%) 0,137
min DBP (mmHg)
50�7,5 50�15 0,414
min SBP (mmHg)
80�12,5 80�31,25 0,853
Total procedure time

(min)

150�57,5
150�65 0,677
LA diamater(cm)
4,1�0,62 4,5�0,55 0,018
Cardioversion
5 (45.5%) 6 (54,5%) 0,133
Parametric variables are demonstrated as median�IQR and non parametric variables demonstrated as n(%)

min: minimal, ACT:activated clotting time, DBP: Diastolic blood pressure, SBP: Systolic blood pressure, LA:

Left atrium

CONCLUSION Serial assessment of serum NSE level may help topredict acute brain injury related to AF ablation in a low price andreadily available manner.

073_16804-H5
Relation Between Heart Rate Change and Recurrence AfterPulmonary Vein Isolation in Patients With Paroxysmal AtrialFibrillation
Y. Sugai, K. Kumagai, K. Minami, M. Inoue, H. Motoda, Y. Otsuka,Y. Take, T. Sasaki, K. Nakamura, S. Naitoh, S. OshimaDepartment of Cardiology, Gunma Prefectural Cardiovascaular Center,Maebashi, Japan

INTRODUCTION We examined the relation between heart rate (HR)change and recurrence of atrial fibrillation (AF) after pulmonary veinisolation (PVI).METHODS We retrospectively examined 49 consecutive cases ofparoxysmal AF who performed first PVI procedure from April toSeptember 2015. HR of electrocardiograms were recorded before andafter the session. Also, recurrence of AF were checked for 6 monthsafter the session.RESULTS Cases categorized to group-A: HR increased more than 10%(27 cases: 55.1%), group-B: HR changed within � 10% (19 cases: 33.8%),group-C: HR decreased more than 10% (3 cases: 6.1%). AF recurredwithin 3 months was 8 cases (16.3% of all): 2 cases to group-A (7.4% ofall group-A), 6 cases to group-B (31.6% of all group-B). AF recurredfrom 3 to 6 months was 4 cases (8.2% of all): 2 cases to group-A (7.4%of all group-A), 2 cases to group-B (10.5% of all group-B). No recurredcase was found in group-C.CONCLUSION The recurrence of AF after PVI procedure may have norelation to HR increase, and it may be low when HR decreased.

073_16720-H6
Results of Surgical Treatment of Lone AF Using RF ModifiedMAZE Procedure
V. Vaskovskii, A.S.h. RevishviliDepartment of treatment of arrhythmia’s, A.V. Vishnevsky Institute ofSurgery, Moscow, Russia

INTRODUCTION To assess periprocedural and long term results ofradiofrequency modified MAZE procedure and role of each step intreatment of lone AF.METHODS 128 patients (98 male, mean age 54.5�9.6) with AFwere included. According to duration of AF 5 groups (G) were allocated.G I – paroxysmal AF (n¼26), II – 7 days – 1 month persistence AF (n¼30),III – 2 – 5months persistence AF (n¼16), IV – 6-12 months persistence AF(n¼29), V – long standing AF. Arithmetical means: bypass time –


POSTERS
60.4�15 min., LA volume – 133.1�26.5 ml., LA diameter – 4.5�0.61. Si-nus Rhythm restoration was observed in G I: 81.82 %; G II: 85.4 %; G III:78.6 %; G IV 64 %; G V 52 %. Mean follow-up has made 36 months.Average effectiveness has made 84 % (86, 89, 75, 83, 66 % in Gs I, II, III,IV, V respectively). No deaths or major complications were registered.CONCLUSION Patients with duration of AF 6 months and morebiatrial approach is recommended. RF modified MAZE procedure iseffective and safe approach for surgical treatment of lone AF accord-ing to gathered data.
073_16972-H6
Our Experience of Persistent Atrial Fibrillation Treatment WithThoracoscopic Approach for Ablation of Pulmonary Veins
A. Baimbetov, T. Bozshagulov, R. Tuleutayev, B. Rakishev,R. TaimanovaInterventional Cardiology and Arrhythmology Department, CardiacSurgery Department A.N. Syzganov’s National Scientific Center ofSurgery. Almaty, Kazakhstan

INTRODUCTION Aims of this study to estimate first results of thor-acoscopic radiofrequency ablation (isolation of pulmonary veins andLA posterior wall) with or without LAA exclusion for long standingpersistent atrial fibrillation.METHODS During 2016 year, 13 patients with long standing persistentAF underwent to thoracoscopic epicardial radiofrequency ablation(isolation of pulmonary veins and LA posterior wall) with or withoutLAA exclusion (Medtronic GeminiS). Operation technique includedablation of pulmonary veins, Marshall’s ligament coagulation, resec-tion of left atrial appendage and epicardial mapping to identify exitblock and entrance block. Contraindicationswere: left atrial appendagethrombosis (for monopolar ablation), weakness of the sinus node, ad-hesive process in pericardium, adhesive process in pleural cavity,chronic obstructive bronchitis of the lungs (difficult long term one lungventilation), atrium size less than 55mm. 13 patients: 9 men,4 women,mean age 58 years (33-74 years), long standing persistent AF-12 pa-tients, persisten AF-1 patient, mean time of AF-4.2 years (3 month-20years), mean size of left atrium 4.3�0,9cm, primary catheter ablationwere done in 5 patients, EF LV 54% (36-67%),mitral regurgitationwas in3 patients, LV EDV-148ml (101-223ml). After operation all patients weretreated with amiodarone 200 mg per day and anticoagulation therapywith warfarine 6 months. Control efficacy of the treatment were doneby 24-Hour Holter Monitor during 1,3,6 months after operation, meantime of follow-up 180 �19 days.RESULTS All patients were on sinus rhythm after operation and up to 6months. Average time of hospital stay 8 days. One patient was read-mitted to the hospital due to atrial flutter which was treated in CathLabby ablation of cava-tricuspid isthmus. Recurrent atrial fibrillation after6 months was in 1 patient. No other perioperative complication wasreported. All patients underwent a 24 hr Holter monitoring 2nd daypostoperatively: no relapse of tachycardia. All patientswere dischargedin good condition on 4th or 5th day postoperatively.CONCLUSIONS Thoracoscopic ablation of pulmonary veins is aperspective method of treatment atrial fibrillation, with high efficacy90,9% in mid-term follow-up, especially in non effective catheterablation, with low complications and fast recovery period. Exclusion ofLAA reduces thromboembolic complications in case of recurrent atrialfibrillation.

AVNRT ABLATION


073_16823-L2
Compared the Efficacy of Cryoablation and RradiofrequencyAblation for Treatment of Atrioventricular Nodal ReentrantTachycardia
M. Nagashima, K. Yamamoto, T. Iseda, J. Morita, K. Hiroshima,S. Tohoku, K. AndDepartment of Cardiology, Kokura Memorial Hospital, Kitakyushu,Japan

Radiofrequency (RF) ablation of the atrioventricular nodal slowpathway is the accepted treatment for atrioventricular nodal reentrant

tachycardia (AVNRT), with success rates greater than 90%. The majorrisk is atrioventricular nodal block requiring permanent pacemakerimplantation. Cryoablation is associated with similar acute successrates and may be associated with a lower risk of AV block. We previ-ously compared the efficacy of RF ablation and cryoablation intreating AVNRT in patients presenting to our center. We compared 56patients (40 cryoablation and 16 RF ablation) with AVNRT remitted toour center for EP study and ablation between June 2016 and March2017. There were no differences in the average number of ablationtimes, total procedure times and total fluoroscopic time. There weretwo complications from the cryoablation: one patient is temporaryA-H time elongation and one patient is temporary AV block. Both thepatient recovered when the ablations were stopped.

CONCLUSION Cryoablation is as effective and safety as RF ablationfor treatment of AVNRT.

073_16975-L2
Is ablation for AVNRT Associated With an Increased LatePacemaker-Risk Due to AV-Block?
S.M. JensenHeart Centre and Department of Public Health and Clinical Medicine,Umeå University, Umeå, Sweden

INTRODUCTION We attempt to detect an increase of late pacemaker-risk due to AV-block in a large countrywide cohort ablated for AVNRT.METHODS The Swedish catheter ablation register contains available dataon all patients in the country ablated for AVNRT between 2004-2014(n¼6977). The Swedish ICD and Pacemaker register, includes all pace-maker patients in Sweden. By matching the two registers we identified228 (3.27%) patients ablated for AVNRT who received pacemaker im-plantation 2004-2014. Annual incidence of pacemaker implantation wascalculated from mean follow-up time. Information of indication forpacemaker implantation were extracted from medical records.RESULTS Mean follow-up time was 2034 days. 35 AVNRT patientsreceived pacemaker 0-30 days after ablation, of these 25 (0.26%) dueto acute AV-block. A total of 104 patients received pacemaker im-plantation later than 30 days after AVNRT ablation, 39 of these due toAV-block confirmed by the records (0.57%).

Annual incidence of pacemaker implantation due to AV-block between the years of 2004-2014.

Comparison of AVNRT patients with pacemaker implantation >30d from ablation and the total population

of Sweden.

AVNRT, PM implantation >30d

&

Population of Sweden

&

0-49y, all
0.69 0.015
men
0.56 0.022
women
0.76 0.015
50-69y, all
0.66 0.286
men
0.81 0.367
women
0.54 0.200
70/ y, all
3.65 1.965
men
4.39 2.555
women
3.07 1.522
CONCLUSION The risk of AV-block and pacemaker implantation is 2-3times higher late after ablation for AVNRT when compared to thebackground population.

CARDIAC ARREST


073_16217-C4
What is the Role of the Stroke Volume During Post-Ectopic Beatin the Occurrence of Ventricular Premature Complex-RelatedSymptoms?
K.M. Park, H.B. Gwag, E.K. Kim, J.K. Hwang, S.J. Park, Y.K. On,J.S. Kim, J. HeoDivision of Cardiology, Department of Internal Medicine, HeartVascular Stroke Institute, Samsung Medical Center, Sungkyunkwan


OSTERS
University School of Medicine, Seoul, Republic of Korea; Department ofPediatrics, Samsung Medical Center, Sungkyunkwan Universi
AIMS It aimed to investigate whether increased stroke volume (SV)after ventricular premature complex (VPC) is related to VPC-relatedsymptoms.METHODS We selected patients having an isolated VPC during echo-cardiography from a prospective registry that included patients with astructurally normal heart and 24-hour VPC >1%. Patients were dividedinto two groups according to the presence or absence of VPC-relatedsymptoms (skipped beat or palpitation) when VPC occurred. Left ven-tricular (LV) volumes and time-velocity integral (TVI) at the LV outflowtract were measured during preceding sinus beat, VPC, and post-ectopic sinus beat. %LV SV of the VPC and post-ectopic sinus beat werecalculated by dividing each SV by the SV of the preceding sinus beat.

RESULTS Total 47 patients were eligible. Most patients had VPC withleft bundle branch block morphology and inferior axis. Patients in thesymptom (+) grouphad a significantly lower SV,%LVSV, andTVI duringpost-ectopic sinus beat than those in the symptom (-) group. The sum ofSVs during VPC and post-ectopic beat was significantly lower insymptomatic patients than non-symptomatic patients (103.4 ml versus125.1 ml, P ¼ 0.02), while the sum of %LV SVs during VPC and post-ectopic beat tended to be lower in patients with symptoms than thosewithout symptoms (P¼0.08). The sumof%LVSVsduringVPCandpost-VPC was positively correlated with coupling interval (CI) and CI ratio.CONCLUSIONS VPC-related symptoms may not be associated withthe amounts of post-VPC SV.

073_16775-Q1
Mechanical Suppression/Elimination of Premature VentricularComplexes
M. Barmeda, M. Stucky, J.T. Shirazi, J.M. Miller, R. JainIndiana University School of Medicine, Cardiology Department,Indianapolis, IN, USA

INTRODUCTION Premature ventricular complexes (PVCs) arecommonly seen. Management options include removing causal agents(e.g., caffeine), antiarrhythmic medications or radiofrequency (RF)ablation. We report 2 cases in which PVCs were suppressed/eliminatedby mapping catheter contact without RF application.METHODS Electrophysiology study was performed in 2 men (46 and61 years old) with a symptomatic PVC burden of 27% (ejection fraction[EF] 45%) and 37% (EF 50%) respectively. In case 1, PVC had rightbundle branch block, left inferior axis morphology; in case 2 it was leftbundle left inferior axis (Fig. 1, panel A and B). The coronary sinuscatheter was positioned at the transition portion from the great car-diac vein and anterior interventricular vein. Activation mapping andpace mapping was done.RESULTS In case 1, earliest pre-potentials (fragmented electrograms)were seen 36 ms (Fig. 1, Panel C) prior to QRS onset, at a site that was 4mm away from the branch point of OM1 from LCX (Fig. 1, Panel D). Incase 2, they were seen 26 ms prior to the onset of QRS, in the pul-monary artery. Pacematch was 95% in both cases. Rubbing the abla-tion catheter at the site in case 1 resulted in complete elimination ofPVCs. In case 2, pressure at the site resulted in suppression of PVC(Fig. 1, panel E). In case 1, ablation was never performed because ofproximity to coronary arteries. In 1.5 yr follow up, the PVC burden is<1%. In case 2, PVCs were transiently suppressed.

Figure 1

CONCLUSION These two cases illustrate the site of origin of PVCs canbe very superficial and may be suppressed/eliminated by mild me-chanical trauma.

073_16948-Q1
Acute Improvement of Chronic Ischemic Cardiomyopathy byAblation of High Frequency Left Aortic Cusp PrematureVentricular Contractions: A Case Report
P. Cheema, C. PerzanowskiInternal Medicine Residency Program Brandon Regional HospitalBrandon, FL, USA

INTRODUCTION High frequency premature ventricular con-tractions(PVC) can lead to PVC cardiomyopathy(CM). However, inischemic-CM, the effects of high density PVCs is less well known. Thisreport illustrates the positive results of ablating incessant left aorticcusp PVCs in a patient with worsening ischemic-CM.CASE A 61-year-old male with history of coronary artery bypassgrafting presented with worsening shortness of breath. Telemetry andelectrocardiogram revealed a high burden of unifocal PVCs with trig-gered automaticity(Fig.A). His left ventricular ejection fraction(LVEF)had declined over two years to 15-20%. The decision was made toproceed with PVC ablation to alleviate his heart failure. Interrogationof the RVOT and CS excluded these structures as sources of ectopy.Mapping the aortic cusps of Valsalva revealed a focus of earliestactivation on the left coronary cusp. Ectopy was successfully elimi-nated with ablation. On ten day follow up the patient’s ejectionfraction had increased to 30% with improvement to NYHA class II.RESULTS Even in cases of ischemic-CM with chronically reducedLVEF, culprit left coronary cusp PVC ablation can result in improve-ment of left ventricular systolic function and NYHA class.


POSTERS

073_16198-F3
The Antiarrhythmic Effects of Omega-3 Fatty Acids on HeartWith Ischemia/Reperfusion Injury Against VentricularArrhythmia
J.B. Kim, J.S. Woo, W.S. Kim, W. Kim, K.S. Kim, J.M. LeeDivision of Cardiology, Department of Internal Medicine, Kyung HeeUniversity Hospital, Kyung Hee University, Seoul, Korea

BACKGROUND Dietary n-3 polyunsaturated fatty acids (PUFAs) havebeen known to reduce risk of coronary heart disease and suddencardiac death (SCD). But limited data were available for acuteischemic/reperfusion model with regular dose n-3 PUFAs supply forshort term period.METHOD Fourteen adult male Sprague-Dawley rats were used. Normalsaline and 100mg of omega-3(Omacor� 100mg daily; consist of EPA46mg and DHA 38mg) were injected into intraperitoneum daily to eachgroup for 10 days (control group (n ¼ 7), Omega-3(n ¼ 7)). LAD(leftanterior descending) arterywas ligated and reperfused for 5minutes. Invivo ventricular arrhythmia induction was done with electrical stimu-lator. Optical mapping was performed. ECG was recorded during allprocedure and HRV(heart rate variability) ratio was acquired.RESULTS There were no significant difference between control andomega-3 group in Ventricular tachyarrhythmia(VT/VF) occurrence inLAD ligation and reperfusion state.(During LAD ligation : 1.1�1.2 timesin control group vs 0.5�0.6 times in omega-3 group, p¼0.299; Duringreperfusion state : 4.7�3.6 times in control group vs 2.7�2.0 in omega-3 group p¼0.351). In vivo ventricular arrhythmia induction test, VT/VFinduction rate showed no difference between two groups(6.6�4.2times vs 3.1�2.1 times for 10 electrical stimulation, p¼0.091). Therewere also no significant difference in HRV ratio(1.28�0.74 in controlgroup vs 1.12�0.62 in omega-3 group, p¼0.837). In optical mapping,there were no significant difference of action potential duration at70%(APD70) between control and omega-3 group at normal(37.1-�32.2ms vs 33.0�34.3ms), borderline area(59.7�51.8ms vs80.8�48.7ms) and infarction area(89.4�47.4ms vs 122.8�24.0ms)respectively(p¼0.876 , p¼0.343 and p¼0.202).CONCLUSIONS Omega-3 was not effective in acute ischemic/reperfusion model with intraperitoneal regular dose of omega-3 forshort term period. There was no significant difference in VT/VFoccurrence, VT/VF induction ratio, HRV ration and APD70 betweentwo groups.

073_16977-D1
A New Possibility of Noninvasive Differential Diagnosis of WideComplex Arrhythmias Using Multivariate Analysis of RRIntervals and QRS Complex Durations
M. Budanova, M. Chmelevsky, V. Tikhonenko, T. TreshkurCardiac Electrophysiology lab, Federal Almazov North-West MedicalResearch Centre, Saint-Petersburg, Russia

INTRODUCTION The correct noninvasive differential diagnosis ofwide complex arrhythmias is an actual problem in electrophysiology.The most part of current algorithms are based on the detailed analysisof QRS morphology using standard 12-lead ECG. However, it is wellknown that RR intervals and QRS duration can be used to identifysupraventricular arrhythmias (SVA) with aberrant conduction andventricular arrhythmias (VA). The aim of the study was to investigatea diagnostic value of comprehensive multivariate analysis of RR in-tervals and QRS duration in differential diagnosis of wide complexarrhythmias.METHODS The study enrolled 108 patients (male – 64 (59,3%), age Me(min; max) – 56,5 (8; 85)) with 279 wide QRS morphologies (min; Me;max – 120; 144; 222 ms) during sinus rhythm. An average (min, max) of3 (1;8) different wide QRS morphologies were selected from Holter 24-h ECG data (KT Result 3, INCART, RF). Beforehand, a number of 230(82,4%) and 49 (17,6%) of all wide QRS morphologies were validatedas SVA with aberrant conduction and VA, respectively. Five consec-utive RR intervals before and after examined wide QRS complex wereselected as well as nine QRS morphologies. The durations of all theseintervals (ms) were exported to perform a statistical uni- and multi-variate analysis followed by evaluation of specifity (Sp) and sensivity(Sn) with 95% CI level (Statistica v.12, Statsoft Inc., USA and SPSS v.23,IBM Corp., USA). A p-value <0.001 was considered as statisticallysignificant.RESULTS The duration of SVA (min; Me; max – 120; 132; 179 ms) andVA (min; Me; max – 120; 148; 222 ms) was different (p <0,001; Mann-Whitney U test). ROC analysis showed Sn (95% CI) 59,6% (52,9 –

66,0%) and Sp 79,6% (65,7 – 89,8%) for QRS duration with 140 mscriterion. The following linear discriminant function analysis of allRR intervals and QRS durations classified SVA and VA with Sn 78.3%(72.4 – 83.4%) and Sp 83.7% (70.3 – 92, 7%) with p <0.001.CONCLUSIONS RR intervals and QRS complex durations criteria havenon-significant or low Sn and Sp and cannot be used as separatelytaken criteria to identify SVA and VA. The results show the funda-mental possibility to improve differential diagnosis of wide complexarrhythmias using comprehensive multivariate analysis of RR in-tervals and QRS durations without other morphological QRS complexcharacteristics. Further research is needed to evaluate diagnosticvalue of this new approach.

073_16726-M1
Survival From Inpatient Cardiac Arrest in a Specialist ReferralHospital for Cardiology and Cardiac Surgery
P. Cokkinos, E. Papadopoulou, A. Gkouziouta, K. Farsalinos,A. Tasouli, V. VoudrisCardiology Division Onassis Cardiac Surgery Center, Athens, Greece

INTRODUCTION To assess survival from inpatient cardiac arrest atour Institution.METHODS We recorded arrests over 60 months using the Utstein formatfor cardiac and surgical inpatients (pts). Telemetry monitoring recordedthe arrest rhythm. Our Cardiac Arrest Teams (CAT) are trained inAdvanced Life Support. Biphasic defibrillators are on every floor.RESULTS Of 107,895 admissions, we recorded 198 arrests (55 women, age69.9� 13.9 years): 86 (43%) Cardiology and 112 (57%) Surgery. Of those, 121presented with Asystole, 75 with VF or pulseless VT, and 2 in PEA.Adrenalinewas administered to 43%ofVF/VT and 83%of asystole cases. Intotal, 149 pts (75%) survived the initial resuscitation attempt (IRA) and 85(43%) survived to discharge (34% Cardiology and 50% Surgery). We intu-bated 144 pts: 74% survived IRA and 35% to discharge. Survival from IRAand to discharge was 66% and 26% for asystole and 87% and 66% for VF/VT. Both PEA pts survived to discharge.CONCLUSIONS Survival from inpatient arrest to discharge in ourinstitution was 43%. Telemetry, defibrillator availability, and trainedCAT contributed to successful resuscitation.


OSTERS
073_16963-C5 The Association of Cardiopulmonary Comorbidities With EarlyIn-Hospital Outcome Post Out-of-Hospital Cardiac Arrest
T.S. Potpara,1,2 M. Mihajlovic,2 S. Stankovic,3 T. Jozic,3 I. Jozic,3

M.R. Asanin,2,3 G.Y.H. Lip2,4

1Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia; 2School ofMedicine, Belgrade University, Belgrade, Serbia; 3Emergency Centre,Clinical Centre of Serbia; 4Institute of Cardiovascular Sciences,University of Birmingham, United Kingdom

INTRODUCTION Out-of-hospital cardiac arrest (OHCA) is highly fataldespite improving management. We examined early in-hospitaloutcome of OHCA according to cardiopulmonary comorbidities.METHODS Electronic medical records of consecutive OHCA patientsadmitted to Emergency Centre Reanimation Unit, from April 2013 toOctober 2016, were retrospectively analysed. Patients who diedbefore admission were excluded from this analysis. Baseline patientcharacteristics including cardiopulmonary comorbidities are pre-sented in Table, as well as the comparisons between survivors andnon-survivors. We used univariate logistic regression analyses toexamine the relationships between early in-hospital outcome ofOHCA and cardiopulmonary comorbidities.RESULTS Of 547 consecutive patients with OHCA who were referred tothe Emergency Centre Reanimation Unit, 227 (41.5%) were non-survi-vors. While patient age was significantly associated with the outcome ofOHCA (p¼0.011, Table), sex and cardiopulmonary comorbidities werenot significantly associated with fatal outcome of OHCA.

Table - Baseline characteristics, including the baseline cardiopulmonary comorbidities.

All N[547

Survivors

N[320

(58.5)

Non-survivors

N[227 (41.5)
OR 95% CI p
Age, years

(mean±SD)

66.3 �16.2
64.8 � 16.5 68.4 �15.5 1.014 1.003-1.026 0.011
Sex (male)
316 (57.8) 175 (54.7) 141 (62.1) 1.358 0.960-1.922 0.083
HTA
68 (12.4) 44 (13.8) 24 (10.6) 0.742 0.437-1.259 0.268
DM
57 (10.7) 39 (12.2) 18 (7.9) 0.621 0.345-1.116 0.111
COPD
27 (5.0) 18 (5.6) 9 (4.0) 0.697 0.307-1.580 0.387
Dilated CMP
34 (6.2) 20 (6.3) 14 (6.2) 0.986 0.487-1.996 0.969
Previous CABG
10 (1.8) 9 (2.8) 1 (0.4) 0.153 0.019-1.215 0.076
Previous CVA
25 (4.6) 14 (4.4) 11 (4.8) 1.113 0.496-2.499 0.795
Previous MI
33 (6.0) 21 (6.6) 12 (5.3) 0.795 0.383-1.650 0.538
HTA: hypertension, DM: diabetes mellitus, COPD: chronic obstructive pulmonary disease, CMP: cardiomy-

opathy, CABG: coronary artery bypass surgery, CVA: cerebrovascular accident, MI: myocardial infarction.

CONCLUSIONS In our cohort of OHCA patients referred to a tertiaryhealthcare facility, baseline cardiopulmonary comorbidities were notsignificantly associated with early in-hospital outcome, suggestingthat the initial treatment decision-making should not be driven by thepresence of cardiopulmonary comorbidities.

073_16803-M1
Heartsaver CPR AED Guidelines: A Comparison of ConventionalTeaching and Peer-Led Training for High School Students
M. Santomauro, G. Castellano, G. Comentale, G. Palma, C. Riganti,S. Saccenti, L. Grande, V. De Amicis, G. IannelliDepartment of cardiology, Cardiac Surgery and Cardiovascularemergency, Federico II University of Naples, Italy

Survival rate after cardiac arrest strongly depends on the delayoccurring from the onset to basic life support and then advanced lifesupport. Providing more bystanders could improve survival on theterritory. In this paper we present our experience in BLSD training foradult.

METHODS This study was a randomized controlled trial with ablinded outcome assessor. We evaluated the feasibility and efficacyof a peer to peer BLSD teaching to High school students compared toa professional led teaching. In years 2010-2013, 420 High School 15-18years old students were divided into two groups (A and B) whounderwent a BLSD course for adult. The 206 Students in Group Awere thaught in peer to peer way while Group B 214 students was

trained in conventional way by a professional instructors AHAcertified. At the end a final exam by a blinded instructor was held,and results were analyzed comparing the data from the final exams.The items value was the percentage of check responsiveness, of call118, of opening the Airway and giving breaths (head tilt-chin lift,mouth-to mouth breaths, mouth-to mask breaths, chest compressionswith position hand, adequate depth, CPR ratio and correct ratecomplete chest recoil by means of a QCPR on the training manikinused for CPR training by model Resusci Anne manikin for measuresCPR performance by the Wireless SimPad SkillReporter (LaerdalMedical -Stavanger, Norway), of use of semiautomatic external defi-brillator (AED) and retention of BLSD knowledge as assessed by 10-point questionnaire.CONCLUSIONS The results demonstrate, that check responsivenesspercentage was 72.5% in the peer-led group and 75.4% in theprofessional-led group, that call 118 percentage was 82.5% in thepeer-led group and 86.9% in the professional-led group. Open theairway and giving breaths percentage was failed in 32% in theGroup A and 38% in the Group B (ns). Chest compressions (positionhand, adequate depth, correct rate, complete chest recoil, CPR ra-tio) percentage was 73.9% in the group A and 76.4% in the group B.The percentage correct use of AED was 53.5% in the peer-led groupand 52.4% in the professional-led group. On the questionnaireadministered after training, the peer-led group scored an average of47.2 % in the Group A and 49.8 % in the Group B. Conclusions:the high school students who were trained by peer-instructorsshowed comparable skills in CPR for adult to those who weretrained by professional instructors. Peer led training in BLSD forHigh school Students is feasible and could be as effective as aprofessional led course. Our data support that peer-led BLSDtraining could be a part of the educational goals in the secondaryschools in Italy.

073_16822-I4
Do Improvements in Ejection Fraction During WearableCardioverter Defibrillator use Influence ICD Implant Rate?
A.M. Sinha, E. Martens, W. Hohenforst-SchmidtDepartment of Cardiology Sana Klinikum Hof, Hof, Germany

BACKGROUND Patients (pts) with cardiomyopathy (CM) andimpaired ejection fraction (EF) have increased risk of ventriculartachycardia or fibrillation (VT/VF). The wearable cardioverterdefibrillator (WCD) protects pts with VT/VF until their responseto guideline directed medical therapy (GDMT) can beascertained. Adherence to GDMT results in better pt outcomes,including improved EF and reduced risk of sudden cardiac death(SCD).PURPOSE Understand the impact of GDMT combined with WCD useon the decision to implant an cardioverter defibrillator (ICD) afterearly diagnosis of heart failure.METHODS A single centre registry of 118 WCD pts was conducted. Allpts had EF recorded at baseline, and 92 pts had EF recorded at day 90.Pts were excluded if they had been previously implanted with an ICD(3) or had EF >35% at baseline (4). Thus, analysis was performed on 85pts.RESULTS Pts were grouped by EF �35% (impaired) or >35%(improved) at follow up. The Table shows the percentage of ptsreceiving an ICD. Comparison of WCD use in the impaired andimproved groups indicated that median days of wear (49 vs 45d) and hours of daily use (22.9 vs 22.6 h) were independent ofEF at follow up,(p>0.05). The distribution of gender (84% vs70% male), median age (71 vs 64 y) and starting EF (26% vs 25%)was similar between groups (p>0.05). The percent pts withimprovement in EF was similar in ischemic vs non-ischemic CM(p>0.05). Symptom based prescription of heart failure medica-tion was similar when compared by EF at follow up. In theabsence of VT/VF, the decision to implant an ICD correlated withEF at follow up (84% in EF impaired vs 7% EF in improved pts,p<0.001). There were 3 pts with non-ischemic CM that wereshocked for sustained VT/VF. All episodes were converted by thefirst shock, and survival was documented at least 24 hours postshock. There were no deaths, and no pt was shocked inappro-priately. There were 3 episodes of new atrial fibrillation detectedas well.


POSTERS
Table: Patients with or without ICD
Total
EF £35% EF >35% p-value
ICD, N (%)
48 (57) 46 (84) 2 (7) <0.001
No ICD, N (%)
32 (38) 4 (7) 28 (93) ——
Unknown, N (%)
5 (6) 5 (9) 0 (0) ——
CONCLUSION Overall, during WCD use, 35% of pts, both ischemic andnon-ischemic CM, manifest improved EF by 90 days. The decision toimplant an ICD was influenced by EF improvement and occurrence ofspontaneous VT/VF. The WCD protects pts from SCD until a patient’sresponse to GDMT can be determined.

073_16955-Q1
Low Anterior Axillary Implantation of an ImplantableCardioverter-Defibrillator in a Patient with Recurrent BilateralPectoral Infection
S. Cay, O. Ozeke, F. Ozcan, D. Aras, S. TopalogluDepartment of Cardiology, Division of Arrhythmia andElectrophysiology, University of Health Sciences, Yuksek IhtisasHeart-Education and Research Hospital, Ankara, Turkey

A 38-year-old male with ischemic cardiomyopathy had recurrentimplantable cardioverter-defibrillator (ICD) device infections withtwo infections on the left pectoral region and one infection on theright pectoral region in a few months. We performed a low ante-rior axillary line incision with laterally located submuscular pocketand a 10 cm, 18 gauge needle was advanced parallel to the anterioraxillary line away from the thoracic cavity and the lung to punc-ture the axillary vein under continuous contrast injection in theanteroposterior view (Panel A). After tenting and puncture of theaxillary vein, a standard guide-wire and a peel-away sheath wereintroduced. A single-coil active-fixation defibrillator lead wasadvanced and implanted at the base of the right ventricle withgood pacing and sensing parameters. The lead was connected toan active single-chamber ICD can, the generator was secured to thefascia and the pocket was closed. In the posteroanterior chestradiography both ventricles were between the active can and theright ventricular shock coil (Panel B). At 6 months follow-up, noinfection recurred and the device parameters were stable withslow ventricular tachycardia events ending with anti-tachycardiapacing.

073_16767-Q1
An Inappropriate Shock Theray Due to ParoxysmalAtrial Flutter in Case With a Subctanuous ImplantableCardioverter-Defibrillator
T. Tokano, Y. Nakazato, T. Shiozawa, Y. Kimura, F. Odagiri, H. Tabuchi,H. Hayashi, G. Sekita, M. Sumiyoshi, H. DaidaCardiology, Juntendo University Urayasu Hospital, Urayasu, Japan

INTRODUCTION It seems that inappropriate shock therapies of sub-cutaneous implantable cardioverter-defibrillator (S-ICD) are morefrequent comparing with those of transvenous implantable car-dioverter-defibrillator.CASE The present case is a 39 year-old male with coronary arterydisease and reduced left ventricular function. The patient underwentan implantation of S-ICD (Model A209, Boston Scientific, Marl-borough, MA, USA) after screening for adequate patient selection. Amonth later, the patient recognized a shock therapy without loss ofconsciousness. S-ICD telemetry data revealed an episode of ventric-ular fibrillation (VF) following a delivered 64J shock. Intracardiacelectrograms showed an atrial flutter (AFL), and S-ICD counted eachflutter waves as ventricular activities. No sensing option of S-ICDwould be available to avoid inappropriate shock therapy due to theAFL in the future, and catheter ablation was subsequently performedto cure the AFL. Inappropriate shock therapy no longer occurred afterthe ablation. In our knowledge, this is the first report of S-ICD inap-propriate shock therapy due to flutter waves.CONCLUSION We should be aware that S-ICD may deliver inappro-priate shock due to prominent surface flutter waves.

073_16758-I1
Long-Term Prognosis Of Patients With ImplantableCardioverter-Defibrillator
J. Zarifis, K. Polymeropoulos, M. Bougiakli, P. Ioannidis,A. StavratiCardiology Department, “George Papanikolaou” General Hospital,Thessaloniki, Greece

INTRODUCTION To elucidate the long-term prognosis of recipients ofimplantable cardioverter-defibrillator (ICD) for prevention of SuddenCardiac Death (SCD).METHODS We followed 311 ICD implanted patients (86.5% male),mean age 65.3 � 12.2 years, 182 for secondary prevention, for 25�17months.RESULTS Appropriate ICD intervention was demonstrated in 26 pa-tients (20.1%) in primary prevention group and in 72 patients (39.5%)in secondary prevention group (OR 2.5, 95% CI 0.95-5.49, p¼ 0,090).Time to first appropriate intervention was 9.37�3.69 months. Inap-propriate ICD intervention was observed in 15 (11.62%) patients inprimary prevention group and in 16 (8.7%) patients in secondaryprevention group (95% CI 0.16-1.0, p¼0.05). History of ischemic car-diomyopathy (65 patients) is related to appropriate ICD intervention(95% CI 0.9-1.59, p¼ 0.055) with no statistical difference betweengroups. There were reported 17 deaths in primary prevention groupand 27 deaths in secondary prevention group (p¼0.011).CONCLUSIONS Appropriate ICD interventions are present in bothprimary and secondary prevention groups, with a minimal differencein the rates of secondary prevention group. The survival was higher insecondary prevention group, as anticipated.

073_16801-Q1
Successfull Catheter Ablation of Electrical Storm in Patient WithNon-Compaction Cardiomyopathy
H.M. Günes, E. _Ibiso�glu, G.G. Demir, Ü. Savur, F. KiliçarslanIstanbul Medipol University Medicine Faculty, Istanbul

We report a patient with non-compaction cardiomyopathy and pre-served left ventricular systolic function presenting with an electricalstorm triggered by premature ventricular contractions; originatingfrom right ventricular free wall. Electrical storm did not respond toantiarrythmic drugs and could be only treated by catheter ablation.During ablation procedure, premature ventricular contractions weremapped and ablated successfully.This case report suggests thatcatheter ablation for electrical storm in patients with non-cmpactioncardiomyopathy.


OSTERS

073_16744-Q1
Percutaneous Transapical Access and Transcatheter Closure forVentricular Tachycardia Ablation
V.K. Vurgun, A.T. Altin, M. Kilickap, B. Candemir,O. AkyurekCardiology Department, Ankara University School of Medicine, Ankara,Turkey

INTRODUCTION We want to demonstrate an uncomplicated trans-apical approach to the LV for VT ablation and transcatheter closure ofapex in a patient with HCM, who had mechanical aortic and mitralreplacement.CASE Apical puncture was performed with coronary angiographyto avoid coronary artery injury, and 8F introducer sheath wasplaced in LV cavity (Figure 1A, 1B). The baseline ECG revealedsustained VT (Figure1C). Local activation mapping with CARTO-3during VT revealed earliest activation at LV mid-lateral segment(Figure 1D). Although voltage mapping during VT revealed no scarareas, low voltage areas was detected at the same segment. Post-pacing interval measurements were not good enough to show ‘VTisthmus’, in spite of good pace mapping with 11/12 (Figure 1D,‘blue point’ in CARTO views). Diastolic potential areas during VTwas tagged and sites showing diastolic potentials and low voltageareas were targeted for ablation but tachycardia was not termi-nated after ablation. When a linear lesion was created from mitralannulus to ablation site at mid-lateral segment (Figure 1E), tachy-cardia terminated (Figure 1F). After ablation, a AmplatzerTM DuctOccluder II was deployed to close the LV apex (Figure 1G,1H).Patient recovered from the procedure without complications, andhe had no recurrence of VT during 1-year follow up period andthere was no VT/VF detection on his ICD.

Figure 1. A. Apical puncture under coronary angiography, B. Ablation catheter in LV cavity, C. BaselineECG, D. Local activation mapping during VT, E. Ablation points, F. Termination of VT, G. Transcatheterclosere of apex, H. Closure device at apex.

073_16835-L4
Endo/Epicardial Ablation of Ventricular Arrhytmias WithContact Force Sensing Catheters in Arrhytmogenic RightVentricular Dysplasia/Cardiomyopathy
F. Ozcan, D. Aras, S. Cay, O. Ozeke, M. Kara, S. TopalogluTurkiye Yuksek Ihtisas Training and Research Hospital Department ofCardiology Division of Cardiac Electrophysiology Ankara, Turkey

INTRODUCTION In this study we sought results of contact forcesensing (CFS) catheters in Arrhythmogenic Right VentricularDysplasia/Cardiomyopathy (ARVD/C).METHODS We included 17 ARVD/C patients, five of whom have pre-mature ventricular contractions (PVC) and the rest admitted withventricular tachycardia (VT) storm. We divided patients into twogroups as PVC and VT groups. Endo/epicardial ablation preferred forVT group. irrigated CFS catheters (Smart Touch, Biosense Webster,Inc) were used for all procedures.RESULTS Mean age left ventricular ejection fraction of patients in PVCgroup (2 male) was 34.6�12.8 and 40.4�12.1%. Mean ratio of PVC in 24hour Holter monitor was 31.8�7.6%. Mean area of bipolar low voltageand scar were 17.4�8.4 and 10.2�5.4cm2, respectively. Mean contactforce in right ventricle was 13�1.2 grams. The mean follow-up durationwas 15�3.1 months for PVC group. All PVC morphologies could not beeradicated in two patients but total percentage of PVC were found to bereduced significantly in those patients. Mean age left ventricular ejec-tion fraction of patients in VT group was 36.6�6.3 (7 male,) and55.5�9.6%. All VT patients had ICD and admitted with electrical stormAll patients in VT group underwent endo-epicardial ablation but one.Low bipolar voltage area was found less in endocardium than epicar-dium (112.6�44.7 cm2 versus 257.5�144.4 cm2). Mean contact force forendocardium and epicardium were 12.5�1.2 and 12.5�4.6 grams. Allclinical and non-clinical VT’s were ablated successfully except twopatient who had still non-clinical VTs. No complication occurred. Themean follow-up duration was 15.5�4.5months. None of the VT patientsexperienced electrical storm or death. Two patients had single shockone patient had two shocks during follow-up. No complicationoccurred.CONCLUSION Endo/epicardial ablation of ventricular arrhythmiaswith CFS catheters in ARVD/C seems safe and effective.

073_16944-L4
Collateral Injury of the Conduction System DuringInterventricular Septal Substrate Modification In Non-IschemicCardiomyopathy: Impact on Long-term Outcomes
D. Muser, P. Santangeli, J.J. Liang, S.A. Castro, T. Hayashi, S. Magnani,R.K. Pathak, F.C. Garcia, G.G. Supple, M.P. Riley, D. Lin, R.D. Schaller,S. Dixit, E. Zado, D.S. Frankel, D.J. Callans, F.E. MarchlinskiCardiac Electrophysiology, Hospital of the University of Pennsylvania,Philadelphia, PA, USA

BACKGROUND Catheter ablation (CA) of ventricular tachycardia (VT)in patients with non-ischemic cardiomyopathy (NICM) and septalsubstrate can be challenging due to the complexity of the underlyingsubstrate, the frequent intramural location, and the proximity to theconduction system. We sought to investigate the clinical impact ofcollateral injury of the conduction system (CICS) during septal sub-strate modification in patients with NICM.METHODS We included 95 consecutive patients (age 63�13 years, 85%males) with NICM and interventricular septal substrate (defined as pres-ence of bipolar/unipolar voltage abnormality according to standard criteria)who underwent CA and substrate modification either targeting the entireabnormal septal substrate resulting inCICS [Group 1, n¼35 (37%)] or sparingthe abnormal substrate adjacent to the conduction system [Group 2, n¼60(63%)]. VT recurrence and changes in left ventricular ejection fraction(LVEF) during follow-up were evaluated.RESULTS Amedian of 1 (1-2) procedures were performed in 95 patients.At time of presentation for the 1st ablation procedure, Group 1 patientswere younger (mean age 58 vs. 65 years; p¼0.018), hadmore frequentlya narrowQRS (80 vs. 28%; p<0.001) a lower prevalence of biventricularpacing (6% vs. 45%; p<0.001), and a similar LVEF (34�11% vs. 31�12%;p¼0.226). At the end of the last procedure, non-inducibility of any VTwith cycle length (CL) >250 ms was achieved in 26/32 (81%) patients inGroup 1 vs. 48/56 (85%) in Group 2 (p¼0.762). After a median follow-upof 44 (12-59) months after the last procedure, patients in Group 1 had asimilar VT recurrence rate compared to Group 2 (20% vs. 32%, p¼0.219)but had a substantial worsening of LVEF (median LVEF variation -5%vs. 6%; p<0.001) with a consequent higher need for biventricular pac-ing device upgrade (37% vs. 15%; p¼0.014).


POSTERS

CONCLUSIONS In patients presenting with NICM and septal sub-strate, a more limited ablation strategy sparing the abnormal substrateharboring the conduction system provides acceptable VT controlwhile preventing a worsening of the systolic function and need forbiventricular pacing compared to a more extensive substrate modifi-cation that results in collateral injury of the conduction system.

PACING


073_16785-P1
Development of a New Integrated Cardiology Results Service
A.J. Robertson,1 D.H.J. Elder21Consultant Cardiologist, Department of Cardiology, NHS Tayside,Dundee, United Kingdom; 2Cardiac Physiologist, Department ofCardiology, NHS Tayside, Dundee, United Kingdom

INTRODUCTION Cardiology patients undergo a number of in-vestigations as part of their management. Follow-up of all thesedisparate investigations can be difficult in many existing hospitalsystems. A new system, agnostic of manufacturer, was thereforedeveloped to integrate these results into one place.METHODS The service initially started as a way to transfer ECGs fromGeneral Practices in the community into the hospital. Over time linkswere developed to integrate reports from echocardiography, angiog-raphy, ambulatory monitoring and eventually device interrogations.The system is written in C#/.net in Visual Studio and deployed onMicrosoft Windows Server 2012.RESULTS 140,000 patients are now listed on the Cardiology ResultsService, including over 4,000 CIEDs. The system is in daily use acrossour organisation, with multiple users entering data. Medication lists &12-lead ECGs carried out in the community along with hospital-basedinvestigations are automatically downloaded onto the system.Automated device downloads from major manufacturers (Biotronik,Boston Scientific, St Jude Medical/Abbott, Medtronic) are all auto-matically downloaded and displayed.

CONCLUSIONS An integrated approach to data management for Car-diology patients has many benefits, improving service delivery andpatient care.


OSTERS
073_16348-J4 The Electromechanical Latency in Right and Left Atrium and ItsPractical Implications on the AV Delay
L. Cassaniti,1 G. Romano,2 G. Busacca,1 G.F. Muscio,2 F. Di Gregorio,3

M. Contarini,2 G. Licciardello11Cardiology COU, Muscatello-Augusta GH, Augusta, Italy; 2CardiologyCOU, Umberto I GH, Siracusa, Italy; 3Clinical Research Unit, MedicoSpa, Rubano, Italy

INTRODUCTION Atrial contraction timing should be considered inAV-delay setting, to avoid AV-valve closure before the end of activefilling.METHODS Tricuspid and mitral flows were assessed by echo-Dopplerin 22 pacemaker patients, measuring the latency between P-waveonset and A-wave onset and end (P-Aon; P-Aend). Implants were alldual-chamber, with leads in right appendage and apex.RESULTS With atrial sensing (As), the tricuspid flow featured P-Aonand P-Aend of 71�43 and 241�77 ms, respectively (mean�sd). Theselatencies increased to 119�57 and 304�88 ms in pacing (Ap). Mitral P-Aon and P-Aend were 94�6 and 281�69 ms with As, and 131�53 and330�65 ms with Ap. All pacing-induced increments were significant(P<2*10-5; paired t-test). The figures show sensed and paced P-Aenddistribution. In 55% of the cases, any paced AV delay <128 ms entailedmitral A-wave shortening, suggesting ventricular interference onactive filling.

CONCLUSIONS The latency to end of mitral or tricuspid A-wave canbe long in a relevant fraction of patients, particularly after Ap. Echo-cardiographic evaluation is advisable before programming a short AVdelay, which might affect the active flow.

073_16774-Q1
Automatic Sensitivity in Patients With Dual ChamberPacemaker: Is it Always Necessary to Program it?
A. Coppolino, L. Valeri, G. Bricco, G. Amoroso, E. Cavallero,A. Battisti, S. Dogliani, C. Iacovino, D. Pancaldo, L. Correndo,M. De Benedictis, F. Piazza, A. Magliarditi, A. Bassignana, B. DoronzoSC di Cardiologia, Ospedale SS. Annunziata ASL CN1, Savigliano, Italy

Sensitivity defines the ability of cardiac pacemaker and implantedcardiac defibrillator (ICD) to correctly detect spontaneous cardiacevents.The amplitude of the spontaneous cardiac depolarization signals isvariable and when the amplitude of signals is associated with atrial orventricular arrhythmias, it might differ markedly from normal signalsoften considerably smaller as in the case of atrial fibrillation or ven-tricular fibrillation . Thus, a fixed sensitivity may not assure thedetection of all events.Automatic sensitivity allows us to solve this potential problem byincreasing the device’s ability to recognize especially arrhythmicevents.When the automatic sensitivity function is activated, pacemakers or ICDsmonitor the amplitude of the sensed signals and the sensitivity is auto-matically increased or decreased in order to preserve a sufficient sensingmargin, commensurate with the patient’s sensed P and R waves.At present, most device manufacturers provide the same automaticsensitivity algorithm for both pacemakers and defibrillators, butclinical efficacy may be different.We present two clinical cases of dependent pacemaker patients inwhich automatic sensitivity algorithm programming has been shownto be ineffective and potentially dangerous.

073_16733-J4
Atrial Sensing Stability in Acute and Chronic Implants of a VDDSingle-Pass Lead
A. Cutaia,1 C. Casalicchio,1 R. Siracusa,1 S. Di Rosa,1 C. Catalano,1

M. Biasiolo,2 F. Di Gregorio,2 G. Caramanno1

1Cardiology COU, San Giovanni Di Dio G.H., Agrigento, Italy; 2ClinicalResearch Unit, Medico Spa, Rubano, Italy

INTRODUCTION Reliable single-lead VDD pacing requires stable atrialsensing performance.METHODS The intracavitary P-wave amplitude was measured in su-pine and upright body position. Amplitude range and mean weredetermined over 4 consecutive cycles and a variability index wasderived as percentage of the former to the latter. The upright/supinemean amplitude ratio expressed the posture effect and was comparedin acute (follow-up < 3 months; n¼17) and chronic implants (meanfollow-up ¼ 27 months; n¼57). All patients were implanted with asingle-pass lead featuring a 30 mm wide atrial dipole (Phymos orHighline models) and a VDD pacemaker of the Sophòs or Gea families(Medico, Italy).RESULTS The P-wave variability index was about 30% in all condi-tions and proved posture-independent in either acute or chronic im-plants (Fig. 1: mean+sd, non-significant difference by paired t-test). Inthese subgroups, the ratio of upright to supine mean amplitudeaveraged 130�76 and 111�59%, respectively (both increments werenot significant). The corresponding data distribution is shown as boxplot in Fig.2.


POSTERS

CONCLUSIONS The tested VDD system was not affected by posturalchanges throughout the follow-up.

073_16838-J4
Ventricular Excitability in Chronic Implants of a VDDSingle-Pass Lead
F. Di Gregorio,1 D. Orsida,2 N. Agostini,2 A. Reggiani,3 P. Pepi,3

G. Arena,4 V.M. Borrello,4 D. Vaccari,5 S. Vittadello,5 G. Neri51Clinical Research Unit, Medico Spa, Rubano; 2Cardiology Dept.,Sant’Antonio Abate GH, ASST Valle Olona, Gallarate; 3Cardiology Dept.,Carlo Poma GH, Mantova; 4Cardiology Dept., Nuovo Ospedale Apuane,Massa; 5Cardiology Dept., San Valentino GH, Montebelluna, Italy

INTRODUCTION Efficient myocardial stimulation ensures reliablepacing with restricted energy expense.METHODS We assessed the ventricular stimulation performance of asingle-pass lead for VDD pacing (Phymos 4, Medico) in the chronicfollow-up (28�14 months) of 29 implants. This lead is tined, non-steroid eluting and features a 5 mm2 tip electrode made of Pt-coatedmicroporous Ti. All patients, affected by AVB with preserved sinusfunction, were implanted in RV apex. The threshold charge-durationcurve was derived in each implant by linear regression of individualdata in the pulse-width range from 0.06 to 0.61 ms (see the enclosed

figure). Regression slope and intercept correspond, respectively, tothe rheobase (in current) and the product of rheobase and chronaxie.RESULTS Rheobase, chronaxie, and limit threshold charge at 0 mswidth averaged 0.76�0.18 mA, 0.38�0.09 ms, and 285�81 nC,respectively, with lognormal data distribution. The voltage thresholdat 0.5 ms was 0.60�0.08 V, with 99% of the cases included between0.41 and 0.85 V in the sampled population, according to lognormalmodeling.

CONCLUSIONS Low-energy chronic VDD stimulation is achieved withthe tested single-pass lead.

073_16956-Q1
Migration of a Pacemaker Lead to an Unusual Site
S. Cay, O. Ozeke, F. Ozcan, D. Aras, S. TopalogluDepartment of Cardiology, Division of Arrhythmia andElectrophysiology, University of Health Sciences, Yuksek IhtisasHeart-Education and Research Hospital, Ankara, Turkey

CASE An 80-year-old female patient with mechanical mitral valveprosthesis, complete heart block and atrial fibrillation was referred toour arrhythmia center for implantation of a pacemaker. Through theleft pectoral region and the axillary vein a single chamber pacemakerwith an active fixation lead was implanted at the right ventricularbase. Due to severe pulmonary hypertension, tricuspid valve regur-gitation and the dilated right ventricle the procedural and fluoro-scopic times were much higher compared to a standard anatomy. Only1 week after the implantation, she was admitted to our emergencydepartment with syncope. The ECG showed complete heart block andbaseline atrial fibrillation as in the initial diagnosis. Device interro-gation demonstrated no sensing and capture. Chest X-ray showed thedislodged lead in the abdominal area. We performed a selective he-patic venography via the femoral vein and inferior vena cava andrealized that the lead was in the hepatic vein and the distal tipembedded into the hepatic tissue (Figure 1). With the back-up of ageneral surgeon, we gently performed a simple traction to remove thelead. No important damage to the liver and bleeding occurred. At thesame procedure, we tried to implant another lead at the right ventricle


OSTERS
however, all attempts failed. Therefore, using a coronary sinus im-plantation system and a coronary sinus lead the lead was implantedinto the posterolateral branch of the great cardiac vein with goodsensing and pacing parameters without diaphragm stimulation(Figure 2). At the 1, 3, and 6 months follow-up, no change in sensingand pacing parameters were observed.
Figure 1. Active pacemaker lead demonstrated in the liver before (a) and after contrast injection (b).The lead tip embedded in the hepatic tissue with the body located in the hepatic vein. White arrow, themulti-purpose catheter.

Figure 2. Bipolar coronary sinus pacemaker lead implanted in the posterolateral branch.

073_16939-J4
Local Experience With a No Post-Procedure Antibiotic for a NewCardiac Implantable Electronic Devices Implantation
N. AlshoaibiCardiology, King Abdulaziz University, Jeddah, Saudi Arabia

BACKGROUND Prophylactic intravenous antibiotic reduces infectionsin patients undergoing cardiac implantable electronic devices (CIEDs)implantations. However, there are few data regarding impact of postprocedures antibiotic on outcomes. On the basis of this reasoning,most patients undergoing CIEDs implant at KAUH over the past 2years have not received antibiotic post procedure. We sought toquantify our experience with this approach.METHODS We retrospectively reviewed all charts of patients whounderwent CIED implantation between February 2014 and August2016 at KAUH. For each patient, data were abstracted regarding thetype of device implanted, demographics, functional class and the

presence or absence of coexisting medical disorders. For every follow-up visit, the presence or absence of local pocket infection and sys-temic infection were noted. For patients not being followed at ourcenter, telephone contact was made with the patient to ascertain thedate of their last review.RESULTS One hundred and forty-five patients underwent CIEDimplant during the period of February 2014 and August 2016. Thecharts of 138 patients were available for review. Ninety-one (66%)patients were male and mean age was 61 +/- 12 (range 23-86).Seventy-six (55%) patients had diabetes and 22 (16%) were hyper-tensive. The NYHA functional class was documented in 105 pa-tients; most were class 2 (46/105; 44%) or class 3 (34/105; 32%)while 24 (23%) were class 1, and 1 patient was class 4. We includedonly the patients with a new CIED implant and excluded patientswith end stage renal disease, intubated patients, patients onImmunosuppressant drugs and patients with active cancer. Thirty(22%) patients had a single chamber pacemaker, 37 (27%) had a dualchamber pacemaker, 21 (15%) had a single chamber ICD, 27 (19.5%)had a dual chamber ICD and 23 (16.5%) patients had a biventricularICD. All patients received pocket irrigation with saline solutiononly. Of the 138 patients, 2 (1.4%) patients had CIED pocket infec-tion. The mean duration of follow-up in these patients was 156 days(range: 29-507 days). Implant to infection time in those 2 patientswere 67 and 156 days respectively, and all of them underwent de-vices and leads extraction, with re-implantation on the contralateralside. No systemic infections or mortality were noted due to infec-tious complications. Seven Patients had no follow-up and two pa-tients died during the follow-up periods.CONCLUSION A no post-procedure antibiotic strategy in patientsreceiving a new CIED has been associated with a very low rate of localinfection. A prospective study examining the value of post-procedureantibiotic is warranted.

073_16194-J1
An Initial Experience of Using Leadless TranscatheterPacing in Chinese
C.P. Chan, Y.Q. Niu, K.C. Tam, Y.S. ChanThe Chinese University of Hong Kong, Hong Kong Kiang Wu Hospital,Macau, Hong Kong

INTRODUCTION Transcatheter pacing system (TPS, Micra, Medtronic)was an alternative to conventional transvenous pacing. The feasibilityof large delivery sheath in Chinese was unknown. The purpose was toreport a series of TPS implantation in 2 centers.METHODS This is a prospective cohort study from 2015. The primaryefficacy was the percentage of patients with stable pacing capturethresholds (< 2V at 0.24 msec) and freedom from procedure relatedcomplications.RESULTS TPS were implanted in 44 patients (Age 81.9�9.8,Male¼19) and mean follow up was 5.1� 4.2 months. One patient hasbioprosthetic tricuspid valve, three underwent hemodialysis, sixunderwent extraction due to infection before and 1 has absence ofsuperior vena cava. Indications were sick sinus syndrome (50%) andheart block (50%). The body weight was 58�9.4 kg (lowest one was34 kg). First attempt successful rate was 36/44. One patient un-derwent 9 attempts and complicated by non-capture. Snaring andre-implanted uneventfully. Safety endpoint was 90.9%. One cardiactamponade and was re-implanted after tapping. The primary effi-cacy was 97.7%.CONCLUSIONS TPS has high successful implantation rate in Chinese.

073_16796-J1
Micra Leadless Pacemaker. Implantation and Mid-TermFollow-Up Results
J.L. Martínez-Sande, J. García-Seara, L. González-Melchor,M. Rodríguez-Mañero, X.A. Fernández-López, D. Iglesias-Alvarez,V. González-Salvado, J.R. González-JuanateyUnidad de Arritmias y Electrofisiología Cardíaca. Servicio deCardiología y Unidad Coronaria. Hospital Clínico Universitario deSantiago de Compostela, Cibercv, Spain

INTRODUCTION Currently, studies on the leadless pacemaker (Micra)have mostly been limited to clinical trials with less than 6 months’follow-up and they often fail to reflect real population outcomes. Wesought to evaluate electrical parameters at implantation and duringfollow-up, as well as the safety of this new technique.


POSTERS
METHODS This prospective, observational study included 74consecutive patients, all � 65 years, with an indication for single-chamber pacemaker implantation. Mean follow-up period was 8,9 �8,4 months.
RESULTS Successful implantation was accomplished in all patientsreferred for leadless implantation. The mean age was 79-0 � 7.1 years(range, 66-89 years); 44 (58,7%) were men and 54 had permanentatrial fibrillation (89.2%).Concomitant atrioventricular node ablationwas performed immediately after implantation in 15 patients (20.3%).The procedure was performed under an uninterrupted anti-coagulation in 58 patients (78.4%). With the exception of 1 femoralarteriovenous fistula and 1 with cardiac tamponade, there were noothers complications. In both cases was required surgical repair whomwere discharged successfully. Sensing and pacing parameterswere stable both at implantation and during the mid-term follow-up. Table 1.

Implant

(n[74)

Predischarge

(n[74)

1 month

(n[54 )

3 months

(n[ 52)

6 months

(n[ 42)

12

months

(n[26)

Threshold

(V a 0.24 ms)

0.54�0.31
0.52�0.36 0.50�0.22 0.50�0.22 0.52�0.25 0.55�0.22
Impedance

(ohm)

731�166
695�151 637�112 594�99 582�101 582�96
R wave (mV)
12.0�4,8 13.1�5.0 14.2�4.9 13.9�4.6 14.4�4.6 15.3�4.8
CONCLUSIONS Implantation of leadless pacemakers is feasible, safeand provides advantages over the conventional system. Furtherstudies with longer follow-up periods will be needed before thesedevices become widely used in routine clinical practice.

073_16797-J1
Feasibility of Concurrent Leadless-Pacemaker Implantation andAtrioventricular Node Ablation
J.L. Martínez-Sande, J. García-Seara, L. González-Melchor,M. Rodríguez-Mañero, X.A. Fernández-López, D. Iglesias-Alvarez,V. González-Salvado, J.R. González-JuanateyUnidad de Arritmias y Electrofisiología Cardíaca. Servicio deCardiología y Unidad Coronaria. Hospital Clínico Universitario deSantiago de Compostela, Cibercv, Spain

INTRODUCTION Feasibility of concurrent leadless-pacemaker (LDP)implantation plus atrioventricular (AV) node ablation is unknown.Moreover, safety issues in the long run are also undetermined. Itseems theoretically attractive since it could avoid one additionalprocedure and catheter could be introduced through the same sheathemployed for the LDP. On the contrary, risk of dislocation/electricalvariations could represent a shortcoming.

OBJECTIVE We aim to report 1) feasibility of concomitant AV nodeablation after a LDP implantation and 2) mid-term outcomes.METHODS Prospective, observational study of 74 consecutivepatients with an indication for single-chamber pacemaker placement� 65 years. The implantation procedure was carried out using afemoral approach and conventional technique.

RESULTS 15 out of 74 (20,3%) patients underwent immediate AVablation. Mean age was 75.5�9,3 years. All of them were females andindication was fast conduction atrial fibrillation (n¼11), atypical atrialflutter (3) or atrial tachycardia (n¼1). Mean acute “R wave” was11.8mV, threshold of 0.66V/0.24ms and impedance of 787U. Un-eventful AV node ablation was performed in all of them immediatelyafter LDP implantation. Additional mean fluoroscopic time was 3.5minutes. There were no vascular or arrhythmic complications afterthe implantation. After a mean follow-up of 10� 8 months, all patientsremained alive without notable event, electrical parameters remainedunchanged.

CONCLUSION Immediate AV node ablation after LDP implantationseems feasible without remarkable complications in the long run. Inour pilot experience, this approach appears more comfortable for thepatients and less time-consuming than conventional pacemakerimplantation with sequential AV node ablation.

HF & CRT


073_16967-M1
Evaluation of Tp-e Interval and Tp-e/QTc Ratio in Patients withHeart Transplantation
S. Cay,5 C. Burak,1 E. Baysal,2 M. Suleymanoglu,3 C. Yayla,4

U. Kervan6

1Midyat State Hospital, Cardiology, Mardin, Turkey; 2Diyarbakir GaziYasargil Training and Research Hospital, Department of Cardiology,Turkey; 3Bingol State Hospital, Cardiology, Bingol, Turkey;4Department of Cardiology, Yuksek Ihtisas Heart-Education andResearch Hospital, Ankara, Turkey; 5Department of Cardiology,Division of Electrophysiology, Yuksek Ihtisas Heart-Education andResearch Hospital, Ankara, Turkey; 6Department of CardiovascularSurgery, Yuksek Ihtisas Heart-Education and Research Hospital,Ankara, Turkey

BACKGROUND The number of patients with heart transplantation hasdramatically increased in the last decade. There is, however, no suffi-cient data regarding arrhythmic risk in such patients. To discuss thisissue, in the current study we analyzed dispersion of myocardialrepolarization using Tp-e interval and Tp-e/QTc ratio in patients withheart transplantation.METHODS This observational study included 38 patients (12 femaleand 26 male) with heart transplantation with a mean age of 40.2 � 15.1years. Noninvasive arrhythmia indicators including Tp-e interval, QTcinterval and Tp-e/QTc ratio of these patients were compared with theparameters of 38 well-matched controls.RESULTS Noninvasive arrhythmia indicators including Tp-e interval(84.63� 14.17ms vs 71.82� 7.47ms, p<0.001), Tp-e/QTc ratio (0.19� 0.04vs 0.16 � 0.02, p<0.001) and QTc interval except QT interval were signif-icantly higher in transplanted hearts compared to normal hearts (Figure).

Figure

CONCLUSION Patients with heart transplantation have increasedmyocardial dispersion of repolarization and higher arrhythmia indi-cators.

073_16826-M1
Do Patients With Acute Heart Failure and Preserved EjectionFraction Have Heart Failure at Follow-Up - Impact ofFramingham Criteria
C. Hage, U. Löfström, E. Donal, E. Oger, J.C. Daubert, C. Linde,L.H. LundKarolinska Institutet, Department of Medicine, Cardiology unit,Stockholm, Sweden

METHODS In the multi-center Karolinska-Rennes HFpEF study, pa-tients with acute HF according to Framingham criteria, EF �45% andelevated brain natriuretic peptides (NPs; NT-proBNP >300 ng/L; BNP>100 ng/L) were assessed again in stable condition 4-8 weeks afterhospitalization. Logistic regression was used to assess association


OSTERS
between baseline characteristics and types and number of Framing-ham criteria in acute HFpEF, and the presence of HF at follow-updefined according to four models based on Framingham, the ESC andthe PARAGON trial echo criteria (TABLE).RESULTS In 398 patients, all met Framingham criteria for HF in acuteHFpEF and the number of Framingham “points” (2 for major criterion; 1for minor) were in median 8 (Interquartile range 6-10) in acute HFpEF and2 (1-4) at stable follow-up (p<0.01). The most common criteria in acuteHFpEF were dyspnoea at exertion (90%) and pulmonary rales (71%),which were present in 70% and 13% respectively at follow-up. At follow-up HFwas present according to the four models in 27%, 22%, 22% and 22%respectively. Associations between acute characteristics and presence ofHF at follow-up are shown in TABLE.
Table. Odds ratios for presence of HFpEF *p<0.05

Variable at baseline

Framingham

criteria only

Framingham

criteria + NP

criteria

Framingham

criteria + NP

criteria + ESC

ECHO HFpEF

criteria

Framingham

criteria + NP +

Paragon ECHO

structural heart

disease criteria

n¼107 (27%)
n¼82 (22%) n¼61(22%) n¼69 (22%)
Age per year
1.02 1.04* 1.05* 1.04*
NYHA I+II vs.

III+IV

0.76
0.80 1.10 1.03
NT-proBNP per

log

1.30
1.23 1.29 1.29
BNP per log
1.09 1.40 1.34 1.37
Framingham per

point

1.06
1.09 1.09 1.10*
Jugular venous

distension

1.80*
2.56 2.89* 2.58*
Pleural effusion
0.45* 0.41* 0.34* 0.35*
Tachycardia

(>100 bpm)

0.87
0.61 0.51 0.52*
CONCLUSIONS Among patients with acute HFpEF, only a quartermeet the HF definition at stable follow-up according to differentcontemporary criteria. Characteristics of acute HFpEF that predictpersistent HF at stable follow-up were higher age and JVD but notseverity of HF. Pleural effusion and tachycardia may yield “falsepositive” HFpEF diagnoses. This has implications for HFpEF trialdesign and patient screening.

073_16208-K1
Guide Wire Shortens Lead Insertion Time Instead ofContrast Medium
H. Taniguchi, N. Ohashi, H. Iwahori, M. Goto, A. Furukawa, Y. Tamura,Y. Kurita, A. Kawamura, T. Okabe, T. Kato, S. OgawaInternational University of Health and Welfare Mita Hospital, Tokyo,Japan

INTRODUCTION Before implanting a new device, venography is rec-ommended to confirm venous condition. Instead of contrast medium,we are using the guide wire as safe and useful tool.METHOD We compared 34 consecutive patients with an indication fora new pacemaker. Before implantation, half of the patients underwentvenography as usual (Contrast group). For the other half patients weinserted a guide wire from peripheral vein near elbow instead ofvenography (Wire group).RESULT The time from entering room to skin incision was significantlylonger in the Wire group than in the Contrast group (p¼0.01). On the otherhand, the time from skin incision to lead insertion was significantlyshorter in the wire group than in the contrast group (p¼0.02).CONCLUSION The guide wire shortened lead insertion time instead ofcontrast medium. Since the guide wire is constantly visible underfluoroscopy, we can confirm venous running during procedure. Wecan easily find cephalic vein because the vessel containing black colorwire is distinguished from other vessels visually.

073_16798-K1
Incision After Percutaneous LV Lead Placement for CRTImplantation: Saving Time and X-Ray Exposure
D. Cozma, C. Vacarescu, L. Petrescu, E.V. GoantaTimisoara Institute of Cardiovascular Diseases, Victor Babes Universityof Medicine and Pharmacy Timisoara, Cardiology Department,Timisoara, Romania

INTRODUCTION outcome of single venous approach using directpercutaneous subclavian vein (DPSV) puncture, without initial inci-sion, for CRT device implantation as a hypothesis for saving time andx-ray exposure.METHODS a retrospective study which included patients (pts)implanted with CRT-P/CRT-D devices using only DPSV puncture,without intial incision. We analyzed the outcome regarding the pro-cedure related difficulties and complications.RESULTS 72 pts (48 male) aged 60�11 y.o. were included (46 pts withCRT-P, 26 pts CRT-D). Intraprocedural difficulties and complications:total AV block (2 pts) and unsuccessful LV lead placement (6 pts). Postimplantation: no pneumothorax or lead displacement cases to report.Follow-up 26�18 months: 1 pt (CRT-D device) developed pocketinfection 4 months after mixed approach (epicardial LV and endove-nous RA and RV lead implantation); device removal and lead extrac-tion were performed. No other complications were noted in long termfollow-up.

Intrapr
ocedural difficulties and complications
AV block during implantation

(during sheath manipulation)

Action required - initial

transitory RV catheter

stimulation
2 pts (3%)
Unsuccessful LV lead

placement due to CS

anatomy

The procedure was aborted, all

materials were withdrawn and

the pts were addressed for

epicardial LV placement using

minithoracotomy, with

subsequent CRT device

implantation using DPSV

puncture for RV and RA leads.

6 pts (8%)

Procedural parameters

Average implantation time
65 � 25 min
Average fluoroscopic time
12 � 9 min
Average incision time
24 � 8 min
Follow-up complications

Pocket infection
Device removal and lead
extraction were performed.

1 pt (1%)


POSTERS
CONCLUSION Our data showed valuable incision time and x-rayexposure reduction and a relatively low rate of occurrence of intra-procedure total AV block, without other complications requiring theimplantation of the RV lead first.
073_16753-K3
Super-Response to Cardiac Resynchronization Therapy inPatients With Dyssynchrony Cardiomyopathy
A. Macias, S. Castaño, I. Madrazo, P. Rodriguez, T. Colchero,M.A. Gómez-SánchezServicio de Cardiología, Hospital General Nuestra Señora del Prado,Talavera de la Reina, Toledo, Spain

INTRODUCTION Left bundle-branch block (LBBB) is associated withintra and interventricular asynchrony, abnormal LV diastolic fillingpatterns and impairment of LV systolic function. So, there are patientswith LBBB and LV systolic dysfunction without another etiology forheart failure, called “dyssynchrony cardiomyopathy”. The aim of thisstudy is to address if CRT with pacemaker (CRT-P) only is able tocorrect these deleterious effects of LBBB.METHODS AND RESULTS Patients with normal LV ejection fraction(LVEF) and LBBB (QRS>120 ms) were followed serially. When LVEFevaluated by echocardiography was <40%, optimal medical treat-ment was started. Ischemic etiology was ruled out by coronariog-raphy. At 12 months the patients were reevaluated again. If LVEF was<36% despite adequate medical treatment, then a CRT-P implantedwas performed. We implanted 32 consecutive patients with thediagnosis of “dyssynchrony cardiomyopathy”. The mean follow-upwas 31+11 months. LVEF and LV volumes and diameters improved inall patients at one year follow-up (table 2), with LVEF normalizationin 93%.

Table 1. Baseline characteristics.

Age (years)
67�10
Males, n (%)
31 (77,5)
NYHA functional class, n(%)

II
11(34)
III
21(66)
Medical treatment (%)

ACEI/ARAs
100%
Diuretics
100%
Betablockers
100%
Spironolactone
93%
Sinus rhythm, n(%)
30 (93)
QRS (ms)
161,5�30,3
PR interval (ms)
189,5�50,1
Time diagnosis-implant (months)
16�4
ACEIs: angiotensin converting enzyme inhibitors; ARAs: angiotensin receptors antagonists; NYHA: New York

Heart Association.

Table 2. Echocardiographic parameters at baseline and at one year follow-up after CRT-P implant.

Basal
12 months p
LVEF (%)
29.2�8.6 53.1�6.5 0.001
LVEDD (mm)
67�12 50�7 0.001
LVESD (mm)
55�10 36�9 0.01
LVEDV (ml)
201�77 142�45 0.01
LVESV (ml)
148�64 83�49 0.01
E/E’
18.0�2.9 10.2�4.5 0,03
Tei index
0.69�0,05 0.37�0.06 0,02
MR
2.8�1.4 1.2�1.0 0,03
EDD: end -diastolic diameter; EDV: end-diastolic volume; ESD: end-systolic diameter; ESV: end-systolic

volumen; EF: Ejection fraction; LV: left ventricular; MR: mitral regurgitation.

CONCLUSIONS In patients with “dyssynchrony cardiomyopathy”, LVdysfunction and heart failure, CRT-P produces an inverse LV remod-elling and an important improvement in LVEF.

073_16779-K3
Resynchronization Therapy: Response and Clinical Outcomes inPatients With Ischemic and Non-Ischemic Cardiomyopathy
R. Baggen Santos, M. Trepa, I. Silveira, M.J. Sousa, B. Brochado,C. Roque, A. PinheiroVieira, V. Lagarto, H. Reis, A. Albuquerque,S. TorresCardiology department, Centro Hospitalar do Porto, Porto, Portugal

INTRODUCTION/AIM Compare baseline characteristics, CRT-response and long-term prognosis of patients with ischemic (ICMP)and non-ischemic cardiomyopathy (NICMP).METHODS Retrospective analysis of 316 patients who underwentbiventricular device placement (CRT-P or CRT-D) between January2002 and March 2016.

RESULTS In our study, 43% of patients had ICMP and 57,3% NICMP.ICMP patients were older, more frequently male, had more chronickidney disease (CKD) and cardiovascular risk factors. There were nosignificant differences between groups concerning baseline LVEF andNYHA functional class. After resynchronization, LVEF improved 5,3 �10,4% in ICMP and 9,5 � 12,3% in NICMP patients (p¼0,006). Changesin NYHA class were 0,7 � 0,6 in ICMP and 0,8 � 0,5 in NICMP groups(p¼ 0,1). At follow-up (47,5 � 38,1 months), mortality rates were 39,6%and 28,3% in the ICMP and NICMP groups (p¼0,037), and hospitali-zation occurred in 23,8% of ischemic and 14,5% of non-ischemic pa-tients (p¼0,039). After inclusion of other significant variables (age,sex, CKD, final LVEF) in multivariate analysis, etiology was not anindependent predictor of mortality or of the composite end-point ofmortality and heart failure hospitalization.

CONCLUSION The group of CRT patients with non-ischemic cardio-myopathy had a better echocardiographic response to resynchroni-zation and better long term prognosis. However, after adjusting forconfounding factors in multivariate analysis, etiology was not an in-dependent predictor of prognosis.

073_16787-K3
Exercise Stress Test Importance in CRT Patients Follow-Up
D. Cozma, C. Vacarescu, L. Petrescu, E.V. GoantaTimisoara Institute of Cardiovascular Diseases, Victor Babes Universityof Medicine and Pharmacy Timisoara, Cardiology Department,Timisoara, Romania

INTRODUCTION Assessing CRT device optimization according to ex-ercise test performance in CRT patients.

METHODS Observational retrospective study of pts with CRT devices;periodic follow-up visits at intervals of 6 months: we collected clinicaland echocardiography data, device interrogation and exercise test wasperformed. In the event of capture loss during exercise test subse-quent programming was performed individualized for each patient tomaximize BiV pacing.

RESULTS Demographic data: 26 pts (16 male) aged 60.7�9.1 yo withdilated cardiomyopathy, NYHA functional class II and triple chamberCRT devices (CRT-P 21 pts, CRT-D 5 pts); sinus rhythm 96% of pts,permanent AF 4 % of pts. Follow-up period: 24.6�19.1 months.Cycloergometer exercise test was performed in all pts: loss of ven-tricular capture was noted in 27% of pts, individualized optimizingwas done for each pt and the exercise test was repeated to ensure Bivpacing after reprogramming the device.

Cycloergometer execise test – Bruce protocol

mean exercise load
5.4±1.2 METS (111.1±35.6 Watts)
peak heart rate (HR)

66±11.3 % of maximum age predicted HR (all pts under optimal betablocker

treatment, 42% of pts with amiodarone association)

loss of ventricular

capture

(27 % of patients)

physiological

shortening of

atrioventricular

interval (AVI)

12 % of pts
CRT device reprogramming:
� short and dynamic PR

interval

� rate adaptive AVI

� individualized MTR

� threshold level and slope

activity reprogrammed

exceeding maximum

tracking rate (MTR)

8 % of pts

loss of BiV pacing due

to high ventricular

response above

lower later limit

7 % of pts


OSTERS
CONCLUSIONS A significant percent of pts need CRT device optimi-zation to ensure biventricular pacing during exercise. Routine exer-cise test should be a standard approach to maximize the CRT responseduring follow-up.
TELEMONITORING


073_16792-M3
Impact of Cardiac Implantable Electronic Devices Monitoring forRisk Stratification of Stroke Events in Older Patients
S. Shiohira, S. Maeda, A. Fujimaki, M. Kaneko, Y. Shirai, A. Yagishita,Y. Takahashi, M. Kawabata, M. Goya, K. HiraoHeart Rhythm Center, Tokyo Medical and Dental University,Bunkyo-ku, Tokyo, Japan

BACKGROUND According to the recent guidelines, anticoagulationtherapy may be recommended to the patients with cardiac implant-able electronic devices (CIEDs) who had previously no atrialfibrillation (AF) but have the episodes of AF/AT (atrial tachycardia)during CIEDs monitoring. However, the relationship between theAF/AT burdens and stroke occurrence remains unclear in the oldpatients.METHODS There were 780 patients visiting our pacemaker clinic,and 584 of them were older than 65 y/o. We evaluated the dura-tion of persistence of the AF/AT episodes and the stoke events inthem.RESULTS Of 584 patients, the AT/AF episodes were detected in 39%(231 patients; 78.6 y/o, male 126) during 1400 days follow-up, who aredivided into 3 groups based on AT/AF duration; Group-1: AT/AF>60min (n¼112), Group-2: AT/AF>5, �60min (n¼43), Group-3: AT/AF�5min (n¼76). Stroke occurrence rate per year was higher in Group-1 and 2 compared to Group-3, 0.75%, 0.85% vs. 0.25%, respectively.CONCLUSION In older patients with CIEDs, the AF/AT episodesoccurred about 40% during 1400 days follow-up and the AF/AT epi-sodes lasting >5 min is a possible risk factor of stroke occurrence.

073_16805-M3
Comparison of the Implantable Cardiac Monitor Reveal XT vsReveal LINQ in Young Patient With Syncope of Uncertain Origin
M. Santomauro, G. Palma, P. Abete, G. Comentale, A. Rapacciuolo,C. Riganti, R. Tozzi, M. Mottola, V. de Amicis, G. IannelliDepartment of cardiology, Cardiac Surgery and cardiovascularemergency, Federico II University of Naples, Italy

Syncope is a common medical condition encountered in clinicalpractice. The pathophysiology can be complex and at times making adefinitive diagnosis can be difficult. It can be associated with highrates of morbidity and mortality. Physicians’ approaches to this con-dition are varied and at times, due to lack of a methodical approach,potential life threatening conditions are missed. Some patients areunder investigated while other patients are over investigated. Thisincreases the already high health care costs associated with managing

this condition. This experience discusses an new insertable CardiacMonitor evidence based methodical approach to diagnosis of thisoften complex condition in younger patients.

METHODS We report on a prospective, single-centre, non-random-ized, observational experience of consecutive Reveal XT and RevealLINQ (Medtronic Inc) implantation in the electrophysiology laboratorybetween September 2012 and Jenuary 2017. Of 108 consecutive pa-tients who underwent Reveal XT (69 m, 39 f mean age 13þ4 years) and15 Reveal LINQ ( 6 m, 9 f, mean age 14þ5 years) device insertion,implanted in a procedure room.RESULTS There were no significant differences in baseline patientcharacteristics. All implants were performed in the recommendedmanufacturer method. All pts received peri-procedural antibiotics.Overall, there were 2 - traumatic extrusion - (1.7%) complications withno significant difference between the different devices groups (2 [3%]versus 0 [0%], p¼0.45).CONCLUSION ILR is useful in determining the presence or absence ofan arrhythmia during symptoms of syncope, near syncope, and pal-pitations as well as Reveals in patients with and without structuralheart disease when conventional diagnostic testing, such as electro-cardiogram, Holter monitoring, and/or external loop recording, isinconclusive in young patients.

073_16786
Experience Of A Cardiac Physiologist-Led Implantable LoopRecorder Insertion Service
D.H.J. Elder, S. Ferguson, K. Fyfe, L. Stevenson, A.J. RobertsonDepartment of Cardiology, NHS Tayside, Dundee, United Kingdom

INTRODUCTION The Medtronic Reveal underwent a redesign inrecent years to an injectable device that could be implanted outwith atheatre environment. Given the increasing demand for monitoring wedeveloped a cardiac physiology-led implantation and follow upservice.METHODS Referrals from consultant cardiologists are processed byone of the senior pacing physiologists. The patient is offered anappointment to attend the department and informed consent is un-dertaken by the cardiac physiologist. The patient is prepared andusing accepted sterile technique local anaesthetic is infiltrated prior tothe insertion of the device. The wound is closed with surgical glue.The cardiac physiologist explains the device function and issues thehome monitoring equipment at the same appointment. Patients aresubsequently followed-up by the Carelink remote monitoring service.RESULTS The waiting list prior to the service was over 250 days, thecurrent waiting time is under 14 days.

Number

LINQ Implant
164 (122 solely by cardiac physiologists)
Infection
3
Subsequent permanent pacemaker
16
Subsequent RF ablation
4
CONCLUSIONS Implantation of Reveal LINQ loop recorders by cardiacphysiologists is efficient, safe, and reduces waiting times.

AUTHOR INDEX


Author . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Number
Author . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Number Author . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Number
Abdou, Y.H. ... . . . . . . . . . 073_16735-H5Abela, E. . . . . . . . . . . . . . . . . 073_16203-H5Abete, P. . . . . . . . . . . . . . . . .073_16805-M3Abilkhanov, E. . . . . . . . . . 073_16973-H5Abt, R.B. . . . . . . . . . . . . . . . . . . . . .073_16791Abzaliev, K. . .. . . . . . . . . . 073_16725-H5Abzaliyev, K. .. . . . . . . . . . 073_16973-H5Acibuca, A. . . . . . . . . . . . . . 073_16742-H5Aggio, S. . . . . . . . . . . . . . . 073_17036P-K3Agostini, N. . . . . . . . . . . . . . . 073_16838-J4Ahmed, M.M. .. . . . . . . . . . 073_16794-J1Akçevin, A. . . . . . . . . . . . . . 073_16741-Q1Akchurin, R.S. . . . . . . . . . 073_16936-H5Akyurek, O. ... . . . . . . . . 073_16742-H5,

073_16743-Q1, 073_16744-Q1Alavi, A. . . . . . . . . . . . . . . .073_17038P-C4Albuquerque, A. . . . . . . 073_16779-K3,

073_16780, 073_16781-K3Alshoaibi, N. .. . . . . . . . . . . 073_16939-J4Altin, A.T. .. . . . . . . . . . . . 073_16742-H5,

073_16743-Q1, 073_16744-Q1Amoroso, G. ... . . . . . . . . . 073_16774-Q1And, K. .. . . . . . . . . . . . . . . . . 073_16823-L2Ando, K. .. . . . . . . . . . . . . . . . . . . .073_16212Andrsova, I. . . . . . . . . . . . . 073_16776-B2Antoli, B. . . . . . . . . . . . . . . . 073_16739-L5Antoniou, S. . . . . . . . . . . . . 073_16759-H1Arıcı Düz, Ö. .. . . . . . . . . . 073_16741-Q1Aras, D. . . . . . . . . . . . . . . . . .073_16835-L4,

073_16950-F1, 073_16955-Q1,073_16956-Q1, 073_16957-H5

Ardashev, A. .. . . . . . . . . . 073_16195-H2Ardus, D.F.073_16934-X, 073_16936-

H5Arena, G. .. . . . . . . . . . . . . . . . 073_16838-J4Arena, R. . . . . . . . . . . . . . . . . 073_16815-K2Artyukhina, E.A. .. . . . . . 073_16387-H5Asahi, T. . . . . . . . . . . . . . . . . 073_16734-H5Asanin, M.R. .. . . . . . . . . . 073_16963-C5Asimakopoulou, N.I. . 073_16965-Q1,

073_16970-F1Assef, J.E. . . . . . . . . . . . . . . . .073_16802-P1Awano, K. .. . . . . . . . . . . . . 073_16740-H5Babur Güler, G. .. . . . . . . 073_16741-Q1Bagai, A. . . . . . . . . . . . . . . . . 073_16815-K2Baggen Santos, R. .. . . 073_16779-K3,

073_16781-K3, 073_16752,073_16780, 073_16789

Baimbetov, A. .. . . . . . . . 073_16725-H5,073_16972-H6, 073_16973-H5

Bairamova, S. . . . . . . . . . . 073_16292-H6Baracca, E. .. . . . . . . . . . .073_17036P-K3,

073_17041p

Barbetta, A. . . . . . . . . . . . . . . . . 073_17041pBarmeda, M. .. . . . . . . . . . . 073_16775-Q1Barretto, R.B.M. ... . . . . .073_16802-P1Bassignana, A. .. . . . . . . . 073_16774-Q1Basso, C. . . . . . . . . . . . . . . . . 073_16729-B2Bastian, D. . . . . . . . . . . . . . . . 073_17092p,

073_17093pBattisti, A. . . . . . . . . . . . . . . 073_16774-Q1Bauce, B. . . . . . . . . . . . . . . . . 073_16729-B2Bayramova, S. . . . . . . . . . . . . . . .073_16289Baysal, E. .. . . . . . . . . . . . . .073_16967-M1Bebarova, M. .. . . . . . . . . . 073_16776-B2Bernstein, N. . . . . . . . . . . . . . . . .073_16230Beukema, R.J. . . . . . . . . . . 073_16772-H5Bhan, A. .. . . . . . . . . . . . . . . . . 073_16794-J1Bhasin, K. .. . . . . . . . . . . . . . . . . . .073_16230Bhat, G. . . . . . . . . . . . . . . . . . . 073_16794-J1Biasiolo, M. .. . . . . . . . . . . . 073_16733-J4Bizhanov, K. .. . . . . . . . . 073_16725-H5,

073_16973-H5Boaretto, G. . .. . . . . . . . . . . . . . 073_17041pBogachev-Prokophiev, A. 073_16292-

H6Boknik, P. .. . . . . . . . . . . . . . 073_16253-B1Bonmassari, R. .. . . . . . . . 073_16762-K3Borrello, V.M. ... . . . . . . . . 073_16838-J4Botting, L. . . . . . . . . . . . . . . . 073_16795-J1Bottoli, M.C. .. . . . . . . . . . 073_16762-K3Bougiakli, M. .. . . . . . . . . . . 073_16758-I1Bozshagulov, T. . . . . . . . 073_16972-H6,

073_16973-H5Branzoli, S. . . . . . . . . . . . . . 073_16762-K3Breakwell, N.E. . . . . . . . . 073_16759-H1Breault, C. . . . . . . . . . . . . . 073_16284-H5,

073_16731-A1Bricco, G. .. . . . . . . . . . . . . . 073_16774-Q1Brochado, B. . . . . . . . . . . . . . . . 073_16752,

073_16779-K3, 073_16780,073_16781-K3, 073_16789

Brouwer, M.A. .. . . . . . . . 073_16772-H5Bruegger, D. .. . . . . . . . . . . 073_16840-D1Brunelli, M. ... . . . . . . . . . . . . 073_17092p,

073_17093p, 073_16977-D1Buldakova, N.A. ... . . . . 073_16936-H5Burak, C. . . . . . . . . . . . . . . . .073_16967-M1Busacca, G. . .. . . . . . . . . . . . 073_16348-J4Calabrese, V. . . . . . . . . . . . . . . . .073_16782Callans, D.J. .. . . . . . . . . . .073_16944-L4,

073_16945-L4, 073_17038P-C4Calore, C. .. . . . . . . . . . . . . . 073_16729-B2Calore, M. .. . . . . . . . . . . . . 073_16729-B2Candemir, B. . . . . . . . . . . 073_16742-H5,

073_16743-Q1, 073_16744-Q1

Caramanno, G. .. . . . . . . . . 073_16733-J4Cardoso, A. .. . . . . . . . . . . . . . . . .073_16791Casalicchio, C. . . . . . . . . . . 073_16733-J4Cassaniti, L. . . . . . . . . . . . . . 073_16348-J4Castaño, S. . . . . . . . . . . . . . . 073_16753-K3Castellano, G. .. . . . . . . . .073_16803-M1Castro, A. . . . . . . . . . . . . . . . . 073_16730-J3Castro, S. .. . . . . . . . . . . . . . . 073_16945-L4Castro, S.A. .. . . . . . . . . . . .073_16944-L4,

073_17038P-C4Catalano, C. . . . . . . . . . . . . . 073_16733-J4Cavallero, E. . . . . . . . . . . . . 073_16774-Q1Cay, S. . . . . . . . . . . . . . . . . . . .073_16835-L4,

073_16950-F1, 073_16955-Q1,073_16956-Q1, 073_16957-H5,073_16967-M1

Chan, C.P. . . . . . . . . . . . . . . . 073_16194-J1Chan, Y.S. . . . . . . . . . . . . . . . 073_16194-J1Chapurnikh, A.V. .. . . . . 073_16936-H5Chaudhry, S. . . . . . . . . . . . . 073_16815-K2Cheema, P. . . . . . . . . . . . . . 073_16836-Q1,

073_16948-Q1Chen, G. ... . . . . . . . . . . . . . . . 073_16795-J1Cherkashin, D.I. . . . . . . . . 073_16936-H5Chierchia, G.B. . . . . . . . . . 073_16772-H5Chlupova, T. . . . . . . . . . . . . 073_16776-B2Chmelevsky, M. .. . . . . . 073_16977-D1Choi, K.-J. . . . . . . . . . . . . . . . 073_16746-J4Chokr, M. .. . . . . . . . . . . . . . 073_16807-L4Cokkinos, P. . . . . . . . . . . . .073_16726-M1Colaiori, I. . . . . . . . . . . . . . . . . . . .073_16782Colchero, T. . . . . . . . . . . . . 073_16753-K3Comentale, G. .. . . . . . . . 073_16803-M1,

073_16805-M3Conesa, J.R. . . . . . . . . . . . . 073_16735-H5Contarini, M. ... . . . . . . . . . 073_16348-J4Coppolino, A. .. . . . . . . . . 073_16774-Q1Corbisiero, R. .. . . . . . . . . . 073_16227-J2Corrado, D. .. . . . . . . . . . . . 073_16729-B2Correndo, L. . . . . . . . . . . . . 073_16774-Q1Corzani, A. .. . . . . . . . . . . . 073_16832-L2Coser, A. .. . . . . . . . . . . . . . . 073_16762-K3Costa, P.A. . .. . . . . . . . . . . . . . . 073_16791,

073_16802-P1Cowger, J. . . . . . . . . . . . . . . . 073_16794-J1Cozma, D. ... . . . . . . . . . . 073_16787-K3,

073_16798-K1Creta, A. .. . . . . . . . . . . . . . . . . . . .073_16782Cunha, C.R. . . . . . . . . . . . . . . . . .073_16791Cutaia, A. . . . . . . . . . . . . . . . . 073_16733-J4Daida, H. 073_16757-H5, 073_16764-

Q1, 073_16767-Q1Daliento, L. .. . . . . . . . . . . . 073_16729-B2

AUTHOR INDEX


Author . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Number
Darrieux, F. . . . . . . . . . . . . .073_16807-L4,073_16808-L5

Daubert, J.C. . . . . . . . . . . . .073_16826-M1De Amicis, V. . . . . . . . . . .073_16803-M1de Amicis, V. . . . . . . . . . .073_16805-M3De Benedictis, M. .. . . . 073_16774-Q1De Bortoli, M. ... . . . . . . 073_16729-B2De Caterina, R.. . . . . . . . . 073_16968-G2Demir, G.G. ... . . . . . . . . 073_16741-Q1,

073_16801-Q1Desjardins, B. . . . . . . . . .073_17038P-C4Dhawan, R. . . . . . . . . . . . . . . 073_16794-J1Di Gregorio, F. . . . . . . . . . 073_16348-J4,

073_16733-J4, 073_16838-J4,073_17041pDi Rosa, S. . . . . . . . . . . . . . . 073_16733-J4Di Sciascio, G. . .. . . . . . . . . . . .073_16782Dias, V.A.... . . . . . . . . . . . . . . . . .073_16789DiBiase, L. .. . . . . . . . . . . . . 073_16751-H1Dillier, R. . . . . . . . . . . . . . . . . 073_16737-J1Dixit, S. . 073_16944-L4, 073_16945-

L4, 073_17038P-C4Dogliani, S. . . . . . . . . . . . . . 073_16774-Q1Donal, E. . . . . . . . . . . . . . . . .073_16826-M1Dorfman, F.K. .. . . . . . . . . . . . . .073_16791Doronzo, B. . . . . . . . . . . . . . 073_16774-Q1Droghetti, A. .. . . . . . . . . . 073_16762-K3Drzewiecki, K. . . . . . . . . . 073_16253-B1Elder, D.H.J. . . . . . . . . . . . .073_16785-P1,

073_16786Elesin, D. . .. . . . . . . . . . . . . . . . . 073_16289,

073_16292-H6Endo, H... . . . . . . . . . . . . . . . . . . . .073_16754Enomoto, Y. ... . . . . . . . . . 073_16783-H4Ergeshov, K. ... . . . . . . . . . 073_16973-H5Erol, C. .. . . . . . . . . . . . . . . . . 073_16742-H5Evertz, R. . . . . . . . . . . . . . . . 073_16772-H5Fabritz, L. . . . . . . . . . . . . . . . 073_16253-B1Farsalinos, K. .. . . . . . . . . .073_16726-M1Fedorowski, A. . . . . . . . . . 073_16968-G2Felsöci, M. .. . . . . . . . . . . . . 073_16962-A1Ferguson, S. . . . . . . . . . . . . . . . . .073_16786Fernández-López, X.A. 073_16796-J1,

073_16797-J1Ferrero, C. .. . . . . . . . . . . . . 073_16735-H5Ferrick, K.J. . . . . . . . . . . . . 073_16751-H1Fertl, E. .. . . . . . . . . . . . . . . . .073_16748-M3Filice, G. . . . . . . . . . . . . . . . . 073_16211-G2Finko, V. .. . . . . . . . . . . . . . . 073_16195-H2Fisher, J. . . . . . . . . . . . . . . . . 073_16751-H1Frankel, D. .. . . . . . . . . . . . .073_16945-L4,

073_17038P-C4Frankel, D.S. .. . . . . . . . . . 073_16944-L4Franzini, C. . . . . . . . . . . . . . . 073_16737-J1

Frontera, A. . . . . . . . . . . . . 073_16987-H2,073_16988-H2

Fujii, S. . . . . . . . . . . . . . . . . . . . . . . .073_16824Fujimaki, A. .. . . . . . . . . . .073_16792-M3Fukunaga, M. .. . . . . . . . . . . . . . .073_16212Furukawa, A. .. . . . . . . . . . 073_16208-K1Fyfe, K. . . . . . . . . . . . . . . . . . . . . . .073_16786Gómez-Sánchez, M.A. 073_16753-K3Göhl, K. . . . 073_17092p, 073_17093pGössinger, H. . . . . . . . . . . . . . . . .073_16800Güler, E. . . . . . . . . . . . . . . . . 073_16741-Q1Günes, H.M. .. . . . . . . . . . . 073_16801-Q1Gaillyova, R. . . . . . . . . . . . 073_16776-B2Gallina, S. .. . . . . . . . . . . . . . 073_16968-G2Gandhi, G. . . . . . . . . . . . . . . . 073_16795-J1García-Seara, J. . . . . . . . . 073_16796-J1,

073_16797-J1Garcia, F. .. . . . . . . . . . . . . . 073_16945-L4Garcia, F.C. . . . . . . . . . . . . . 073_16944-L4Gerede, D.M. .. . . . . . . . . . 073_16742-H5Gergs, U. . .. . . . . . . . . . . . . . 073_16253-B1Giatti, S. . . . . . . . . . . . . . . . 073_17036P-K3Giau, G. .. . . . . . . . . . . . . . . . . . . 073_17041pGikas, A. 073_16965-Q1, 073_16970-

F1Gkouziouta, A. .. . . . . . . .073_16726-M1Goanta, E.V. .. . . . . . . . . . . 073_16787-K3Goanta, E.V. .. . . . . . . . . . . 073_16798-K1Goette, J. . . . . . . . . . . . . . . . . 073_16840-D1González-Juanatey, J.R.073_16796-J1,

073_16797-J1González-Melchor, L. . 073_16796-J1,

073_16797-J1González-Salvado, V. . 073_16796-J1,

073_16797-J1Gopinathannair, R.. . . . . 073_16794-J1,

073_16795-J1Goto, M. ... . . . . . . . . . . . . . 073_16208-K1Goya, M. 073_16783-H4, 073_16792-

M3Graffigna, A. .. . . . . . . . . . 073_16762-K3Granato, J.E. .. . . . . . . . . . . . 073_16795-J1Grande, L. . . . . . . . . . . . . . .073_16803-M1Greenspan, A.M. ... . . . . 073_16938-C4Gross, J. . . . . . . . . . . . . . . . . . 073_16751-H1Guarracini, F. . . . . . . . . . . . 073_16762-K3Guedes, H. . . . . . . . . . . . . . . . 073_16730-J3Gul, I.S. . . . . . . . . . . . . . . . . . 073_16742-H5Gwag, H.B. . .. . . . . . . . . . . 073_16217-C4Gwechenberger, M... . . . . . . .073_16800Habib, R.G. ... . . . . . . . . . . .073_16802-P1Hachul, D. . . . . . . . . . . . . . .073_16807-L4,

073_16808-L5Haeberlin, A. . . . . . . . . . . . 073_16840-D1

Hage, C. . .. . . . . . . . . . . . . . .073_16826-M1Hardy, C. .. . . . . . . . . . . . . .073_16807-L4,

073_16808-L5Hasun, M. .. . . . . . . . . . . . . .073_16748-M3Hata, R. . . . . . . . . . . . . . . . . . . . . . .073_16824Hayashi, H. .. . . . . . . . . . . 073_16757-H5,

073_16764-Q1, 073_16767-Q1Hayashi, T. .. . . . . . . . . . . .073_16944-L4,

073_16945-L4, 073_17038P-C4Heim, E.J. . . . . . . . . . . . . . . . 073_16735-H5Hemels, M.E.W. .. . . . . . 073_16772-H5Heo, J. . . . . . . . . . . . . . . . . . . . 073_16217-C4Higa, N. . .. . . . . . . . . . . . . . . 073_16734-H5Hipólito-Reis, A. .. . . . . . . . . . .073_16752Hiraishi, M. .. . . . . . . . . . . . 073_16740-H5Hirao, K. .. . . . . . . . . . . . . . 073_16783-H4,

073_16792-M3Hiroshima, K. .. . . . . . . . .073_16823-L2,

073_16212Hoch, E. . . . . . . . . . . . . . . . . . 073_16751-H1Hoda, E. . . . . . . . . . . . . . . . . . .073_16970-F1Hohenforst-Schmidt, W.073_16822-I4Holm, N. .. . . . . . . . . . . . . . . . 073_16737-J1Hosek, J. . . . . . . . . . . . . . . . . 073_16776-B2Hwang, J.K. . . . . . . . . . . . . 073_16217-C4_Ibiso�glu, E. .. . . . . . . . . . . . 073_16801-Q1Iacovino, C. .. . . . . . . . . . . . 073_16774-Q1Iannelli, G. . . . . . . . . . . . . . 073_16803-M1,

073_16805-M3Idemoto, Y. .. . . . . . . . . . . . 073_16809-H5Iglesias-Alvarez, D. .. . 073_16796-J1,

073_16797-J1Iliceto, S. .. . . . . . . . . . . . . . . 073_16729-B2Imaizumi, S. . . . . . . . . . . . . 073_16809-H5Inoue, M. .. . . . . . . . . . . . . . . 073_16804-H5Ioannidis, P. . . . . . . . . . . . . . 073_16758-I1Iseda, T. .. . . . . . . . . . . . . . . . 073_16823-L2,

073_16212Ishii, H. . . . . . . . . . . . . . . . . . . . . . . .073_16754Isikay, C. .. . . . . . . . . . . . . . . 073_16742-H5Ivanickii, E. .. . . . . . . . . . . . 073_16292-H6Iwahori, H. . . . . . . . . . . . . . . 073_16208-K1Jacomet, M. .. . . . . . . . . . . . 073_16840-D1Jain, R. . . . . . . . . . . . . . . . . . . 073_16775-Q1Jamal, S.Z. . . . . . . . . . . . . . . .073_16788-P1Jan, M. .. . . . . . . . . . . . . . . . . 073_16739-L5Jensen, S.M. .. . . . . . . . . . . 073_16975-L2Joshi, K.P. . . . . . . . . . . . . . . 073_16938-C4Jozic, I. . . . . . . . . . . . . . . . . . . 073_16963-C5Jozic, T. . . . . . . . . . . . . . . . . . 073_16963-C5Kılıçaslan, F. . . . . . . . . . . . 073_16741-Q1Kadota, K. . .. . . . . . . . . . . . . . . . .073_16824Kaneko, M. .. . . . . . . . . . . 073_16783-H4,

073_16792-M3

AUTHOR INDEX


Author . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Number
Kanoupakis, E. . . . . . . . . .073_16825-F1,073_16965-Q1

Kara, M. . 073_16835-L4, 073_16957-H5

Karaskov, A. .. . . . . . . . . . 073_16292-H6Kargoli, F. .. . . . . . . . . . . . . 073_16751-H1Kato, T. . . . . . . . . . . . . . . . . . 073_16208-K1Kawabata, M. .. . . . . . . . 073_16783-H4,

073_16792-M3Kawamura, A. . . . . . . . . . . 073_16208-K1Kawase, Y. . . . . . . . . . . . . . . . . . .073_16824Kaypakli, O. . . . . . . . . . . . . 073_16225-H5Keller, H. . . . . . . . . . . . . . . .073_16748-M3Kervan, U. .. . . . . . . . . . . . .073_16967-M1Khurram, I. . . . . . . . . . . . . . 073_16938-C4Kiliçarslan, F. . . . . . . . . . . 073_16801-Q1Kilickap, M. ... . . . . . . . . 073_16742-H5,

073_16744-Q1Kim, E.K. ... . . . . . . . . . . . . 073_16217-C4Kim, H. .. . . . . . . . . . . . . . . . . 073_16192-H1Kim, J.B. . . . . . . . . . . . . . . . . .073_16198-F3Kim, J.S. . . . . . . . . . . . . . . . . 073_16217-C4Kim, K.S. . . . . . . . . . . . . . . . .073_16198-F3Kim, S. .. . . . . . . . . . . . . . . . . 073_16751-H1Kim, W. .. . . . . . . . . . . . . . . . .073_16198-F3Kim, W.S.. . . . . . . . . . . . . . . .073_16198-F3Kimura, Y. .. . . . . . . . . . . . 073_16757-H5,

073_16764-Q1, 073_16767-Q1Kirchhof, P. . . . . . . . . . . . . . 073_16253-B1Klemen, L. .. . . . . . . . . . . . . 073_16739-L5Koc, M. .. . . . . . . . . . . . . . . . 073_16225-H5Komaki, T. .. . . . . . . . . . . . . 073_16809-H5Kreps, E. . . . . . . . . . . . . . . . . . 073_16795-J1Krumerman, A.... . . . . . . 073_16751-H1Kubota, H. .. . . . . . . . . . . . . . . . . .073_16754Kumagai, K. . . . . . . . . . . . 073_16242-H5,

073_16804-H5Kumar, N. . .. . . . . . . . . . . . . 073_16815-K2Kurita, Y. . . . . . . . . . . . . . . . 073_16208-K1Kuzhukeev, M. ... . . . . . . 073_16973-H5Löfström, U. ... . . . . . . . . .073_16826-M1Lacal, L. . . . . . . . . . . . . . . . . . 073_16735-H5Lagarto, V. .. .073_16752, 073_16779-

K3, 073_16780, 073_16781-K3,073_16789Lakkireddy, D. ... . . . . . . . 073_16795-J1Lanza, D. . . . . . . . . . . . . . . 073_17036P-K3Lara, S.073_16807-L4, 073_16808-L5Le Bihan, D. ... . . . . . . . . . .073_16802-P1Lee, J.M. .. . . . . . . . . . . . . . . .073_16198-F3Lee, K. .. . . . . . . . . . . . . . . . . 073_16719-A1Lee, S. . . . . . . . . . . . . . . . . . . . 073_16192-H1Leiserowitz, A. . . . . . . . . . . 073_16795-J1Leventis, D. . . . . . . . . . . . . . .073_16970-F1

Levine, E. .. . . . . . . . . . . . . . . . . . .073_16230Liang, J.J.073_16944-L4, 073_16945-

L4, 073_17038P-C4Licciardello, C. .. . . . . . . . 073_16832-L2Licciardello, G. .. . . . . . . . . 073_16348-J4Lima, T. . . . . . . . . . . . . . . . . . 073_16808-L5Lin, D. .. . . . . . . . . . . . . . . . . . 073_16944-L4Linde, C. . . . . . . . . . . . . . . . .073_16826-M1Lip, G.Y.H. ... . . . . . . . . . . 073_16963-C5Lobban, T.C.A. .. . . . . . . 073_16759-H1Lorenzon, A. .. . . . . . . . . . 073_16729-B2Losik, D. . .. . . . . . . . . . . . . 073_16284-H5,

073_16289, 073_16292-H6,073_16731-A1

Lubkina, E. . . . . . . . . . . . . . 073_16768-H5Lund, L.H. .. . . . . . . . . . . . .073_16826-M1Luz, A. .. . . . . . . . . . . . . . . . . . . . . .073_16752Müller, A. .. . . . . . . . . . . . . . . 073_16737-J1Müller, F.U. .. . . . . . . . . . . 073_16253-B1Macias, A. . . . . . . . . . . . . . . 073_16753-K3Madrazo, I. . . . . . . . . . . . . . 073_16753-K3Maeda, S. .. . . . . . . . . . . . . 073_16783-H4,

073_16792-M3Magliarditi, A. . . . . . . . . . . 073_16774-Q1Magnani, S. . . . . . . . . . . . . .073_16944-L4,

073_16945-L4, 073_17038P-C4Mainigi, S.K. . . . . . . . . . . . 073_16938-C4Manita, M. .. . . . . . . . . . . . . 073_16734-H5Mar, P.L. . . . . . . . . . . . . . . . . . 073_16795-J1Maragkoudakis, S. . . . . . 073_16965-Q1Marcantoni, L. . . . . . . . .073_17036P-K3,

073_17041pMarchionni, N. .. . . . . . . . 073_16211-G2Marchlinski, F.E. .. . . . .073_16944-L4,

073_16945-L4, 073_17038P-C4Marini, M. .. . . . . . . . . . . . . 073_16762-K3Marques, L. . . . . . . . . . . . . . . 073_16730-J3Martínez-Sande, J.L. .. 073_16796-J1,

073_16797-J1Martínez, C. .. . . . . . . . . . . 073_16735-H5Martens, E. . . . . . . . . . . . . . . 073_16822-I4Martha, J.W. .. . . . . . . . . . . 073_16969-Q1Mazurov, M. .. . . . . . . . . . . 073_16195-H2Mazzotti, E. . . . . . . . . . . . . . 073_16729-B2Melacini, P. . . . . . . . . . . . . . 073_16729-B2Melander, O. . . . . . . . . . . . 073_16968-G2Metzadonakis, G. .. . . . . .073_16970-F1Mihajlovic, M. .. . . . . . . . 073_16963-C5Mikhaylichenko, S. . . . . 073_16768-H5Mikheenko, I. . . . . . . . . . 073_16284-H5,

073_16289, 073_16731-A1Miller, J.M. ... . . . . . . . . . . 073_16775-Q1Minami, K. . .. . . . . . . . . . 073_16242-H5,

073_16804-H5

Minin, S. 073_16284-H5, 073_16731-A1

Mittell, A. . . . . . . . . . . . . . . . 073_16751-H1Miura, S. .. . . . . . . . . . . . . . . 073_16809-H5Moggio, P. . . . . . . . . . . . . . . 073_16762-K3Mohallem, G.M. .. . . . . . .073_16802-P1Moreira, D.A.R. . .. . . . . . . . . . 073_16791,

073_16802-P1Morii, J. . . . . . . . . . . . . . . . . . 073_16809-H5Morita, J. . . . . . . . . . . . . . . . .073_16823-L2,

073_16212Mortier, S. . . . . . . . . . . . . . . 073_16840-D1Motoda, H. ... . . . . . . . . . . 073_16242-H5,

073_16804-H5Mottola, M. .. . . . . . . . . . . .073_16805-M3Mountantonakis, S. . . . . . . . . .073_16230Muscio, G.F.. . . . . . . . . . . . . 073_16348-J4Muser, D. 073_16944-L4, 073_16945-

L4, 073_17038P-C4Nagashima, M. .. . . . . . . .073_16823-L2,

073_16212Nagata, Y. . .. . . . . . . . . . . . 073_16809-H5Naito, S. . . . . . . . . . . . . . . . . . 073_16242-H5Naitoh, S. . . . . . . . . . . . . . . . 073_16804-H5Nakagawa, M. .. . . . . . . . . 073_16740-H5Nakamura, K. .. . . . . . . . 073_16242-H5,

073_16804-H5Nakata, M. ... . . . . . . . . . . . 073_16734-H5Nakazato, Y. . . . . . . . . . . . 073_16757-H5,

073_16764-Q1, 073_16767-Q1Negreva, M. .. . . . . . . . . . 073_16773-H1,

073_16784-H2Nenna, A. .. . . . . . . . . . . . . . . . . . .073_16782Neri, G. . . . . . . . . . . . . . . . . . . . 073_16838-J4Neuhold, C. .. . . . . . . . . . . .073_16748-M3Neumann, J. . . . . . . . . . . . . 073_16253-B1Niederhauser, T. .. . . . . . 073_16840-D1Nikitin, N. . . . . . . . . . . . . . 073_16284-H5,

073_16731-A1Nikolaeva, O.A. ... . . . . . .073_16934-X,

073_16935-H5, 073_16936-H5Niu, Y.Q. .. . . . . . . . . . . . . . . 073_16194-J1Nomura, C. .. . . . . . . . . . . . 073_16808-L5Noventa, F. .. . . . . . . . . . 073_17036P-K3Novotny, T. .. . . . . . . . . . . . 073_16776-B2Odagiri, F. . . . . . . . . . . . . . 073_16757-H5,

073_16764-Q1, 073_16767-Q1Ogawa, M. ... . . . . . . . . . . . 073_16809-H5Ogawa, S. . . . . . . . . . . . . . . . 073_16208-K1Oger, E. . . . . . . . . . . . . . . . . .073_16826-M1Ohashi, N. . . . . . . . . . . . . . 073_16208-K1,

073_16824Okabe, T. . . . . . . . . . . . . . . . 073_16208-K1Okar, S. . . . . . . . . . . . . . . . . . 073_16225-H5

AUTHOR INDEX


Author . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Number
Olivotto, I. . . . . . . . . . . . . . . 073_16211-G2On, Y.K. .. . . . . . . . . . . . . . . 073_16217-C4Orsida, D. . .. . . . . . . . . . . . . . 073_16838-J4Oshima, S. .. . . . . . . . . . . . 073_16242-H5,

073_16804-H5Otsuka, Y. .. . . . . . . . . . . . 073_16242-H5,

073_16804-H5Ozaki, M. ... . . . . . . . . . . . . . . . . .073_16824Ozcan, F. . . . . . . . . . . . . . . . .073_16835-L4,

073_16950-F1, 073_16955-Q1,073_16956-Q1, 073_16957-H5

Ozeke, O. ... . . . . . . . . . . . .073_16835-L4,073_16950-F1, 073_16955-Q1,073_16956-Q1, 073_16957-H5

Palermi, S. .. . . . . . . . . . . . . 073_16968-G2Palma, G.073_16803-M1, 073_16805-

M3Panagiotakis, S. .. . . . . . 073_16965-Q1,

073_16970-F1Pancaldo, D. ... . . . . . . . . . 073_16774-Q1Panousieris, M. ... . . . . . . .073_16970-F1Papadopoulou, E. . . . . . .073_16726-M1Papakonstantinou, P. . . .073_16825-F1Papakonstantinou, P.E.073_16965-Q1,

073_16970-F1Parga, J. . . . . . . . . . . . . . . . . . 073_16808-L5Park, K. . . . . . . . . . . . . . . . . . 073_16192-H1Park, K.M. .. . . . . . . . . . . . . 073_16217-C4Park, S.J. . . . . . . . . . . . . . . . . 073_16217-C4Park, W.J. . . . . . . . . . . . . . . . 073_16192-H1Partigulova, A.S. . . . . . . . 073_16936-H5Pastore, G. .. . . . . . . . . . .073_17036P-K3,

073_17041pPathak, R.K. ... . . . . . . . . .073_16944-L4,

073_16945-L4Pauschinger, M. .. . . . . . . . . 073_17092p,

073_17093pPaylos, J.M... . . . . . . . . . . . 073_16735-H5Pederzolli, C. .. . . . . . . . . . 073_16762-K3Pepi, P. .. . . . . . . . . . . . . . . . . . 073_16838-J4Perazzolo Marra, M. .. 073_16729-B2Perzanowski, C. .. . . . . . 073_16836-Q1,

073_16948-Q1Petrescu, L. . . . . . . . . . . . . 073_16787-K3,

073_16798-K1Piazza, F. . . . . . . . . . . . . . . . . 073_16774-Q1Picariello, C. . . . . . . . . . . 073_17036P-K3Pidanov, O. .. . . . . . . . . . . . 073_16292-H6Pinheiro Vieira, A. . . . . . . . . 073_16780,

073_16781-K3Pinheiro-Vieira, A. . . . . . . . . .073_16752PinheiroVieira, A. .. . . . 073_16779-K3Pinto, P. . . . . . . . . . . . . . . . . . . 073_16730-J3Piovaccari, G. . . . . . . . . . . 073_16832-L2

Pisani, C. . . . . . . . . . . . . . . . .073_16807-L4,073_16807-L4, 073_16808-L5,073_16808-L5

Pokushalov, E. .. . . . . . . 073_16284-H5,073_16289, 073_16292-H6,073_16731-A1

Poli, S. .. . . . 073_17092p, 073_17093pPoloni, G. .. . . . . . . . . . . . . . 073_16729-B2Polymeropoulos, K. . .. . 073_16758-I1Ponomarev, D. .. . . . . . . . . . . . 073_16289,

073_16292-H6Popovic, D. . .. . . . . . . . . . . 073_16815-K2Pospsil, D. . . . . . . . . . . . . . . 073_16962-A1Potpara, T.S. .. . . . . . . . . . . 073_16963-C5Quintarelli, S. . . . . . . . . . . . 073_16762-K3Rafanelli, M... . . . . . . . . . 073_16211-G2,

073_16211-G2Raffagnato, P. . . . . . . . . . . . . . 073_17041pRajappan, A. .. . . . . . . . . . . 073_16806-K1Rakishev, B. .. . . . . . . . . . . 073_16972-H6Ramírez, R. . . . . . . . . . . . . . 073_16735-H5Rambhatla, T. . . . . . . . . . . . . . . .073_16230Rame, J.E. . . . . . . . . . . . . . . 073_16945-L4Rampazzo, A. ... . . . . . . . 073_16729-B2Rapacciuolo, A. . . . . . . . .073_16805-M3Ravichandran, A. .. . . . . . 073_16794-J1Reggiani, A. .. . . . . . . . . . . . 073_16838-J4Reis, H. . . . . . . . . . . . . . . . . . 073_16779-K3,

073_16780, 073_16781-K3,073_16789

Renda, G. .. . . . . . . . . . . . . . 073_16968-G2Revishvili, A. . . . . . . . . . . . 073_16768-H5Revishvili, A.S.h. .. . . . 073_16387-H5,

073_16720-H6Ricci, F. . . . . . . . . . . . . . . . . . 073_16968-G2Richter, P. .. . . . . . . . . . . . . . . . 073_17092p,

073_17093pRiganti, C. . . . . . . . . . . . . .073_16803-M1,

073_16805-M3Rigato, I. . . . . . . . . . . . . . . . . 073_16729-B2Riley, M.P.. . . . . . . . . . . . . . 073_16944-L4Rittger, H. . 073_17092p, 073_17093pRizzo, T. . . . . . . . . . . . . . . . . . 073_16737-J1Robertson, A.J. .. . . . . . . . 073_16785-P1,

073_16786Rochitte, C. . . . . . . . . . . . . . 073_16808-L5Rodríguez-Mañero, M. 073_16796-J1,

073_16797-J1Rodríguez, O. . .. . . . . . . . 073_16735-H5Rodriguez, P. . . . . . . . . . . . 073_16753-K3Romano, G. ... . . . . . . . . . . . 073_16348-J4Romanov, A. .. . . . . . . . . 073_16284-H5,

073_16289, 073_16292-H6,073_16731-A1

Roncon, L. . . . . . . . . . . . .073_17036P-K3,073_17041p

Roque, C.073_16752, 073_16779-K3,073_16780, 073_16781-K3,

073_16789Roukoz, H. ... . . . . . . . . . . . . 073_16794-J1Sabbatani, P. . . . . . . . . . . . . 073_16832-L2Saccenti, S. .. . . . . . . . . . . .073_16803-M1Sacchetti, L. . . . . . . . . . . . . 073_16832-L2Saciloto, L. .. . . . . . . . . . . . 073_16807-L4Sahin, D.Y. .. . . . . . . . . . . . 073_16225-H5Saku, K. ... . . . . . . . . . . . . . . 073_16809-H5Salami, H.F. . . . . . . . . . . . . 073_16936-H5Sammut, M.A. .. . . . . . . . . 073_16203-H5Santangeli, P. . . . . . . . . . . .073_16944-L4,

073_16945-L4, 073_17038P-C4Santomauro, M. ... . . . . 073_16803-M1,

073_16805-M3Santos, R. . . . . . . . . . . . . . . . . 073_16730-J3Sapelnikov, O.V... . . . . . .073_16934-X,

073_16936-H5Saporito, D. .. . . . . . . . . . . . 073_16832-L2Sasaki, T.073_16242-H5, 073_16783-

H4, 073_16804-H5Savur, Ü. .. . . . . . . . . . . . . . . 073_16801-Q1Sbaraini, E. .. . . . . . . . . . . . . . . . .073_16791Scanavacca, M... . . . . . . .073_16807-L4,

073_16808-L5Schaller, R.D. .. . . . . . . . . 073_16944-L4Schukro, C. .. . . . . . . . . . . . . . . . .073_16800Schwab, J. 073_17092p, 073_17093pSeabra, D. . . . . . . . . . . . . . . . . 073_16730-J3Sekita, G.073_16757-H5, 073_16764-

Q1, 073_16767-Q1Sepsi, M. .. . . . . . . . . . . . . . . 073_16962-A1Serafim, K.R.073_16791, 073_16802-

P1Sezer, S. . . . . . . . . . . . . . . . . . 073_16772-H5Shabanov, V. ... . . . . . . . 073_16284-H5,

073_16289, 073_16731-A1Shaik, M. .. . . . . . . . . . . . . . . 073_16806-K1Shiohira, S. .. . . . . . . . . . . 073_16783-H4,

073_16792-M3Shiozawa, T. . . . . . . . . . . . 073_16757-H5,

073_16764-Q1, 073_16767-Q1Shirai, Y. 073_16783-H4, 073_16792-

M3Shirazi, J.T. .. . . . . . . . . . . . 073_16775-Q1Shivdas, S. . . . . . . . . . . . . . . 073_16806-K1Shlevkov, N.B. . . . . . . . . . 073_16936-H5Shulman, E. .. . . . . . . . . . . . 073_16751-H1Silveira, I.073_16752, 073_16779-K3,

073_16780, 073_16781-K3,073_16789

AUTHOR INDEX


Author . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Number
Simantirakis, E. .. . . . . . . .073_16825-F1Sinagra, G. .. . . . . . . . . . . . . 073_16945-L4Sinha, A.M. .. . . . . . . . . . . . . 073_16822-I4Siracusa, R. . . . . . . . . . . . . . . 073_16733-J4Skipitaris, N.. . . . . . . . . . . . . . . . .073_16230Slaughter, M.S. . . . . . . . . . . 073_16794-J1Smeets, J.L.R.M. .. . . . . . 073_16772-H5Sommer, P. . . . . . . . . . . . . .073_16748-M3Sousa, M.J. . .073_16752, 073_16779-

K3, 073_16780, 073_16781-K3,073_16789

Sousa, R. . . . . . . . . . . . . . . . . . 073_16730-J3Spinar, J. . . . . . . . . . . . . . . . . 073_16776-B2Stankovic, S. .. . . . . . . . . . 073_16963-C5Stavrati, A. .. . . . . . . . . . . . . . 073_16758-I1Steinberg, J.S.073_16289, 073_16292-

H6Stenin, I. 073_16284-H5, 073_16289,

073_16731-A1Stevenson, L. .. . . . . . . . . . . . . . .073_16786Stirrup, J. . . . . . . . . . . . . . . . 073_16284-H5,

073_16731-A1Stucky, M. .. . . . . . . . . . . . . 073_16775-Q1Sugai, Y. 073_16242-H5, 073_16804-

H5Suleymanoglu, M. .. . . .073_16967-M1Sumiyoshi, M. .. . . . . . . . 073_16757-H5,

073_16764-Q1, 073_16767-Q1Supple, G.G. ... . . . . . . . . . 073_16944-L4Sutton, R. . . . . . . . . . . . . . . . 073_16968-G2Svecova, O. .. . . . . . . . . . . . 073_16776-B2Sweda, R. . . . . . . . . . . . . . . . 073_16840-D1Synkova, I. . . . . . . . . . . . . . . 073_16776-B2Tabata, K. . .. . . . . . . . . . . . . 073_16734-H5Tabuchi, H. . . . . . . . . . . . . 073_16757-H5,

073_16764-Q1, 073_16767-Q1Tada, T. . . . . . . . . . . . . . . . . . . . . . .073_16824Tagashira, T.. . . . . . . . . . . . 073_16740-H5Taimanova, R. . . . . . . . . . . 073_16972-H6Takahashi, Y. .. . . . . . . . . 073_16783-H4,

073_16792-M3Takami, K. .. . . . . . . . . . . . . 073_16740-H5Take, Y.073_16242-H5, 073_16804-H5Tam, K.C. ... . . . . . . . . . . . . . 073_16194-J1Tamura, Y. .. . . . . . . . . . . . . 073_16208-K1Taniguchi, H. .. . . . . . . . . . 073_16208-K1

Tanner, H. . . . . . . . . . . . . . . 073_16840-D1Tasaka, H. . . . . . . . . . . . . . . . . . . .073_16824Tasheva, R. . . . . . . . . . . . . . 073_16773-H1Tasouli, A. . . . . . . . . . . . . . .073_16726-M1Terakawa, K. .. . . . . . . . . . . . . . .073_16754Tereschenko, S.N. .. . . . . .073_16934-XThiene, G. .. . . . . . . . . . . . . . 073_16729-B2Tikhonenko, V. .. . . . . . . 073_16977-D1Tiribello, A.. .. . . . . . . . . . . . . . 073_17041pTohoku, S. . . . . . . . . . . . . . .073_16823-L2,

073_16212Tokano, T. . . . . . . . . . . . . . 073_16757-H5,

073_16764-Q1, 073_16767-Q1Topaloglu, S. . . . . . . . . . . .073_16835-L4,

073_16950-F1, 073_16955-Q1,073_16956-Q1, 073_16957-H5

Torres, S. 073_16752, 073_16779-K3,073_16780, 073_16781-K3,073_16789

Tozzi, R. . . . . . . . . . . . . . . . .073_16805-M3Trêpa, M. .. . . 073_16752, 073_16789Trepa, M. 073_16779-K3, 073_16780,

073_16781-K3Treshkur, T. .. . . . . . . . . . . 073_16977-D1Tripuraneni, A. .. . . . . . . . . 073_16795-J1Trivedi, J. . . . . . . . . . . . . . . . . 073_16794-J1Tsuchiya, H. .. . . . . . . . . . . . . . . .073_16754Tuleutayev, R. . . . . . . . . . . 073_16972-H6Ungar, A. .. . . . . . . . . . . . . . 073_16211-G2Uskach, T.M. .. . . . . . . . . . . 073_16934-X,

073_16936-H5Vacarescu, C. . . . . . . . . . . 073_16777-H4,

073_16787-K3, 073_16798-K1Vaccari, D. . . . . . . . . . . . . . . . 073_16838-J4Valaskova, I. . . . . . . . . . . . 073_16776-B2Valencia, F. . . . . . . . . . . . . . 073_16735-H5Valeri, L. . . . . . . . . . . . . . . . . 073_16774-Q1Valsecchi, S. .. . . . . . . . . . . 073_16762-K3van Vugt, S.P.G. . .. . . . . 073_16772-H5Vardas, P. .. . . . . . . . . . . . . . .073_16825-F1Varma, R. .. . . . . . . . . . . . . . 073_16806-K1Vaskovskii, V. .. . . . . . . . 073_16720-H6Vaskovsky, V.A. ... . . . . 073_16387-H5Verma, S. .. . . . . . . . . . . . . . 073_16719-A1Vieira, A.P. . . . . . . . . . . . . . . . . . .073_16789Vit, P. . . . . . . . . . . . . . . . . . . . . 073_16776-B2

Vitali-Serdoz, L. .. . . . . . . . 073_17092p,073_17093p

Vitlianov, K. .. . . . . . . . . . . 073_16773-H1Vitlianova, K. .. . . . . . . . . 073_16784-H2Vittadello, S.. . . . . . . . . . . . . 073_16838-J4Voudris, V. .. . . . . . . . . . . .073_16726-M1Vurgun, V.K. ... . . . . . . . 073_16742-H5,

073_16743-Q1, 073_16744-Q1Walascheck, J. . . . . . . . . . . . . 073_17092p,

073_17093pWeidinger, F. . . . . . . . . . . .073_16748-M3Westra, S.W. ... . . . . . . . . 073_16772-H5Wildhaber, R.A. ... . . . . . 073_16840-D1Wiley, J. . . . . . . . . . . . . . . . . . 073_16719-A1Winkler, W.-B. . . . . . . . . .073_16748-M3Woo, J.S. .. . . . . . . . . . . . . . . .073_16198-F3Wu, T. . . . . . . . . . . . . . . . . . . . 073_16807-L4Wurm, R. .. . . . . . . . . . . . . . . . . . .073_16800Yagishita, A. . . . . . . . . . . 073_16783-H4,

073_16792-M3Yakupova, I. . . . . . . . . . . . 073_16725-H5,

073_16973-H5Yamada, S. .. . . . . . . . . . . . 073_16740-H5Yamamoto, K. .. . . . . . . . . 073_16823-L2Yamawaki, K. .. . . . . . . . . 073_16740-H5Yashkov, M.V. .. . . . . . . . 073_16387-H5Yayla, C. .. . . . . . . . . . . . . . .073_16967-M1Yergeshov, K. .. . . . . . . . . 073_16725-H5Yildirim-Oeguet, Z. .. . . 073_16213-J4Yoshida, A. .. . . . . . . . . . . . 073_16740-H5Yoshino, M. .. . . . . . . . . . . . . . . .073_16824Zado, E. . . . . . . . . . . . . . . . . .073_16944-L4,

073_16945-L4,073_17038P-C4

Zahid, M. .. . . . . . . . . . . . . . .073_16788-P1Zaidi, K.A. ... . . . . . . . . . . . .073_16788-P1Zanon, F. .. . . . . . . . . . . . .073_17036P-K3,

073_17041pZarifis, J. . . . . . . . . . . . . . . . . . 073_16758-I1Zbinden, R. .. . . . . . . . . . . . . 073_16737-J1Zhambeev, A.A. .. . . . . . 073_16936-H5Zhelyakov, E. .. . . . . . . . . 073_16195-H2Zhirov, I.V. .. . . . . . . . . . . . . .073_16934-X�Zi�zek, D. .. . . . . . . . . . . . . . . 073_16739-L5Zouzou, H. ... . . . . . . . . . . . 073_16756-G1Zuurmond, K. .. . . . . . . . . 073_16806-K1


SUBJECT INDEX

Category T
ype S ession Numbers P age Numbers
AF Ablation: Mapping and Imaging Issues O
rals 4 .01 – 4.09 S 6–S8
AF Catheter and Surgical Ablation P
osters 2 00.1 – 200.20 S 23–S29
Atrial Fibrillation and Pharmacologic Therapy P
osters 1 00.1 – 100.8 S 22–S23
Atrial Fibrillation: Epidemiology and Anticoaugulation Issues O
rals 3 .01 – 3.08 S 5–S6
Atrial Tachyardia, Atrial Flutter and Other Atrial Arrhythmias: Diagnosis and Treatment O
rals 2 .01 – 2.07 S 2–S5
AVNRT Ablation P
osters 3 00.1 – 300.2 S 29
Cardiac Arrest P
osters 4 00.1 – 400.19 S 29–S35
Cardiac Implantable Electronic Devices: Different Issues O
rals 9 .01 – 9.08 S 17–S19
Cardiac Resynchronization Therapy: Technical Aspects O
rals 1 0.01 – 10.08 S 19–S21
Catheter Ablation of Ventricular Arrhythmias O
rals 7 .01 – 7.08 S 12–S14
HF & CRT P
osters 6 00.1 – 600.8 S 39–S42
Pacing P
osters 5 00.1 – 500.11 S 35–S39
Pacing: Clinical Issues O
rals 8 .01 – 8.08 S 14–S16
Sudden Cardiac Death Risk in Hereditary Arrhythmogenic Disease and Athletes O
rals 6 .01 – 6.08 S 11–S12
Syncope Miscellaneous O
rals 1 .01 – 1.05 S 1–S2
Telemonitoring P
osters 7 00.1 – 700.4 S 42
Transcatheter Ablation and Surgical Ablation of AF: Clinical Results O
rals 5 .01 – 5.08 S 8–S11

Venice Arrhythmias 2017 15th Edition · and lead to uncertainties in non-invasive arrhythmia...

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Transcript of Venice Arrhythmias 2017 15th Edition · and lead to uncertainties in non-invasive arrhythmia...