Abstract
Background
Atrial fibrillation (AF) is the more frequent arrhythmia in clinical practice and probably one of the more analyzed. Despite this, the clinical pattern classification not always ...correlates with the clinical course of AF. There are still a lack of biomarkers to predict recurrence and the clinical course of this disease.
Purpose
ST2 soluble (ST2S) biomarker has being previously analyzed by our group in patients with AF and electrical cardioversion (ECV) demonstrating utility to predict recurrence. We sought to analyze the clinical outcome of patients with AF who underwent an ECV or pulmonary vein isolation (PVI) and its correlation with the ST2S biomarker at mid-term follow-up.
Methods
We performed a prospective, observational clinical trial that included 250 patients with AF who were referred to our hospital for a clinical procedure including ECV or PVI from September 2016 to 2019. A total of 40 matched controlled patients were also included for the initial analysis. ST2S was analyzed from blood samples at baseline, 3- and 6-months follow-up.
Results
From 250 patients with AF: 94 underwent an ECV and 156 patients an PVI. Mean age was of 58.5 ±10.4 years. From the 156 PVI: 68 had paroxysmal and 88 persistent AF. Clinical follow-up was continued for 1 year and recurrence was of 65.9% in ECV and 22.4% in PVI patients. Clinical and echocardiographic characteristic are described in table1. The initial value of the ST2S biomarker was higher in AF cases with respect to controls (p<0.001). The patients with paroxysmal AF had higher levels of ST2S.0 (12113.4 pg/mL) respect to control cases but with no significant difference (p=0.234). Comparing the values of ST2S in persistent AF patients (15634.8 pg/mL) with controls the value was higher with a significant difference. ST2S baseline values were compared according to the rhythm and patients in AF had significantly higher levels with respect to those in sinus rhythm (SR). ST2S baseline values were also compared according to heart rate (HR) and those in tachycardia had higher levels respect to those who didn't(Table2). When analyzing ST2S levels in the complete cohort of patients with AF according to recurrence, there were no significant differences (Figure1). In multivariant analysis only AF rhythm and LA index volume were significant predictors of recurrence at 3 months follow-up and AF rhythm and age were predictors at 6 months follow-up.
Conclusions
ST2S baseline values were higher in persistent AF with respect to paroxysmal AF and only persistent AF patients had higher levels compared with controls. Initial ST2S biomarker levels did not have a predictive value in the global cohort of AF but do correlate with the type of AF and AF rhythm. With these results we consider that even though there is an association with AF and ST2S biomarker levels, when analyzing independently to the type of procedure ST2S values were not predictive of recurrence at mid-term follow-up.
Abstract
Background
Leadless pacemakers systems (LPM), have demonstrated safety and efficacy at mid-long term follow-up. There are still issues that cannot be completely avoided with conventional ...transvenous pacemaker (VVI) such as infectious or pocket related complications in which LPM are clearly superior.
Purpose
The aim of the study was to compare the clinical and device performance between LPM and VVI in a one-center long-term follow-up.
Methods
This was a prospective, observational, one-center study. We include all patients with a single chamber pacemaker implantation from June 1 2015 to March 1 2022 to complete a long-term follow-up. All clinical, electrical and echocardiographic characteristics, including electrical parameters, complications and mortality, were described.
Results
We included 245 patients with VVI pacemakers and 315 LPM. Mean age was 79.6±6.6 in LPM and 83.5±8.9 y/o in VVI pacemakers. All clinical, electrical and echocardiographic characteristics are described in Table 1. Electrical parameters of LPM were stable at long-term follow-up. There were a total of 7 complications in LPM and 17 in VVI pacemakers (p=0.006). There were no significant differences between major complications but there were in minor complications as shown in Table 2. There were no significant differences in mortality between both groups, but there was one death related to endocarditis in a VVI pacemaker patient during the follow-up (40,3±10 months).
Conclusions
In our study, there were no significant differences in terms of mortality and major complications between LMP and VVI at long-term follow-up. We consider our study supports the results in favor of the safety and effectiveness of LPM in the long-term.
Funding Acknowledgement
Type of funding sources: None.
Abstract
Introduction
Cardioneuroablation (CNA) or ablation of the ganglionated plexi (GP) is an emergent procedure that has been used in the treatment of vasovagal syncope Conclusions: (VVS), ...functional sinus node dysfunction (SND) and functional atrioventricular block (AVB), however long term effects of this technique are not well defined. The aim of the present study was to describe our initial experience with this technique and to assess long term hear rate (HR) variability.
Methods
Prospective, unicentric, observational study of consecutive patients which were referred to our institution for VVS, functional SND or functional AVB. Prior the procedure, all the patients underwent atropine test and 24-hour holter monitoring. Heart rate variability was assessed at 3 and 6 months with repeated 24-hour holter monitoring. Survival from syncope and pacemaker implantation was calculated in the cohort.
Results
24 patients (52 ± 10 years, 70.8% males) were included in the study. 83.3% of the cohort had history of syncope (1.3 ± 3.4 episodes/month) and 95.8% of presyncope. Indication for CNA was SND 29.2%, AVB 25% and recurrent VVS in 45.8%. After a median follow up of 9.9 (4.3-20.7) months, 91.7% were free from syncope recurrence and only 29.2% had presyncope (p<0.001) (Figure 1). There was also a significant increase in minimum HR (p=0.01) and medium HR (p=0.02), without any differences in the maximum HR (p=NS). There was also a decrease in all the parameters used to assess HR variability (SDNN24 p=0.02; rMSSD p=0.017; pNN50 p<0.01) that was constant during the 6 months (Figure 2).
Conclusions
In our cohort, CNA was associated with a syncope free survival of 91.7% and could be a reasonable choice for patients with functional SND or AVB and recurrent VVS. There was an increase in the maximum and medium HR and a decrease in HR variability that remained constant at 6 months.Figure 1Figure 2
Abstract
Background and purpose
High density (HD) mapping is associated with a reduction in fluoroscopy time compared to conventional mapping in accessory pathway (AP) ablation. The Open Window (OW) ...technique (CARTO 3, Biosense Webster) is a new tool that automatically uses conventional electrophysiology criteria for AP location, as shorter local EGM AV interval (extended early meets late tool), earliest local activation time (LAT) and annotation at unipolar signal (wavefront annotation). However, no studies comparing its feasibility to conventional mapping have been conducted. Therefore, the aim of the present study was to assess the feasibility and the clinical implications of high-density OW mapping when compared to conventional HD mapping.
Methods
A prospective, unicentric cohort study was conducted that included consecutive patients which were referred to our institution for AP ablation with OW mapping technique and compared to a recent retrospective cohort of patients who underwent conventional HD mapping. Total fluoroscopy time, total mapping time and the rate of recurrence of the AP were compared between groups. A schematic step by step graphic of the workflow procedure is represented in figure 1.
Results
A total of 33 consecutive patients (32.28 ± 18 years, 58% males) were included in the OW group and compared with a cohort of 29 patients (29.6 ± 18 years, 52% males) who underwent conventional HD mapping. An example of Right Superior AP ablation is showed in figure 2. No differences in the location of the AP were observed (p=NS). OW mapping was associated to a lower mapping time (29.3 vs 37.8 min; p=0.04), lower fluoroscopy time (14.3 vs 21.3 min; p= 0.04) and lower radiofrequency time (p=0.007). After a median follow up of6 months, there were no differences in the rate of recurrence of the AP conduction between groups (p=NS).
Conclusions
In our experience, OW mapping was a feasible tool for AP location associated to a lower mapping time, lower radiofrequency time and lower X-ray exposure time with no differences in recurrence rate when compared to conventional HD mapping. However, more studies should be performed to corroborate these conclusions.Step by Step WorkflowRight Superior AP ablation
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background and purpose
Cardioneuroablation (CNA) or ablation of the ganglionated plexi (GP) is an emergent procedure that has been ...used in the treatment of vasovagal syncope (VVS), functional sinus node dysfunction (SND) and functional atrioventricular block (AVB). The aim of the present study was to describe our initial experience with this technique.
Methods
Prospective, unicentric, observational study of consecutive patients which were referred to our institution for VVS, functional SND or functional AVB. Prior the procedure, all the patients underwent atropine test.
Results
A total of 19 patients were included in the study (51.5 ± 12.7 years, 68.4% males). 15 patients (78.9%) had prior syncope with a median of 1.6 ± 3.8 episodes per month. 8 patients (42.1%) underwent the procedure due to recurrent VVS, 6 patients (31.6%) due to SND and 5 patients (26.3%) due to AVB. Prior the procedure there was an increase of 39 ± 8% of the heart rate (HR) with the atropine test. Extracardiac vagal stimulation, was attempted in 11 patients (59.7%) and from them, only 63.6% had vagal responses. We used an anatomic approach in 79% of the patients. The right superior GP was ablated with a bi-atrial approach in 100% of the patients. At the end of the procedure all the patients had a negative atropine test with an increase in the HR significantly lower than prior the procedure (39 ± 8% vs 5 ± 5%; p=0.002). After a median follow-up of 8.5 (3.9-17.7) months, freedom from syncope was 93.3% and the incidence decrease from 1.6 ± 3.8 to 0.02 ± 0.11 episodes per month. Freedom from pacemaker implantation was 88.8%. There was a significant reduction in the patients who experience presyncope after the procedure (94.7% vs 21.1%; p=0.002) (Figure 1). No complications were observed related to the procedure.
Conclusions
In our initial experience CNA could be a reasonable option for young patients with recurrent VVS, and functional SND or AVB, which could even be an alternative to pacemaker implantation. However more prospective and randomized studies are needed to support these conclusions.
Survival free from syncope
Example of the procedure
Abstract
Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): No fundings related
Background
Atrial fibrillation (AF) is the more frequent arrhythmia in ...clinical practice and the efficacy of pulmonary vein ablation has being widely demonstrated. There is still a lack of information about the predictive value of electroanatomical voltage maps or biomarkers to predict recurrence.
Purpose
ST2 soluble (ST2S) biomarker has being previously analyzed by our group in patients with AF and electrical cardioversion demonstrating utility to predict recurrence . So we sought to analyze the clinical utility of ST2S biomarker in patients with AF that underwent to an electrophysiology study and pulmonary isolation (PVI) to compare the predictive value of this biomarker.
Results
This was a prospective, observational clinical trial that included a total of 156 patients with AF who were referred to our hospital for a PVI from September 2016 to September 2019. We also included 40 matched control patients for the initial analysis. All the patients with AF underwent an electroanatomical voltage map in sinus rhythm and PVI. From the 156 PVI: 68 had paroxysmal AF and 88 persistent. ST2S mean value in AF patients was of (13178.5 pg/ml) and had no significant difference with matched controls (11016.2 pg/ml) in baseline analysis. There was no association of ST2S baseline values and recurrence in AF patients. When we analyzed by type of AF, persistent AF patients had a significantly higher level of the biomarker and there was also a significant elevation of the biomarker according to heart rate (>100 bpm) (p 0.038). We observed an elevation of the ST2S levels at 3 and 6 months follow-up with no difference according to recurrence. The levels of ST2S were lower in the cases with a lower voltage map area and in the cases with a wider lower map area but there was no a significant association nor with recurrence. In multivariant analysis only AF rhythm and LA index volume was a significant predictor or recurrence at 3 months follow-up.
Conclusions
We consider that even though there is an association with AF patients and ST2S biomarker levels, specially in those with persistent AF, in patients undergoing an PVI, ST2S values had a generalized elevation at follow-up probably related to inflammation and were not predictive of recurrence.
Figure 1
Figure 2
Abstract
Background
Atrial fibrillation (AF) is the more frequent arrhythmia in clinical practice. The ST2S is a biomarker that has demonstrated to be predictor of cardiovascular outcomes in patients ...with heart failure but there is scarce information of his utility in patients with AF.
Purpose
Considering the characteristics of the ST2S we hypothesize this biomarker could correlate to recurrence in patients with AF and electrical cardioversion (ECV).
Methods
This was an observational and prospective clinical trial. We compared all patients with AF referred for ECV with a control group without AF, from September 1th 2016 to September 30 2019. Clinical, ECG, echocardiographic and ST2S levels were analyzed in both groups at basal, at 3 and 6 months of follow-up in such cases with AF. Patients with inflammatory or allergic diseases, moderate/severe ventricular dysfunction, structural cardiomyopathy, moderate/severe hepatic, renal or respiratory disease were excluded.
Results
We included a total of 94 patients with AF and 40 paired controls. Clinical variables are presented in Table 1. Fifty-eight (61.7%) patients with AF had recurrence at follow-up. There was a significant difference between the ST2S levels at baseline between AF patients (17163.8 pg/mL) and controls (11016.2 pg/mL) (p=0.001). ST2S biomarker levels at 3 and 6 months of follow-up decreased in those patients without AF recurrence as shown in Figure 1. Covariable models were performed and ST2S biomarker levels at 3 months were significant to predict recurrence at 6 months follow-up (Table 2). The calculated cut-point of the biomarker was of 15511.51 pg/ml with a c-value: 0.669.
Conclusions
In our experience ST2S was a useful biomarker to predict recurrence of AF after ECV. Considering the size of the study more studies should be performed to confirm this results.
Funding Acknowledgement
Type of funding sources: None.
Abstract
Introduction and purpose
We sought to described a new protocol of open window mapping (OW) utilizing high-density mapping in accessory pathways (AP) in CARTO® 3 system. This protocol ...automatically map conventional electrophysiology criteria for AP location, as shorter local EGM AV interval (extended early meets late tool), earliest local activation time (LAT)and annotation at unipolar signal (wavefront annotation).
Methods
This was a single center, prospective and observational trial of 21 consecutive patients who underwent an AP catheter ablation.
Results
We included 16 men and 5 women, with a mean age of 32.6±17.9 years. The characteristics of AP, including mapping and ablation were described in Table 1. Twelve AP were of left location and 9 in right location. Mapping was performed in anterograde conduction in 17 patients (80.9%), retrograde in 9 patients (42.9%) and orthodromic tachycardia in 7 patients (33.3%). Mean mapping points were 3205±2034, with 29.2 min±12.5 min of mapping. All 21 patients had a successful ablation after OW mapping and mean radiofrequency time until complete AP elimination was 2.76 s.
We present an example of a Left lateral AP OW mapping in antegrade and retrograde conduction in Figure 1, which shows EEML mapping tool, targeting shorter interval EGM AV or VA and color adjust to determine earliest LAT in chamber of exit.
Conclusions
In our experience, automatically mapping of conventional electrophysiology criteria for AP diagnostic is feasible to localize AP insertion, suggesting an increasing in effectiveness of procedure, and reducing mapping time, ablation time and X-ray exposure time. More studies should be performed to corroborate these conclusions.
Funding Acknowledgement
Type of funding sources: None.
Abstract Introduction Carotid sinus syndrome (CSS), characterized by exaggerated vagal responses leading to asystolic pauses with carotid sinus massage (CSM), often necessitates pacemaker ...implantation. This study investigates cardioneuroablation (CNA) as an alternative management strategy for CSS. Methods Prospective study of consecutive patients referred for CNA. All patients underwent CSM, atropine test, 24-hour Holter monitoring and SF-36 quality of life questionary before the procedure and at 6 months. The objective of the study was to assess syncope free survival, grade of cardioinhibition with CSM and heart rate variation (HRV) and quality of life after the procedure. Results A total of 13 patients (84.6% male, mean age 63.8 ± 12.3 years) were included. After a median follow-up of 9.2 (8.6-14.3) months, none of the patients experienced syncope (0%) and none of the patients required pacemaker implantation. After the procedure all the patients had a negative CSM and only one patient (7.7%) had a positive CSM at 6 months (Figure 1). There was an improvement in the energy and health change items in the SF-36 quality of life questionary. There was a reduction in HR increase in the atropine test at 6 months (pre-CNA: 66% (52-84) vs. post-CNA 27.4% (21.9-90.9); p=0.027) and in most of the 24-hour Holter monitoring HRV parameters (Figure 2). Conclusions Cardioneuroablation emerges as a promising and effective alternative to pacemaker implantation in managing cardioinhibitory CSS. Further research is warranted to solidify these findings and explore the long-term effects of CNA in this scenario.Maximum RR interval with CSMHeart rate increase in the atropine tes
Abstract
Introduction
Sodium-glucose cotransporter-2 (SLGT2) inhibitors have demonstrated benefits on survival and hospital admissions in patients with heart failure and reduced ejection fraction. ...However, their impact on the burden of ventricular (VA) and atrial arrhythmias (AA) is unknown.
Methods
Retrospective multicentric study of heart failure patients with implantable cardiac defibrillator device (ICD) from 2015 to 2020 with or without cardiac resynchronization therapy (CRT) receiving SGLT2 inhibitors. Device-registered arrhythmic events were analyzed and compared during one year following SLGT2 inhibitor initiation and during one year before initiation. Relevant VA were defined as the occurrence of any sustained VT (SVT) (>30 seconds), ventricular fibrillation (VF), or appropriate therapy (antytachycardia pacing or shock). All VA included all the relevant VA and the occurrence of non-sustained ventricular tachycardia (NSVT). AA included atrial fibrillation (AF) burden, and episodes of more than 24 hour of AF.
Results
147 patients (67 ± 10 years, 82.3% males, LVEF 30.3 ± 11%, CRT 39.3%), were included in the study. 77.6% had complete remote tele-monitoring during the entire follow up and there was no difference in the antiarrhythmic therapy between the two periods. Following SGLT2 inhibitor initiation, there was a significant reduction in the percentage of patients with relevant VA (19.7% pre vs 10.9% post; p=0.019) and all VA (47.6% pre vs 30.6% post; p<0.001) (Figure 1 and 2). There was a reduction in the prevalence of NSVT (40.1% pre vs. 27.2% post; p<0.001), of SVT (17.7% vs 8.8%; p<0.001), of VF (4.1% vs 2%; p=NS) and appropriate therapies (14.3% vs 9.5%; p=NS). Among patients with any VA, there was a significant reduction in the incidence of NSVT (p<0.001), but not in the incidence of SVT or appropriate therapies (p=NS). There was no impact on atrial fibrillation burden or in the number of AF episodes lasting more than 24 hours (p=NS).
Conclusions
In our study, initiation of a SGLT2 inhibitor in patients with heart failure, was associated with a reduction in the prevalence of relevant VA and any VA, with a significant reduction in the number of NSVT per patient. There was no impact on AF burden or the number of AF episodes lasting more than 24 hours. Prospective studies should be performed to sustain these conclusions.Relevant ventricular arrhythmiasAny ventricular arrhythmia
