Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Patient-device mismatch in patients undergoing left atrial appendage closure (LAAC) may lead to failure to implant, ...dislocation, and cardiac tamponade. There is limited data about patient cohorts that are especially susceptible to these complications.
Objective
To analyse the association between body height, weight and acute complications due to probable device mismatch.
Methods
A retrospective analysis from a multicentre registry including consecutive patients undergoing LAAC was performed. Device related complications were defined as dislocation, failure to implant or cardiac tamponade requiring intervention.
Results
A total of 431 patients from 9 centres were included. Median age was 75 (interquartile range, IQR 70-79) years and 35.7% were female. Mean±SD body height was 171.3±8.8 cm and median weight was 80 (IQR 70-90) kg. Median CHADS-VASc score was 5 (IQR 3-5) and HAS-BLED score was 3 (IQR 3-4). Indications were bleeding (66.6%), stroke (9.7%) and other (23.6%). Acute device-related complications after LAAC occurred in 5.6% of cases (24/431): Failure to implant (3.0%), cardiac tamponade (2.1%), and dislocation (0.7%). Complications occurred significantly more often in the tercile with lowest body weight and highest body height (23.5% vs. 4.3%, p=0.01, Figure).
Conclusion
Acute device-related complications as sign of patient-device mismatch are most pronounced in patients with lowest body weight and highest body height.
Device-related complications after LAAC
Randomized controlled trials have shown conflicting results regarding the outcome of bivalirudin in primary percutaneous coronary intervention (PPCI). The aim of this study was to evaluate the ...in-hospital outcomes of patients receiving heparin or bivalirudin in a real-world setting of PPCI: 7,023 consecutive patients enrolled in the Austrian Acute PCI Registry were included between January 2010 and December 2014. Patients were classified according to the peri-interventional anticoagulation regimen receiving heparin (n = 6430) or bivalirudin (n = 593) with or without GpIIb/IIIa inhibitors (GPIs). In-hospital mortality (odds ratio OR 1.13, 95% confidence interval CI 0.57 to 2.25, p = 0.72), major adverse cardiovascular events (OR 1.18, 95% CI 0.65 to 2.14, p = 0.59), net adverse clinical events (OR 1.01, 95% CI 0.57 to 1.77, p = 0.99), and TIMI non–coronary artery bypass graft-related major bleeding (OR 0.41, 95% CI 0.09 to 1.86, p = 0.25) were not significantly different between the groups. However, we detected potential effect modifications of anticoagulants on mortality by GPIs (OR 0.12, 95% CI 0.01 to 1.07, p = 0.06) and access site (OR 0.25, 95% CI 0.06 to 1.03, p = 0.06) favoring bivalirudin in femoral access. In conclusion, this large real-world cohort of PPCI, heparin-based anticoagulation showed similar results of short-term mortality compared with bivalirudin. We observed a potential effect modification by additional GPI use and access favoring bivalirudin over heparin in femoral, but not radial, access.
Abstract
Funding Acknowledgements
Medtronic, Inc.
Background/Introduction
Accelerometer (ACC)-based AV synchronous pacing by tracking atrial activity is feasible using a leadless ventricular ...pacemaker. Patients may experience variable AV conduction (AVC) and/or atrial arrhythmias during the lifetime of their device. ACC-based AV synchronous pacing should facilitate AVC and pace appropriately in those two common rhythms.
Purpose
To characterize the behavior of ACC-based AV synchronous pacing algorithms during paroxysmal AV block (AVB) and atrial arrhythmias.
Methods
The MARVEL2 (Micra Atrial tRacking using a Ventricular accELerometer) was a 5-hour acute study to assess the efficacy of atrial tracking with a temporarily downloaded algorithm into a Micra leadless pacemaker. Patients with a history of AVB were eligible for inclusion. The MARVEL2 algorithm included a mode-switching algorithm that switched between VDD and VVI-40 depending upon AVC status. The AVC algorithm requires 2 ventricular paces (VP) at 40 bpm out of 4 pacing cycles to switch to VDD.
Results
Overall, 75 patients (age 77.5 ± 11.8 years, 40% female, median time from Micra implant 9.7 months) from 12 centers worldwide were enrolled. During study procedures, 40 patients (53%) had normal sinus rhythm with complete AVB, 18 (24%) had 1:1 AVC, 5 (7%) had varying AVC status, 8 (11%) had atrial arrhythmias, and 2 other rhythms. Two patients with complete AVB had the AVC mode switch feature disabled due to an idioventricular rate >40 bpm. Among the 40 subjects with a predominant 3rd degree AVB and normal sinus function the median %VP was 99.9% compared to 0.2% among those with 1:1 AVC (Figure). In the patients with 1:1 AVC, there were 64 opportunities to AVC mode switch with 48 switching to VDI-40. In the other 16 cases (2 patients) the mode remained VDD due to sinus bradycardia varying between 40-45 bpm. High %VP was observed in 2 patients with 1:1 AVC and sinus bradycardia <40 bpm. The AVC mode switch minimized %VP (<1%) in patients with PR intervals > 300 ms (N = 2). Among patients with varying AVC, the algorithm appropriately switched to VDD when the ventricular rate was paced at 40 bpm. During infrequent AVB or AF with ventricular response >40 bpm, VVI-40 mode was maintained.
In patients with AF, the ACC signal was of low amplitude and there was infrequent sensing, resulting in VP at the lower rate (50 bpm). In the one patient with atrial flutter, the ACC was intermittently detected, resulting in VP at 67 bpm (IQR 66-67 bpm).
Conclusion(s)
The mode switching algorithm in the MARVEL2 reduced %VP in patients with 1:1 AVC and appropriately switched to VDD during complete AVB. If greater AV synchrony or rate support is required, disabling the AVC algorithm may be appropriate for low grade AVB or idioventricular rhythms. In the presence of atrial arrhythmias, the algorithm paced near the lower rate.
Abstract Figure. Distribution of VP% by heart rhythm
Background
There is still limited data on the very long term clinical outcomes after ABSORB BRS in daily practice. We sought to evaluate the 3 year‐performance of the Absorb bioresorbable vascular ...scaffolds for the treatment of low/moderate complexity patients enrolled in the ABSORB EXTEND trial.
Methods
ABSORB EXTEND is a prospective, single‐arm, open‐label clinical study in which 812 patients were enrolled at 56 sites. This study allowed the treatment of lesions ≤28 mm in length and reference vessel diameter of 2.0–3.8 mm (as assessed by on‐line QCA). To determine the independent predictors of MACE, a multivariable logistic regression model was built using a stepwise (forward/backward) procedure.
Results
Average population age was 61 years and 26.5% had diabetes. Most patients had single target lesion (92.4%). Adequate scaffold deployment (PSP) was achieved in 14.2% of the cases. At three years, the composite endpoints of MACE and ischemia‐driven target vessel failure were 9.2% and 10.6%, respectively. The cumulative rate of ARC definite/probable thrombosis was 2.2%, with 1.2% of the cases occurring after the 1st year. Independent predictors of MACE were hypertension and the need for “bail out” stent.
Conclusion
At three‐year follow‐up, the use of ABSORB in low/moderate complex PCI was associated with low and acceptable rates of major adverse clinical events, despite the infrequent use of the recommended contemporary scaffold deployment technique. However, scaffold thrombosis rate was higher than reported with current generation of metallic DES. The study is registered on clinicaltrials.gov (unique identifier NCT01023789).
Abstract
Funding Acknowledgements
None.
OnBehalf
Go for Zero Fluoroscopy Project investigators
Background Contact force sensing catheters provide electrophysiologists with direct feedback and ...therefore improve safety and help to generate more effective lesions. The use of contact force may also reduce fluoroscopy and procedure times.
Purpose The aim of this study was to systematically evaluate the impact of using contact force sensing catheters (CFSCs) on fluoroscopy times and procedure times in left-sided atrial procedures.
Methods In this multinational, multicenter study, data from 622 left-sided procedures (142 without and 480 with CFSCs) of 25 participating European centers were prospectively collected with a structured questionnaire. Examinations comprised 393 pulmonary vein isolations (PVIs, group 1G1), 122 PVIs with linear lesions (group 2G2), 65 left-sided accessory pathway ablations (group 3 G3) and 42 ablations for left atrial tachycardia (group 4 G4). Fluoroscopy and procedure times were compared with respect to the use of CFSCs, procedure type, and level of operator experience as possible confounders. A Mann-Whitney U-test was applied for comparison, and a p-value <0.05 was considered statistically significant.
Results With the use of CFSCs, fluoroscopy time was significantly reduced when performing pulmonary vein isolations (G1 median IQR: 19 11.0-33.7 vs. 7.2 4.0-13.0 min., p < 0.001, G2: 45.3 34.9-61.8 vs. 7.3 5.0-14.0, p < 0.001, respectively). For groups G3 and G4, no difference could be detected. Procedure times were shortened for pulmonary vein isolations with additional lesions only (G4: 210 180-240 vs. 153 127-200 min., p < 0.001). When assessing the effect of operator experience, all left-sided atrial procedures were combined. Significantly shorter fluoroscopy times with contact force were found at all career levels (early career < 5 years: median -6 min., p = 0.024, mid-career 5-15 years: -15 min., p < 0.001, mentor status with experience > 15 years: -6.5 min., p < 0.001). The use of contact force proved to be especially beneficial in reducing fluoroscopy time in operators performing one to 19 procedures per month (1-9: median -15.8 min., p < 0.001, 10-19: -15.9 min., p < 0.001), whereas it lost its statistical significance when more than 20 procedures per month were performed (20-39: - 3.2 min., p = 0.100, >40: -1.5 min., p = 0.346).
Conclusion Contact force sensing catheters can help to reduce fluoroscopy times, especially when performing pulmonary vein isolations. This effect could be demonstrated for all career levels. However, it diminished with the operator"s caseload. A shortening of procedure time was found for PVIs with additional linear lesions.
Robots should be capable of interacting in a cooperative and adaptive manner with their human counterparts in open-ended tasks that can change in real-time. An important aspect of the robot behavior ...will be the ability to acquire new knowledge of the cooperative tasks by observing and interacting with humans. The current research addresses this challenge. We present results from a cooperative human-robot interaction system that has been specifically developed for portability between different humanoid platforms, by abstraction layers at the perceptual and motor interfaces. In the perceptual domain, the resulting system is demonstrated to learn to recognize objects and to recognize actions as sequences of perceptual primitives, and to transfer this learning, and recognition, between different robotic platforms. For execution, composite actions and plans are shown to be learnt on one robot and executed successfully on a different one. Most importantly, the system provides the ability to link actions into shared plans, that form the basis of human-robot cooperation, applying principles from human cognitive development to the domain of robot cognitive systems.
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