scholarly journals Optimized radiofrequency lesions through local impedance guidance for effective cavo-tricuspid isthmus ablation in typical right atrial flutter: data from the CHARISMA registry

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
V Ducceschi ◽  
A Carbone ◽  
G Botto ◽  
G Nigro ◽  
C Lavalle ◽  
...  
Keyword(s):  
Atrial Flutter ◽  
Conduction Block ◽  
Right Atrial ◽  
Complete Agreement ◽  
Tissue Impedance ◽  
Funding Sources ◽  
Radiofrequency Lesions ◽  
The Mean ◽  
Mean Time ◽  
Funding Acknowledgements

Abstract Funding Acknowledgements Type of funding sources: None. Background Radiofrequency (RF) catheter ablation of the cavo-tricuspid isthmus (CTI) is an established treatment for typical right atrial flutter (RAFL). However, whether local tissue impedance (LI) is able to predict effective CTI ablation and what LI drop values during ablation should be used to judge a lesion as effective remains to be established. Purpose We aimed to investigate the ability of LI to predict ablation efficacy in patients (pts) with RAFL and to characterize the CTI in terms of LI. Methods Consecutive pts undergoing RAFL ablation from the CHARISMA registry were enrolled at 9 centers. A novel RF ablation catheter with dedicated algorithm (DirectSense - DS -) was used to measure LI at the distal electrode of this catheter. RF applications (RFC) were targeted to a minimum LI drop of 10 Ω within 30 seconds and were stopped when a maximum cutoff LI drop of <40 Ω was observed. Successful single RFC was defined according with a split in two separate potentials (SPL), reduction of voltage (RedV) by at least 50% or changes at unipolar EGM (UPC). Agreement among criteria was evaluated. Ablation endpoint was the creation of bidirectional conduction block (BDB) across the isthmus. Results A total of 279 ablation spot lesions were delivered in 30 pts (mean RFC 9 ± 6 lesions per pt): 106 (38%) at anterior, 115 (41%) at mid and 58 (21%) at posterior portions of the CTI. BDB was obtained in all cases and no complications were observed. The median RFC delivery time was 30 [19–45] seconds per lesion. 132 (47%), 150 (54%) and 86 (31%) ablation spots were effective according with SPL, RedV and UPC, respectively. Complete agreement of all the criteria was reached in 70% of the cases. The mean LI was 104.4 ± 11Ω prior to ablation and 92.1 ± 11Ω after ablation (p < 0.0001, mean absolute LI drop 12.2 ± 7Ω, mean time to LI drop 13 ± 8 seconds). Effective ablation spots showed a higher LI drop compared with ineffective sites at each single criteria (16.6 ± 7Ω vs 8.3 ± 4Ω for SPL, p < 0.0001; 16.1 ± 6Ω vs 7.8 ± 5Ω at for RedV, p < 0.0001; 19 ± 6Ω vs 9.2 ± 4Ω for UPC, p < 0.0001) and LI drop values significantly increase according to the number of criteria satisfied (ranging from 7.5Ω % -no criteria- to 19.1 -all criteria-). A 15Ω cut-off value for LI (AUC 0.91, sensitivity = 67%, specificity = 92%, p < 0.0001) was associated with the achievement of all criteria with an OR of 21.9 (95%CI: 11.1 to 43.5, p < 0.0001) and a positive predictive value of 76%. Starting LI and LI drop seem to be higher at mid-septal areas. Conclusion In our preliminary experience, a LI-guided approach of CTI seems to be safe and effective in RAFL ablation. The magnitude of LI drop was associated with effective lesion formation and conduction block and could be used as a marker of ablation efficacy.

scholarly journals Feasibility and efficacy using the KODEX-EPD imaging system in right atrial flutter ablation: a single center experience

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
V Schillaci ◽  
G Stabile ◽  
G Shopova ◽  
A Arestia ◽  
A Agresta ◽  
...  
Keyword(s):  
Atrial Flutter ◽  
Imaging System ◽  
Conduction Block ◽  
Right Atrial ◽  
Atrial Pacing ◽  
Funding Sources ◽  
Single Center Experience ◽  
Typical Atrial Flutter ◽  
Procedural Time

Abstract Background Isthmus-dependent right atrial flutter is the most frequently encountered atrial flutter in clinical practice (80–90% of atrial flutters). Purpose The aim of our study was to assess as first experience the feasibility and safety of radiofrequency catheter ablation (RFCA) of cavo-tricuspid isthmus (CTI) guided by KODEX-EPD imaging system in patients presenting with typical atrial flutter (AFL). Methods 16 consecutive patients (mean age 68,46±7,8 years, 80% males) with diagnosis of AFL underwent RFCA guided by KODEX-EPD imaging system. In 15 patients the analysis performed during tachycardia showed a counter-clockwise activation. In 1 patient no tachycardia could be induced and the ablation was performed in sinus rhythm with fixed pacing from the coronary sinus. The KODEX-EPD imaging system was also used to guide ablation and to confirm persistent bidirectional block after ablation. Results Mean procedural time was 37,6±8,2 min, mean radiofrequency ablation time was 7,8±3,4 min, and mean fluoroscopy time was 2,1±1,2 min. All procedures were acutely successful with interruption of AFL during RFCA along the inferior CTI in 15 patients and achievement of the bidirectional conduction block in 16 patients proven by atrial pacing medial and lateral to the ablation line. There were no major procedural and 30-day complications. Over a mean follow-up of 18 months, we observed no recurrence of arrhythmia and no complications. Conclusions Our study shows that RFCA for AFL using the KODEX-EPD imaging system is feasible, safe, and effective. FUNDunding Acknowledgement Type of funding sources: None.

P1447Use of novel local impedance-based catheter in typical right atrial flutter ablation: preliminary data from a multicenter Italian study

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
V Ducceschi ◽  
C Pandozi ◽  
A Arestia ◽  
L Rossi ◽  
G Bencardino ◽  
...  
Keyword(s):  
Atrial Flutter ◽  
Conduction Block ◽  
Right Atrial ◽  
Rf Ablation ◽  
Lesion Formation ◽  
Tissue Impedance ◽  
Novel Technology ◽  
Before And After ◽  
Acute Success ◽  
Tissue Characteristics

Abstract Funding Acknowledgements NO FUNDING Background Many studies demonstrated the importance of an optimal tissue contact to obtain safe and effective lesions and to improve the clinical outcome in ablation of cavotricuspid isthmus (CTI) for typical right atrial flutter (AFL). Data about a novel technology able to measure local tissue impedance (LI) providing a measure of tissue characteristics and lesion formation is still lacking in right atrium or CTI working. Purpose This analysis explores the relationship between LI measures and ablation spot lesion locations during ablation of CTI in common AFL patients (pts). Methods Consecutive pts undergoing AFL ablation from the CHARISMA registry were included. A novel RF ablation catheter with dedicated algorithm (DirectSense - DS -) was used to measure LI at the distal electrode of this catheter. Each targeted spot was characterized in terms of LI parameters during RF delivery at the lateral, intermediate and posterior portions of the CTI. Successful single RF ablation was defined according with a reduction of voltage (RedV) by at least 50% or split in two separate potentials (SPL). Ablation endpoint was the creation of bidirectional conduction block across the isthmus. Results A total of 135 ablation spot lesions were delivered in 20 pts (median 5 [3-11] lesions per pt): 7 (5%) at lateral, 88 (65%) at intermediate and 40 (30%) at posterior portions of the CTI. Acute success was obtained in all cases and no complications were observed. The median ablation time was 26 [17 – 36] seconds per lesion. 100 (74%) and 51 (38%) ablation spots were effective according with RedV or SPL, respectively. The mean LI was 106 ± 15Ω prior to ablation and 93 ± 13Ω after ablation (p < 0.0001, mean absolute LI drop 14 ± 7Ω, mean percentage LI drop 13%±6). Effective ablation spots showed a higher absolute impedance drop (15 ± 7Ω at effective RedV vs 9.6 ± 8Ω at ineffective RedV, p = 0.0001; 15.6 ± 7Ω at effective SPL vs 12.5 ± 7Ω at ineffective SPL, p = 0.0173) or % impedance drop (14%±6 at effective RedV vs 9%±7 at ineffective RedV, p < 0.0001; 14.5%±6 at effective SPL vs 11.6%±6 at ineffective SPL, p = 0.0103) compared with ineffective sites. No significant differences were found in terms of starting LI, ending LI or LI drop among CTI areas. The percentage of LI drop was associated both with RedV (odd ratio 1.17 (95%CI: 1.08 to 1.26, p = 0.0001)) and with SPL (odd ratio 1.08 (1.02 to 1.14, p = 0.0132)). Conclusion In our preliminary experience, measured LI before and after RF delivery and LI drop appear to be consistent and homogeneous across different CTI ablation locations. The magnitude of the LI drop was associated with effective lesion formation and conduction block.

scholarly journals Oral procainamide as pharmacological treatment of recurrent and refractory ventricular tachyarrhythmias

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
M Toniolo ◽  
G Grilli ◽  
A Proclemer ◽  
L Rebellato ◽  
D Muser ◽  
...  
Keyword(s):  
Ventricular Arrhythmias ◽  
Beta Blockers ◽  
Cardioverter Defibrillator ◽  
Funding Sources ◽  
Therapy Strategy ◽  
Secondary Endpoints ◽  
The Mean ◽  
Initiation Of Therapy ◽  
Mean Time ◽  
Funding Acknowledgements

Abstract Funding Acknowledgements Type of funding sources: None. Background The antiarrhythmic therapy of recurrent ventricular arrhythmias in patients having undergone catheter ablation and in whom amiodarone and/or beta blockers were ineffective or contraindicated, is a controversial issue. Purpose The present study sought to evaluate the efficacy and tolerability of oral procainamide in patients with recurrent ventricular arrhythmias, when the standard therapy strategy failed. Methods All patients with an implantable cardioverter defibrillator (ICD)  treated with oral procainamide for recurrent ventricular tachycardia (VT) or ventricular fibrillation (VF) in our institution between January 2010 and May 2019 were enrolled. The primary endpoint was the total number of ICD interventions after the beginning of procainamide therapy. Secondary endpoints were total number of VTs and VFs recorded on the ICDs controls, and discontinuation of therapy. The events occurring during procainamide treatment were compared with a matched duration period before the initiation of therapy with procainamide. Patients therefore served as self-controls. Results A total of 33 consecutive patients (31 males, 93.3%; mean age 73.3 ± 10 years) were included in the retrospective analysis. The mean time of procainamide treatment was 12.5 ± 13.5 months. The mean dose of procainamide was 1194 ± 495 mg/die. Procainamide therapy significantly decreased ICD interventions (DC shock: 102 vs 132; anti-tachycardia pacing: 418 vs 603; 12 patients manifested DC shock after the beginning of treatment vs 25 patients before treatment). Procainamide also decreased the total number of VT/VF episodes (514 vs 1078 episodes) [p < 0,01]. Only 2 patients (6%) presented severe side effects (hypothension) requiring discontinuation of therapy. Conclusions Procainamide was associated with a significant decrease of ICD therapies and ventricular arrhythmias showing an optimal profile of tolerability.

The underrepresentation of female participants in studies assessing the impact of high-dose exercise on cardiovascular outcomes: a scoping review

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
S Pallikadavath ◽  
R Patel ◽  
CL Kemp ◽  
M Hafejee ◽  
N Peckham ◽  
...  
Keyword(s):  
Scoping Review ◽  
High Volume ◽  
Cardiovascular Outcomes ◽  
High Dose ◽  
Funding Sources ◽  
Review Protocol ◽  
The Mean ◽  
The Impact ◽  
Over Time ◽  
Funding Acknowledgements

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Cardiovascular adaptations as a result of exercise conducted at high-intensity and high-volume are often termed the ‘Athlete’s heart’. Studies have shown that these cardiovascular adaptations vary between sexes. It is important that both sexes are well represented in this literature. However, many studies assessing the impact of high-dose exercise on cardiovascular outcomes under-recruit female participants. Purpose This scoping review aimed to evaluate the representation of females in studies assessing the impact of high-dose exercise on cardiovascular outcomes and demonstrate how this has changed over time. Methods The scoping review protocol as outlined by Arksey and O’Malley was used. OVID and EMBASE databases were searched and studies independently reviewed by two reviewers. Studies must have investigated the effects of high-dose exercise on cardiovascular outcomes. To assess how the recruitment of females has changed over time, two methods were used. One, the median study date was used to categorise studies into two groups. Two, studies were divided into deciles to form ten equal groups over the study period. Mean percentage of female recruitment and percentage of studies that failed to include females were calculated. Results Overall, 250 studies were included. Over half the studies (50.8%, n = 127) did not include female participants. Only 3.2% (n = 8) did not include male participants. Overall, mean percentage recruitment was 18.2%. The mean percentage of recruitment was 14.5% before 2011 and 21.8% after 2011. The most recent decile of studies demonstrated the highest mean percentage of female recruitment (29.3%) and lowest number of studies that did not include female participants (26.9%). Conclusion Female participants are significantly underrepresented in studies assessing cardiovascular outcomes caused by high-dose exercise. The most recent studies show that female recruitment may be improving, however, this still falls significantly short for equal representation. Risk factors, progression and management of cardiovascular diseases vary between sexes, hence, translating findings from male dominated data is not appropriate. Future investigators should aim to establish barriers and strategies to optimise fair recruitment. Mean percentage females recruited per study (%) Percentage studies that do not include women (%) Overall (n = 250) 18.2 50.8 (n = 127) Studies before 2011 (n = 121) 14.5 59.5 (n = 72) Studies after 2011 (n = 129) 21.8 42.6 (n = 55) Table 1: Female recruitment characteristics. The year 2011 (median study year) was chosen as this divides all included studies into two equal groups.

Outcomes of a Cardiac Rehabilitation (CRH) Program after phase II: what about our patients almost 4 years later?

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
J Borrego Rodriguez ◽  
C Palacios Echevarren ◽  
S Prieto Gonzalez ◽  
JC Echarte Morales ◽  
R Bergel Garcia ◽  
...  
Keyword(s):  
Phase Ii ◽  
Hospital Readmissions ◽  
Clinical Results ◽  
Level Of Evidence ◽  
Coronary Syndrome ◽  
Funding Sources ◽  
The Mean ◽  
Acute Cardiovascular Event ◽  
Mean Time

Abstract Funding Acknowledgements Type of funding sources: None. INTRODUCTION CRH in patients with ischemic heart disease is recommended by the different clinical practice guidelines with an IA level of evidence, with an important role in reducing cardiovascular mortality and hospital readmissions during follow-up. OBJECTIVE The goal of this study is to show the 4-year clinical results of a population of patients who participated in an CRH program after an Acute Coronary Syndrome (ACS). METHODS Between May/2014 and September/2017, 221 patients who had recently presented an ACS completed the 12 weeks of phase II of the CRH program at our center. In May/2020 we collected epidemiological, clinical and echocardiographic information at the time of the acute cardiovascular event; and we evaluate the current vital status of the patients and the incidence of readmissions for: angina, HF, new ACS, or arrhythmic events. RESULTS Of the 221 patients, 182 were men (82%). The mean age of our population was 58.3 ± 7.8 years. 58% (129 patients) suffered from ST-elevation ACS. The mean time of hospital stay was 6.20 ± 2.9 days. An echocardiogram was performed at discharge, which showed an average LVEF of 56 ± 6%. Eight patients (4%) developed early Ventricular Fibrilation (VF) during the acute phase of ACS. Among the classic CVRF, smoking (79%) was the most prevalent, followed by dyslipidemia (53%) and hypertension (47%). The mean time from hospital discharge to the start of phase II RHC was 42 ± 16 days. The overall incidence of events was 9%: 10 patients suffered reinfarction during follow-up, and 7 were readmitted for unstable angina, all of whom underwent PCI; no patient was admitted for HF; and none of the 8 patients with early VF had a new tachyarrhythmia, registering a single admission for VT during follow-up. None of the patients had sustained ventricular tachyarrhythmias during exercise-training. At the mean 4.5-year follow-up, 218 patients were still alive (98%). CONCLUSION The incidence of CV events in the follow-up of our cohort was low, which can be explained by the fact that it is a young population, with an LVEF at low limits of normality at discharge, which is one of the most important predictors in the prognosis after an ischemic event. As an improvement, we must shorten the time until the start of phase II of the program. CRH shows once again its clinical benefit after an ACS, in consonance with the existing evidence. Abstract Figure. Outcomes of a CRH program.

scholarly journals A novel ventricular map of electrograms duration as a method to identify areas of slow conduction during ablation of ventricular tachycardia

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
P Rossi ◽  
FM Cauti ◽  
M Polselli ◽  
L Iaia ◽  
V Fanti ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Wave Front ◽  
Conduction Delay ◽  
Funding Sources ◽  
Diastolic Phase ◽  
Slow Conduction ◽  
Reentry Circuit ◽  
Background Wave ◽  
Mean Time ◽  
Funding Acknowledgements

Abstract Funding Acknowledgements Type of funding sources: None. Background – Wave front inhomogeneous propagation is crucial for reentry circuit generation. Bipolar EGM duration is indicative of local conduction delay and may identify areas of low conduction as a functional substrate. This study aimed to create a map of EGM duration during the VT (VEDUM Map) to identify the area of the slowest conduction and to verify if RF delivery at this area allows to rapidly interrupt the VT. Methods – 24 high-density VTs maps (21 patients) were analyzed. Activation maps and voltage maps during SR were performed. An offline remap confirmed with MathLab software was customized to visualize the longest duration electrogram during VT. Results – All of the VTs were interrupted during the first RF delivery (mean time 7,3 ± 5,4 sec (range 3-25 sec)) at the area with the longest EGM duration (212 ± 47 ms (range 113-330 ms)). . In 9 pts (37,5%) the longest EGM was located at the entrance or exit area of the activation maps while in 5 pts (21%) the EGM covered the full diastolic phase. Finally, in 10 pts the longest EGM occurred in the mid-exit-diastolic phase. Conclusions - A novel Ventricular map of Electrograms DUration (VEDUM Map) is highly accurate in defining a conductive vulnerable zone of the VT circuit. The longest EGM duration within the isthmus is highly predictive of rapid VT termination. Quantitative variablesQualitative variablesMeanMedianStandard DeviationAge71738.40BMI26.624.54.02LV EDV16315442.7LV EDD61.2629.9LV EF38.7369.74VT cycle lenght (TCL)35537556.4EGM max. duration in VT21220847EGM max dur / TCL58.260.512Maximum EGM duration localization in CLProto = 12.5%Meso = 33.3%Tele = 25%Full = 20.8%Myocardium voltage characteristics in VEDUM EGMHealthy = 25%Transition = 20.8%Scar = 41.7%Critical Isthmus area12.3107.3VT Interruption during RFYes = 79.2%No = 20.8%Time (seconds) to interruption765Access typeEndo = 58.3%Epi = 29.2%Clinical and procedural dataAbstract Figure.

scholarly journals The use of half normal saline during catheter ablation of typical atrial flutter has no impact on the time to achieve bidirectional block

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
N.J.H Alhammad ◽  
D.R Redfearn ◽  
A.E Enriquez ◽  
S.C Chacko ◽  
K.H Hong ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Atrial Flutter ◽  
Normal Saline ◽  
Conduction Block ◽  
Ionic Concentration ◽  
Typical Atrial Flutter ◽  
Population Reduction ◽  
Significant Difference ◽  
Power Setting ◽  
The Mean

Abstract Background Achieving bidirectional block (BB) is generally considered to be the endpoint in the ablation of typical atrial flutter (AFL), however acute reconnection is common. Recent data suggest that deeper ablation lesions may be created by decreasing the irrigant ionic concentration using half normal saline (HNS) delivered through an open irrigated ablation catheter compared with normal saline (NS). We sought to assess whether the use of HNS was associated with a more rapid achievement of BB and less reconnections compared with NS. Methods Patients were randomly allocated to catheter ablation with either NS or HNS using a 4-mm irrigated catheter at a power setting of 30 W. Ablation approach employing either a maximum voltage guided (MVG) or empiric cavo-tricuspid isthmus (CTI) line was performed aiming for BB that was confirmed by double potentials separated by an isoelectric line measuring ≥110 ms and evidence of conduction block using differential pacing. Study was powered to an endpoint of acute reconnection within 30 mins. Results A total of 60 patients underwent catheter ablation for typical AFL with either HNS (n=30) or NS (n=30). There were no significant differences between the two groups in terms of patient age (68±7 yrs HNS vs. 68±10 yrs NS) and BMI (31±7 HNS vs 31±5 NS). BB was achieved in all patients. The MVG approach was employed in 28/60 patients. Acute reconnection was observed in 11 patients (18%); 4 in HNS vs 7 in NS group (ns). The mean RF time to achieve BB was 386±262 seconds in HNS vs 456±270 seconds in NS (p=0.21). The approach to CTI ablation showed a significant difference in time to BB: Time to block in MVG cases was 264±143 seconds vs 567±273 in empiric CTI line cases. Figure 1 demonstrates the time to block in both approaches with the choice of irrigant not appearing to impact the time to BB. There were 4 steam pops in the HNS arm and 0 steam pops observed in the NS arm. There were no significant complications in either arm. Conclusion Irrigation with HNS resulted in no statistically significant reduction in duration of RF time or improvement in acute outcomes over NS in the atrial flutter population. Reduction in duration of RF time was driven by MVG approach. However, acute reconnections were higher in NS group, all 4 steam pops occurred in HNS arm. Figure 1 Funding Acknowledgement Type of funding source: None

scholarly journals Routine follow-up of native valve disease: real life data from a physiologist-led valve clinic

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
K Hyams ◽  
K Balkhausen ◽  
C Townsend
Keyword(s):  
Real Life ◽  
Heart Association ◽  
Native Valve ◽  
Conservative Strategy ◽  
Funding Sources ◽  
Real Life Data ◽  
Number Of Patients ◽  
The Mean ◽  
Funding Acknowledgements

Abstract Funding Acknowledgements Type of funding sources: None. Purpose The 2014 American Heart Association (AHA) guidelines for the management of Valvular Heart Disease (VHD) suggest that patients with mild and moderate native VHD should be followed up with echocardiography at regular intervals. Following audits at our hospital in 2016, dedicated Physiologist Led Valve Clinics (PLVC) were initiated to improve guideline adherence. A conservative strategy for follow-up frequency based on AHA guidelines was chosen (3 years for mild VHD, and 1 year for moderate VHD). This audit aimed to ascertain adherence to this conservative follow-up strategy, and to assess the progression of VHD between echocardiographic assessments to inform a strategy for safe follow-up in our PLVC. Methods Our echocardiography database Cognos was searched for patients with isolated mild and moderate native VHD, seen in our PLVC between 2016-2018 and followed up between 2017-2019. Patients with severe, prosthetic, combined or significant mixed VHD were excluded. Echocardiography reports on McKesson were reviewed and the follow-up interval recorded for each patient. The severity of VHD at the index visit, and then at follow-up, was recorded to determine whether there had been a progression in VHD severity. For patients with progression, it was recorded whether they were symptomatic at follow-up or subsequently underwent valvular intervention. Results 466 index echocardiograms were reviewed; 134 patients were included (mean age 73.4) after removing those with exclusion criteria. The mean follow-up interval in mild VHD ranged between 587.6 ± 188.3 days, and 667.3 ± 174.6 days, well above the recommended 3 years (or 1095 days). The majority of patients with moderate VHD received follow-up well before the upper limit of AHA guidance (2 years, or 730 days). Mean follow-up ranged between 408.3 ± 80.8 days (in moderate aortic stenosis (AS)) and 504.0 ± 29.0 days (in moderate mitral stenosis (MS)). The number of patients followed up with mild VHD was very low. 1 patient in each group progressed to moderate VHD (out of 2, 3 and 5 respectively); none became symptomatic, and none progressed from mild to severe VHD. In moderate VHD, progression rates were highest in AS (34.8%). Patients with progressive disease were more frequently symptomatic (43%) or underwent valve intervention (25%). Fewer with mitral regurgitation (MR) (22%) progressed, 44.5% of whom were symptomatic, 11% undergoing intervention. Patients with moderate aortic regurgitation (AR) saw the lowest progression rates (11.4%), 50% of whom were symptomatic. There was no progression in moderate MS. Conclusions Patients with mild VHD can safely be followed up less conservatively in the PLVC setting, adhering to AHA guidance (3-5 years). Patients with moderate AS should be considered to remain under conservative follow-up (12-18 months). Follow-up for moderate AR, MR and MS can safely be adjusted towards the less conservative end of the AHA guidance (2 years). Abstract Figure.

A new electrophysiological triad for atrial flutter critical isthmus identification and localization

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
P Adragao ◽  
D Nascimento Matos ◽  
P Galvao Santos ◽  
F Moscoso Costa ◽  
G Rodrigues ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Atrial Flutter ◽  
Cycle Length ◽  
Low Voltage ◽  
Prospective Analysis ◽  
Electroanatomical Mapping ◽  
Funding Sources ◽  
Activation Times ◽  
Density Zone ◽  
Funding Acknowledgements

Abstract Funding Acknowledgements Type of funding sources: None. Introduction In a previous retrospective study it was demonstrated that an electrophysiological triad was able to identify critical isthmus in atrial flutter (AFL) patients.  This triad is based in the Carto® electroanatomical mapping (EAM) version 7, which displays a histogram of the local activation times (LAT) of the tachycardia cycle length (TCL), in addition to the activation and voltage maps. This study aimed to prospectively assess the ability of an electrophysiological triad to identify and localize the AFL’s critical isthmus. Methods Prospective analysis of a unicentric registry of individuals who underwent left AFL ablation with Carto® EAM. All patients with non-left AFL, lack of high-density EAM, less than 2000 collected points or lack of mapping in any of the left atrium walls or structures were excluded. Ablation sites of arrhythmia termination were compared to an electrophysiological triad constituted by: areas of low-voltage (0.05 to 0.3mV), sites of deep histogram valleys (LAT-Valleys) with less than 20% density points relative to the highest density zone and a prolonged LAT-Valley duration that included 10% or more of the TCL. The longest LAT-Valley was designated as the primary valley, while additional valleys were named as secondary. Results A total of 12 patients (9 men, median age 72 IQR 67-75 years) were included. All patients presented with left AFL and 67% had a previous atrial fibrillation and/or flutter ablation. The median TCL and number collected points were 250 (230─290) milliseconds and 3150 (IQR 2340─3870) points, respectively. All AFL presented with at least 1 LAT-Valley in the analysed histograms, which corresponded to heterogeneous low-voltage areas (0.05 to 0.3mV) and encompassed more than 10% of TCL. Eleven of the 12 patients presented with at least 1 secondary LAT-Valley. All arrhythmias were effectively terminated after undergoing radiofrequency ablation in the primary or the secondary LAT-Valley location. Conclusion In a prospective analysis, an electrophysiological triad was able to identify the AFL critical isthmus in all patients. Further studies are needed to assess the usefulness of this algorithm to improve catheter ablation outcomes.

Is transesophageal echocardiogram mandatory for patients undergoing ablation for right atrial flutter with uninterrupted anticoagulants? A prospective single registry

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
A Suzat ◽  
A Da Costa ◽  
JB Guichard ◽  
ROMAIN Pierrard ◽  
K Benali ◽  
...  
Keyword(s):  
Atrial Flutter ◽  
Predictive Factors ◽  
Left Atrial ◽  
Atrial Arrhythmia ◽  
Right Atrial ◽  
Atrial Remodeling ◽  
Limited Data ◽  
Funding Sources ◽  
Time Period ◽  
Similar Risk

Abstract Funding Acknowledgements Type of funding sources: None. Background. Limited data exist regarding the prevalence of left atrial appendage (LAA) thrombi and spontaneous echocardiographic contrast (SEC) in patients with atrial flutter (AFL). Objectives. Our prospective single-center observational study sought to evaluate the prevalence of LAA thrombi in patients referred for AFL ablation, compared to those requiring atrial fibrillation (AFib) ablation during the same time period, as well as to determine the predictive factors of LAA thrombi in terms of arrhythmia etiology. Methods and Results. From July 2019 to August 2020, 321 consecutive patients who were referred for either AFib ablation (n = 229) or AFL ablation (n = 92) were included in the study, with a thrombus detected by transesophageal echocardiography (TEE) in 3.22% (12/321). Prior to ablation under anticoagulants, the percentage of thrombi was similar between patients referred for AFL ablation and those referred for AFib ablation (5.4% [n = 5/92] vs. 3.1% [n = 7/229]; p = 0.3). In the overall population, patients with LAA thrombi had a higher CHA²DS²-VASc score (3 ± 2 vs. 2 ± 1.5; p = 0.048) and a higher presence of valvular prothesis (25% vs. 4.9%; p = 0.003), with relevant left atrial remodeling  more often observed, such as demonstrated by a higher left atrium (LA) volume (57 ± 19 vs. 46 ± 17 ml/m²; p = 0.04), a lower LAA velocity (0.41 ± 0.3 vs. 0.55 ± 0.2; p = 0.04) and a more severe LAA echo contrast (83.3% vs. 3.2%; p <0.0001). In the subset of patients with right AFL, patients with LAA thrombi had a higher CHA²DS²-VASc score (4.4 ± 1 vs. 2.5 ± 1.5; p = 0.008), had more often hypertension (100% vs. 53%; p = 0.04) and more often diabetes mellitus (60% vs. 18.4%; p = 0.03), and a more severe LAA echo contrast (80% vs. 5.7%; p <0.0001). Predictive factors of atrial thrombi evaluated by crude odds ratios were the presence of valvular prosthesis (OR = 6.53; [1.60, 26.65] ; p = 0.009), the CHA²DS²-VASc score (OR = 1.41 [0.99, 2.01] ; p = 0.05), the LAA velocity (cm/s) (OR = 0.03; [0.001, 0.79]; p = 0.04) and presence of severe LAA contrast (OR = 188 ; [35.32, 1002.02] ; <0.0001) rather than the atrial arrhythmia itself. Conclusions. Patients referred for ablation with right AFL have a similar risk of LAA thrombi, compared to those with AFib. The risk of LAA thrombi is better related to the presence of valvular prosthesis, CHA²DS²-VASc score and LA remodelling than the atrial arrhythmia itself. Accordingly, TEE should be recommended before right AFL ablation, especially in case of a valvular prosthesis, high CHA²DS²-VASc score or LA alteration.

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