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Electrical Remodelling Following CRT as Assessed by Intracardiac Electrograms Using a Quadripolar Left Ventricular Lead
Abstracts
S144
Baseline
Post-risk factor treatment
P value
134.3 ± 14.2 67.8 ± 11 81.4 ± 14 28.8 ± 4.9 7 ± 2.2 60.8 ± 5.5 1205 ± 6118
0.002 0.20 <0.001 0.003 0.002 0.02 <0.001
............................................. Age Systolic blood pressure Diastolic blood pressure Weight BMI OSA [AHI] LVEF PVC burden per 24 hours
65.38 ± 11 149.7 ± 16 71.5 ± 9.9 91.2 ± 17 31.9 ± 6.4 27 ± 2.8 58.2 ± 6.7 17114 ± 9578
http://dx.doi.org/10.1016/j.hlc.2016.06.339 339 Electrical Remodelling Following CRT as Assessed by Intracardiac Electrograms Using a Quadripolar Left Ventricular Lead L. Toner ∗ , D. Flannery, H. Sugumar, M. Ord, A. Teh, H. Liam, D. O’Donnell Austin Health, Melbourne, Australia Cardiac resynchronisation therapy (CRT) is an important treatment for cardiac failure with proven mortality benefit. There are multiple studies showing structural remodelling which correlates with long-term outcomes. The purpose of this study was to evaluate electrical remodelling following CRT using the quadripolar left ventricular (LV) lead with electrical remodelling as a potential contributor to long-term outcomes either on its own or as a precursor to structural remodelling. We performed a prospective study on consecutive patients undergoing initial CRT implantation for standard indications using a quadripolar LV lead. Patients were assessed at the time of implant and up to 12 months with evaluation of intracardiac electrograms (EGMs). Changes in relative electrical activation sequences were measured using the LV lead and the standard device programmer. Electrical changes were then correlated to echocardiographic response to CRT. Echocardiographic response was defined as >15% relative reduction in LV end systolic volume. 40 consecutive patients were included in the study. 22 (55%) were responders. The maximum, minimum and mean EGM values decreased significantly in all patients (p<0.001). The reduction was asymmetrical with the pacing electrode of the LV lead reducing more than the other leads (p<0.01). The was a trend toward larger reductions in responders compared to non-responders (p>0.05). This novel study used EGMs from a quadriopolar LV lead to demonstrate asymmetrical electrical remodelling which would not solely be due to a reduction in LV size. In addition, we have demonstrated electrical remodelling is more apparent in CRT responders compared to non-responders. Further study is required to explore the concept of electrical remodelling as an underlying mechanism for response to CRT. http://dx.doi.org/10.1016/j.hlc.2016.06.340
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340 Evolution of Catheter Based Ablation Lesion Characteristics; Systematic Review Over 25 Years D. Chapman 1,2,∗ , D. Lau 1,3 , P. Sanders 1,3 1 Centre
for Heart Rhythm Disorders, Adelaide University, Adelaide, Australia 2 Royal Adelaide Hospital, Adelaide, Australia 3 SAHMRI Heart Health, Adelaide, Australia Introduction: The safety and efficacy RF ablation has steadily increased over time. Catheters have evolved over this period; solid (conventional) tip, first generation irrigated (10 irrigated) and recently porous tips. The purpose was to determine evolution lesions and safety of catheters over 25 years. Methods: Databases were searched using Boolean search criteria: (electrophysiology OR cardiac) AND (radiofrequency OR ablation OR RF) AND catheter AND lesion AND (size OR depth OR volume). Date was limited to articles between 1990 and 2015. Included were lesions examined histologically for depth, width or volume. Results: Thirty-eight studies met inclusion criteria. Some 4064 lesions were assessed. Porous-tip resulted in similar lesion depth compared to 10 irrigated and conventional at 30W-39W (P=NS). At 20W-29W, porous catheters gave shallower lesions than 10 irrigated and conventional (p<0.05) with no difference between conventional and 10 irrigated (p=0.26). One experiment of 93 reported steam-pop (12%) with conventional catheters. There were 22 of 89 experiments with 10 irrigated reported steam pop (max 100%), and porous tip catheters reported steam pop in 15 of 30 experiments (max 100%). Char was reported more with conventional catheters, however up to 50% was observed with 10 irrigated, and 12.7% with porous tip. Conclusions: The evolution of catheter design has resulted in equivalent or shallower lesion depth over the past 25 years in the power range 10W-39W. The adverse event profile has changed, however the incidence of steam pop appears to have increased with irrigated catheters. http://dx.doi.org/10.1016/j.hlc.2016.06.341
S144
Baseline
Post-risk factor treatment
P value
134.3 ± 14.2 67.8 ± 11 81.4 ± 14 28.8 ± 4.9 7 ± 2.2 60.8 ± 5.5 1205 ± 6118
0.002 0.20 <0.001 0.003 0.002 0.02 <0.001
............................................. Age Systolic blood pressure Diastolic blood pressure Weight BMI OSA [AHI] LVEF PVC burden per 24 hours
65.38 ± 11 149.7 ± 16 71.5 ± 9.9 91.2 ± 17 31.9 ± 6.4 27 ± 2.8 58.2 ± 6.7 17114 ± 9578
http://dx.doi.org/10.1016/j.hlc.2016.06.339 339 Electrical Remodelling Following CRT as Assessed by Intracardiac Electrograms Using a Quadripolar Left Ventricular Lead L. Toner ∗ , D. Flannery, H. Sugumar, M. Ord, A. Teh, H. Liam, D. O’Donnell Austin Health, Melbourne, Australia Cardiac resynchronisation therapy (CRT) is an important treatment for cardiac failure with proven mortality benefit. There are multiple studies showing structural remodelling which correlates with long-term outcomes. The purpose of this study was to evaluate electrical remodelling following CRT using the quadripolar left ventricular (LV) lead with electrical remodelling as a potential contributor to long-term outcomes either on its own or as a precursor to structural remodelling. We performed a prospective study on consecutive patients undergoing initial CRT implantation for standard indications using a quadripolar LV lead. Patients were assessed at the time of implant and up to 12 months with evaluation of intracardiac electrograms (EGMs). Changes in relative electrical activation sequences were measured using the LV lead and the standard device programmer. Electrical changes were then correlated to echocardiographic response to CRT. Echocardiographic response was defined as >15% relative reduction in LV end systolic volume. 40 consecutive patients were included in the study. 22 (55%) were responders. The maximum, minimum and mean EGM values decreased significantly in all patients (p<0.001). The reduction was asymmetrical with the pacing electrode of the LV lead reducing more than the other leads (p<0.01). The was a trend toward larger reductions in responders compared to non-responders (p>0.05). This novel study used EGMs from a quadriopolar LV lead to demonstrate asymmetrical electrical remodelling which would not solely be due to a reduction in LV size. In addition, we have demonstrated electrical remodelling is more apparent in CRT responders compared to non-responders. Further study is required to explore the concept of electrical remodelling as an underlying mechanism for response to CRT. http://dx.doi.org/10.1016/j.hlc.2016.06.340
.. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ..
340 Evolution of Catheter Based Ablation Lesion Characteristics; Systematic Review Over 25 Years D. Chapman 1,2,∗ , D. Lau 1,3 , P. Sanders 1,3 1 Centre
for Heart Rhythm Disorders, Adelaide University, Adelaide, Australia 2 Royal Adelaide Hospital, Adelaide, Australia 3 SAHMRI Heart Health, Adelaide, Australia Introduction: The safety and efficacy RF ablation has steadily increased over time. Catheters have evolved over this period; solid (conventional) tip, first generation irrigated (10 irrigated) and recently porous tips. The purpose was to determine evolution lesions and safety of catheters over 25 years. Methods: Databases were searched using Boolean search criteria: (electrophysiology OR cardiac) AND (radiofrequency OR ablation OR RF) AND catheter AND lesion AND (size OR depth OR volume). Date was limited to articles between 1990 and 2015. Included were lesions examined histologically for depth, width or volume. Results: Thirty-eight studies met inclusion criteria. Some 4064 lesions were assessed. Porous-tip resulted in similar lesion depth compared to 10 irrigated and conventional at 30W-39W (P=NS). At 20W-29W, porous catheters gave shallower lesions than 10 irrigated and conventional (p<0.05) with no difference between conventional and 10 irrigated (p=0.26). One experiment of 93 reported steam-pop (12%) with conventional catheters. There were 22 of 89 experiments with 10 irrigated reported steam pop (max 100%), and porous tip catheters reported steam pop in 15 of 30 experiments (max 100%). Char was reported more with conventional catheters, however up to 50% was observed with 10 irrigated, and 12.7% with porous tip. Conclusions: The evolution of catheter design has resulted in equivalent or shallower lesion depth over the past 25 years in the power range 10W-39W. The adverse event profile has changed, however the incidence of steam pop appears to have increased with irrigated catheters. http://dx.doi.org/10.1016/j.hlc.2016.06.341