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Sudden cardiac arrest related to structural non ischemic heart disease
98 Conclusions TLE strategy using TightRailTM is safe and predicts a higher rate of complete procedural and clinical success per lead compared to a conventional approach. Disclosure of interest B. Polin declares that he has no competing interest. The other authors have not supplied their declaration of competing interest. https://doi.org/10.1016/j.acvdsp.2017.11.257
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Sudden cardiac arrest related to structural non ischemic heart disease A. Sharifzadehgan 1,2,∗ , W. Bougouin 2 , V. Waldmann 1,2 , N. Karam 1 , F. Dumas 2,3 , E. Gandjbakhch 4 , V. Algalarrondo 5 , K. Narayanan 2 , F. Beganton 2 , F. Extramiana 6 , N. Lellouche 7 , N. Aissaoui 1,2 , N. Cariou 2,3 , X. Jouven 1,2 , E. Marijon 1,2 1 Hôpital Européen Georges-Pompidou 2 PARCC-Centre de recherche cardiovasculaire de Paris 3 Hôpital Cochin 4 Hôpital Pitié-Salpétrière 5 Hôpital Antoine Béclère 6 Hôpital Bichat 7 Hôpital Mondor, Paris, France ∗ Corresponding author at: Corresponding author. E-mail address: [email protected] (A. Sharifzadehgan) Background Sudden cardiac arrest (SCA) is a major cause of deaths in Europe, but population-based data on specific etiologies, such as structural non ischemic heart disease (SNIHD) are lacking. Purpose We sought to determine the frequency, characteristics and outcomes of SCA associated with SNIHD in the general population. Methods In this prospective ongoing multicentre populationbased registry, data from all SCA were analyzed. SNIHD included different non ischemic cardiomyopathies, as well as valvular, hypertensive and congenital heart diseases. Medical records were reviewed by cardiologists to identify clinical conditions underlying SCA. Results Of the 18,622 out-of-hospital cardiac arrests from May 2011 to May 2016, 3028 SCAs (16.2%) were admitted alive to hospital. Two hundred and twenty four (7.4%) SNIHD were diagnosed during hospitalization, including dilated cardiomyopathy (DCM) (44.2%), valvular heart disease (19.2%), hypertrophic cardiomyopathy (13.4%), myocarditis (6.7%), congenital heart disease (3.1%) and arrhythmogenic right ventricular dysplasia (2.7%). As compared to other causes of SCA, SNIHD patients were significantly younger (55.2 vs. 59.6 years, P < 0.001), more likely to be women (35.7% vs. 26.4%, P = 0.003) had fewer cardiovascular risk factors (≥ 1 CVRF, 72.7% vs. 81.8%, P = 0.002), but known heart disease was more likely to be identified (67.4% vs. 30.2%, P < 0.001) in SNIHD. Among patients with previously known DCM, only 46% of cases presented with a left ventricular ejection fraction < 35%. Among survivors, only 87 (74.3%) were implanted with ICD. Conclusion In our registry, SCA associated with SNIHD presented distinctive features compared to non-SNIHD, and overall accounted for only 7% of the overall SCA burden. Main causes were DCM and valvular heart disease. Better characterization of this population, especially the sizeable subgroup with left ventricular ejection fraction > 35% can improve sudden death risk stratification in this group. Disclosure of interest A. Sharifzadehgan declares that he has no competing interest.
05-Rhythmology and stimulation The other authors have not supplied their declaration of competing interest. https://doi.org/10.1016/j.acvdsp.2017.11.258 159
Complex influence of endocrine and neuro-vegetative disorders on ventricular repolarization in diabetic patients L. Hoden 1,2,∗ , P. Dureau 1 , C. Funck-Brentano 1 , F. Badilini 3 , M. Vaglio 3 , A. Hartemann 4 , O. Bourron 4 , J. Salem 1 1 Department of pharmacology, CIC-1421, AP—HP, UPMC, inserm, hospital Pitié-Salpêtrière 2 Department of pharmacy, hospital Pitié-Salpêtrière, Paris, France 3 AMPS-LLC, NY, NYC, United States 4 Department of diabetology, CIC-1421, AP—HP, UPMC, inserm, hospital Pitié-Salpêtrière, Paris, France ∗ Corresponding author at: Corresponding author. E-mail address: [email protected] (L. Hoden) Background Diabetic patients have an increased QT interval duration corrected for heart rate (QTcF) and an increased risk of sudden death, as compared to healthy subjects. Diabetics are characterized by increased insulin resistance and are frequently affected by autonomic neuropathy and other hormonal disorders, such as hypogonadism and decreased IGF1 levels. Data regarding influence of these latter conditions on QT interval duration in diabetics are scarce. Methods A cohort of 195 type II diabetic patients at high cardiovascular risk were prospectively included. Circulating concentrations of FSH, testosterone, insulin, glycaemia, kalemia, HbA1c were measured concomitantly to the recording of a digitized electrocardiogram. Orthostatic hypotension was evaluated at the same time, as a surrogate of autonomic neuropathy. Treatments influencing QTc were recorded and classified according to ® Crediblemeds . Results The cohort consisted of 154 men (79%) aged 64.8 ± 8.6 years with a mean QTcF of 418 ± 25 msec. Eleven patients (5.6%) were taking a medication belonging to Crediblemeds’ known Torsade de Pointe risk category. Twenty-six patients (13.3%) had an orthostatic hypotension. According to multivariable analysis, age ( = 0.14, P = 0.04), presence of orthostatic hypotension ( = 0.14, P = 0.02), intake of medication at known risk of Torsade de Pointe ( = 0.22, P = 0.001), HbA1c, kalemia and FSH levels ( = 0.232, P < 0.001;  = −0.187, P = 0.005; =0.14, P = 0.04; respectively) were related to QTcF (r2 = 0.22, P < 0.01). Conclusion In diabetic patients, cardiac repolarization is influenced by complex interactions between presence of autonomic neuropathy, gonadotropins, poor glycemic control and ionic disturbances. Disclosure of interest L. Hoden declares that he has no competing interest. The other authors have not supplied their declaration of competing interest. https://doi.org/10.1016/j.acvdsp.2017.11.259 218
Effectiveness and safety of flecainide in arrhythmogenic right ventricular cardiomyopathy F. Bouvier 1,∗ , C. Maupain 2 , N.C. Roche 1 , L. Fiorina 3 , D. Poindron 3 , C. Moini 3 , E. Gandjbakhch 2 1 Cardiologie, hôpital d’instruction des armées Bégin, Saint-Mandé 2 Rythmologie, groupe hospitalier Pitié-Salpêtrière, Paris 3 Cardiologie, clinique des Fontaines, Melun, France
January 20th, Saturday 2018 337
Sudden cardiac arrest related to structural non ischemic heart disease A. Sharifzadehgan 1,2,∗ , W. Bougouin 2 , V. Waldmann 1,2 , N. Karam 1 , F. Dumas 2,3 , E. Gandjbakhch 4 , V. Algalarrondo 5 , K. Narayanan 2 , F. Beganton 2 , F. Extramiana 6 , N. Lellouche 7 , N. Aissaoui 1,2 , N. Cariou 2,3 , X. Jouven 1,2 , E. Marijon 1,2 1 Hôpital Européen Georges-Pompidou 2 PARCC-Centre de recherche cardiovasculaire de Paris 3 Hôpital Cochin 4 Hôpital Pitié-Salpétrière 5 Hôpital Antoine Béclère 6 Hôpital Bichat 7 Hôpital Mondor, Paris, France ∗ Corresponding author at: Corresponding author. E-mail address: [email protected] (A. Sharifzadehgan) Background Sudden cardiac arrest (SCA) is a major cause of deaths in Europe, but population-based data on specific etiologies, such as structural non ischemic heart disease (SNIHD) are lacking. Purpose We sought to determine the frequency, characteristics and outcomes of SCA associated with SNIHD in the general population. Methods In this prospective ongoing multicentre populationbased registry, data from all SCA were analyzed. SNIHD included different non ischemic cardiomyopathies, as well as valvular, hypertensive and congenital heart diseases. Medical records were reviewed by cardiologists to identify clinical conditions underlying SCA. Results Of the 18,622 out-of-hospital cardiac arrests from May 2011 to May 2016, 3028 SCAs (16.2%) were admitted alive to hospital. Two hundred and twenty four (7.4%) SNIHD were diagnosed during hospitalization, including dilated cardiomyopathy (DCM) (44.2%), valvular heart disease (19.2%), hypertrophic cardiomyopathy (13.4%), myocarditis (6.7%), congenital heart disease (3.1%) and arrhythmogenic right ventricular dysplasia (2.7%). As compared to other causes of SCA, SNIHD patients were significantly younger (55.2 vs. 59.6 years, P < 0.001), more likely to be women (35.7% vs. 26.4%, P = 0.003) had fewer cardiovascular risk factors (≥ 1 CVRF, 72.7% vs. 81.8%, P = 0.002), but known heart disease was more likely to be identified (67.4% vs. 30.2%, P < 0.001) in SNIHD. Among patients with previously known DCM, only 46% of cases presented with a left ventricular ejection fraction < 35%. Among survivors, only 87 (74.3%) were implanted with ICD. Conclusion In our registry, SCA associated with SNIHD presented distinctive features compared to non-SNIHD, and overall accounted for only 7% of the overall SCA burden. Main causes were DCM and valvular heart disease. Better characterization of this population, especially the sizeable subgroup with left ventricular ejection fraction > 35% can improve sudden death risk stratification in this group. Disclosure of interest A. Sharifzadehgan declares that he has no competing interest.
05-Rhythmology and stimulation The other authors have not supplied their declaration of competing interest. https://doi.org/10.1016/j.acvdsp.2017.11.258 159
Complex influence of endocrine and neuro-vegetative disorders on ventricular repolarization in diabetic patients L. Hoden 1,2,∗ , P. Dureau 1 , C. Funck-Brentano 1 , F. Badilini 3 , M. Vaglio 3 , A. Hartemann 4 , O. Bourron 4 , J. Salem 1 1 Department of pharmacology, CIC-1421, AP—HP, UPMC, inserm, hospital Pitié-Salpêtrière 2 Department of pharmacy, hospital Pitié-Salpêtrière, Paris, France 3 AMPS-LLC, NY, NYC, United States 4 Department of diabetology, CIC-1421, AP—HP, UPMC, inserm, hospital Pitié-Salpêtrière, Paris, France ∗ Corresponding author at: Corresponding author. E-mail address: [email protected] (L. Hoden) Background Diabetic patients have an increased QT interval duration corrected for heart rate (QTcF) and an increased risk of sudden death, as compared to healthy subjects. Diabetics are characterized by increased insulin resistance and are frequently affected by autonomic neuropathy and other hormonal disorders, such as hypogonadism and decreased IGF1 levels. Data regarding influence of these latter conditions on QT interval duration in diabetics are scarce. Methods A cohort of 195 type II diabetic patients at high cardiovascular risk were prospectively included. Circulating concentrations of FSH, testosterone, insulin, glycaemia, kalemia, HbA1c were measured concomitantly to the recording of a digitized electrocardiogram. Orthostatic hypotension was evaluated at the same time, as a surrogate of autonomic neuropathy. Treatments influencing QTc were recorded and classified according to ® Crediblemeds . Results The cohort consisted of 154 men (79%) aged 64.8 ± 8.6 years with a mean QTcF of 418 ± 25 msec. Eleven patients (5.6%) were taking a medication belonging to Crediblemeds’ known Torsade de Pointe risk category. Twenty-six patients (13.3%) had an orthostatic hypotension. According to multivariable analysis, age ( = 0.14, P = 0.04), presence of orthostatic hypotension ( = 0.14, P = 0.02), intake of medication at known risk of Torsade de Pointe ( = 0.22, P = 0.001), HbA1c, kalemia and FSH levels ( = 0.232, P < 0.001;  = −0.187, P = 0.005; =0.14, P = 0.04; respectively) were related to QTcF (r2 = 0.22, P < 0.01). Conclusion In diabetic patients, cardiac repolarization is influenced by complex interactions between presence of autonomic neuropathy, gonadotropins, poor glycemic control and ionic disturbances. Disclosure of interest L. Hoden declares that he has no competing interest. The other authors have not supplied their declaration of competing interest. https://doi.org/10.1016/j.acvdsp.2017.11.259 218
Effectiveness and safety of flecainide in arrhythmogenic right ventricular cardiomyopathy F. Bouvier 1,∗ , C. Maupain 2 , N.C. Roche 1 , L. Fiorina 3 , D. Poindron 3 , C. Moini 3 , E. Gandjbakhch 2 1 Cardiologie, hôpital d’instruction des armées Bégin, Saint-Mandé 2 Rythmologie, groupe hospitalier Pitié-Salpêtrière, Paris 3 Cardiologie, clinique des Fontaines, Melun, France