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Change in P Wave Duration on Electrocardiogram Correlates with Effective Treatment of Heart Failure
S60 Journal of Cardiac Failure Vol. 15 No. 6S Suppl. 2009 status. ICD device records were evaluated for tachyarrhythmia therapies and adjudicated as appropriate or inappropriate. Results: Figure 1 represents the time to first appropriate tachyarrhythmia therapy. This figure illustrates 23.5% (31/132) of patients experience an appropriate device therapy within three years post implant. This is similar to the 22.5% of patients at three years observed in the SCD-HeFT trial. 27.3% (36/132) of patients had an appropriate tachyarrhythmia therapy (223 episodes) with an average follow-up of 2 years. The average time to first appropriate therapy was 301 6 381 days. 8.3% (11/132) of patients experienced an inappropriate therapy (41 episodes). 77.8% (161/223) of episodes received antitachycardia pacing.
Conclusions: Based on this single center retrospective analysis, it appears primary prevention patients in a rural cardiology practice utilize their ICD in a similar manner to patients in the SCD-HeFT clinical study. Therefore, the primary prevention evidence provided by SCD-HeFT appears to be transferable to the non-research rural setting.
CRT-D device were evaluated. Those patients aged greater than 70 at time of implant met inclusion. The date of first CRT-D implant was documented along with all tachyarrhythmia therapies. All therapies were adjudicated by an electrophysiologist for appropriateness. We compared our data to the COMPANION trial for historical comparison. Results: 26.9% (63/234) of CRT-D patients had a tachyarrhythmia therapy (1142 episodes) with an average follow-up of 2.5 years. The average time to first appropriate therapy was 322 6 318 days. Figure 1 represents the time to first appropriate tachyarrhythmia therapy. 22.2% of patients (mean implant age 79.6 6 3.9) experience an appropriate therapy by the second implant year. This is similar to the COMPANION trial where time to first appropriate therapy was 19.3% at two years (average implant age 66).
Conclusions: Based on this single center retrospective analysis, it appears CRT-D patients greater than 70 years of age utilize CRT-D tachyarrhythmia therapies in a manner similar to younger patients observed in large randomized clinical trials. This study suggests CRT patients greater than 70 years of age derive significant benefit from defibrillator therapy and therefore CRT-D therapy should be considered, irrespective of age.
193 Prognostic Impact of Atrial Fibrillation and Other Electrocardiogrphic Indices in a Multi-Ethnic Singapore Population with Well-Defined Clinical Heart Failure on a 3-Year Follow Up Gerard K.T. Leong, Benji Y.Z. Lim, Kenneth B.K. Tan, Kee Tung Tan, Vern Hsen Tan, Siang Chew Chai, Ping Ping Goh; Cardiology, Changi General Hospital, Singapore, Singapore Introduction: Our aim is to study the prognostic impact of atrial fibrillation (AF) and other electrocardiogrphy (ECG) indices on a well-defined clinical heart failure (HF) cohort, not based on mere discharge diagnosis codes, and with a contemporaneous Trans-thoracic echo (TTE) study done. Methods: Patients admitted to our hospital between NOV 10 2003 and APR 10 2004, who prospectively fulfilled the modified Framingham criteria for clinical HF and study inclusion criteria of serum creatinine ! 267 umol/L, serum albumin O 28 g/L, and a contemporaneous ECG and TTE study were enrolled. Three-year follow up data was obtained through patient contact tracing. Results: We enrolled 141 patients. Ethnic Chinese, Malay and Indian constituted 53.2%, 33.3% and 11.3% respectively. Mean (SD) age of the patients was 68.8 (12.0) years. Mean LVEF was 35 (18.3) %. The three-year mortality rate was 44%. The three-year death or any-cause readmission rate was 87.2 %. AF, QRS duration O 120 msec and Bundle branch block morphology (BBBm) constituted 17%, 17%, and 12.1% of the cohort respectively. AF compared to non-AF group was not significantly associated with higher mortality (41.7% v 44.4%, p 5 0.83), or higher mortality and any-cause readmission (91.7% v 86.3%, p 5 0.74). AF compared to non-AF group was significantly associated with older mean age {74 (9.4) v 67.8 (12.2) years, p 5 0.02}, and higher mean LVEF {42.5 (18.3)% v 33.4 (17.9)%, p 5 0.03}. QRS duration O 120 msec compared to QRS duration ! 120 msec group was significantly associated with higher combined mortality and any-cause readmission rate (100% v 84.6, p 5 0.04), significantly lower mean LVEF {24.1 (15.9) % v 37.2 (18.0)%} and higher mean SWMA index {2.3 (0.6) v 1.8 (0.7)}. For both, p value 5 0.001). BBBm compared to non-BBBm was significantly associated with lower mean LVEF {21.9 (13.6)% v 36.8 (18.1)%, p 5 0.001). QRS duration O 120 msec and BBBm were significantly associated with larger LV dimensions. Heart rate and QT interval had no prognostic impact. Conclusions: In a well-defined HF cohort, QRS duration, but not AF or bundle branch block morphology had 3-year prognostic implications. ECG indices are associated with TTE indices.
194 Defibrillator Utilization Rates in 234 Elderly Patients Receiving Cardiac Resynchronization Therapy Thomas A. Charlton1, Frank A. McGrew1, Eric E. Johnson1, Mark A. Coppess1, Barbara Hamilton1, Sandra B. Charlton2, James J. Sims2; 1Stern Cardiovascular Clinic, Germantown, TN; 2Medtronic, Inc., Moundsview, MN Purpose: Few reports document the benefit of utilizing tachyarrhythmia therapies in elderly CRT patients (O70 years). The average patient age in large randomized clinical trials documenting the value of CRT-D has been approximately 66 years. We sought to document whether defibrillator therapy was utilized and the time to first appropriate tachyarrhythmia therapy in our elderly patient cohort. Methods: A retrospective analysis of our CRT database was performed in June 2008. All patients with an FDA approved
195 Change in P Wave Duration on Electrocardiogram Correlates with Effective Treatment of Heart Failure: Sapan N. Talati, Siva Mulpuru, Naresh Mori, Balendu C. Vasavada; Internal Medicine and Cardiovascular Disease, Long Island College Hospital, Brooklyn, NY Background: P wave abnormalities are associated with disturbance in interatrial conduction and increased left atrial volume. In patients with heart failure there is abnormal systolic and diastolic function which may result into increased left atrial volume and inhomogeneous propagation of the sinus impulse. We investigated changes in P wave duration in patients hospitalized for heart failure. Methods: Study population consisted of 30 patients admitted for heart failure in our hospital. We divided these patients into two groups. Group I consisted of patients whose heart failure improved with treatment. Group II consisted of patients whose heart failure worsened over the course and they ended up in CCU. We excluded patients with atrial fibrillation, valvular heart disease, conduction abnormalities and patients on hemodialysis. We measured P wave duration of all these patients from ECG done during admission and ECG done when clinical improvement or worsening was documented. P wave duration was calculated using on screen calipers. Lead II was used for calculation and average of three consecutive beats was taken. A non clinician other than observers was involved for measurement of P wave duration to prevent any bias. A difference between P wave duration was calculated (DPWD). Table 1.
Age Gender(m/f) Mean BNP levels Ejection Fraction Diastolic dysfunction Mean P wave duration Mean (DPWD)
Group I
Group II
60.3 þ 9.1 yrs 12/8 1300.6 pg/ml 44.2 þ 9.1 16/20 98.8 msec þ20 msec
63. 1þ 10.2 yrs 6/4 1800.5 pg/ml 33.1 þ 8.6 8/10 118.2 msec 8 msec
Results: Twenty patients got better with CHF and were classified as Group I. Ten patients had clinical deterioration and classified as Group II. Sixteen patients in Group I showed a decrease in P wave duration (or þ DPWD) once there symptoms had resolved whereas only four patients had a no change or increase in the P wave duration (or - DPWD). However in Group II eight patients had increase or no change in P wave duration. We compared these groups and computed Fischer’s test. Two tailed p value was 0.04 which is statistically significant. Table 2. CHF Better (Group I) Worse (Group II) Total
þ DPWD
DPWD
N
16 2 18
4 8 12
20 10 30
p value 0.04. Conclusion: P wave duration decreases in patients effectively treated for congestive heart failure as compared to patients whose symptoms got worse. However larger study and sample size is required to see this effect.
Conclusions: Based on this single center retrospective analysis, it appears primary prevention patients in a rural cardiology practice utilize their ICD in a similar manner to patients in the SCD-HeFT clinical study. Therefore, the primary prevention evidence provided by SCD-HeFT appears to be transferable to the non-research rural setting.
CRT-D device were evaluated. Those patients aged greater than 70 at time of implant met inclusion. The date of first CRT-D implant was documented along with all tachyarrhythmia therapies. All therapies were adjudicated by an electrophysiologist for appropriateness. We compared our data to the COMPANION trial for historical comparison. Results: 26.9% (63/234) of CRT-D patients had a tachyarrhythmia therapy (1142 episodes) with an average follow-up of 2.5 years. The average time to first appropriate therapy was 322 6 318 days. Figure 1 represents the time to first appropriate tachyarrhythmia therapy. 22.2% of patients (mean implant age 79.6 6 3.9) experience an appropriate therapy by the second implant year. This is similar to the COMPANION trial where time to first appropriate therapy was 19.3% at two years (average implant age 66).
Conclusions: Based on this single center retrospective analysis, it appears CRT-D patients greater than 70 years of age utilize CRT-D tachyarrhythmia therapies in a manner similar to younger patients observed in large randomized clinical trials. This study suggests CRT patients greater than 70 years of age derive significant benefit from defibrillator therapy and therefore CRT-D therapy should be considered, irrespective of age.
193 Prognostic Impact of Atrial Fibrillation and Other Electrocardiogrphic Indices in a Multi-Ethnic Singapore Population with Well-Defined Clinical Heart Failure on a 3-Year Follow Up Gerard K.T. Leong, Benji Y.Z. Lim, Kenneth B.K. Tan, Kee Tung Tan, Vern Hsen Tan, Siang Chew Chai, Ping Ping Goh; Cardiology, Changi General Hospital, Singapore, Singapore Introduction: Our aim is to study the prognostic impact of atrial fibrillation (AF) and other electrocardiogrphy (ECG) indices on a well-defined clinical heart failure (HF) cohort, not based on mere discharge diagnosis codes, and with a contemporaneous Trans-thoracic echo (TTE) study done. Methods: Patients admitted to our hospital between NOV 10 2003 and APR 10 2004, who prospectively fulfilled the modified Framingham criteria for clinical HF and study inclusion criteria of serum creatinine ! 267 umol/L, serum albumin O 28 g/L, and a contemporaneous ECG and TTE study were enrolled. Three-year follow up data was obtained through patient contact tracing. Results: We enrolled 141 patients. Ethnic Chinese, Malay and Indian constituted 53.2%, 33.3% and 11.3% respectively. Mean (SD) age of the patients was 68.8 (12.0) years. Mean LVEF was 35 (18.3) %. The three-year mortality rate was 44%. The three-year death or any-cause readmission rate was 87.2 %. AF, QRS duration O 120 msec and Bundle branch block morphology (BBBm) constituted 17%, 17%, and 12.1% of the cohort respectively. AF compared to non-AF group was not significantly associated with higher mortality (41.7% v 44.4%, p 5 0.83), or higher mortality and any-cause readmission (91.7% v 86.3%, p 5 0.74). AF compared to non-AF group was significantly associated with older mean age {74 (9.4) v 67.8 (12.2) years, p 5 0.02}, and higher mean LVEF {42.5 (18.3)% v 33.4 (17.9)%, p 5 0.03}. QRS duration O 120 msec compared to QRS duration ! 120 msec group was significantly associated with higher combined mortality and any-cause readmission rate (100% v 84.6, p 5 0.04), significantly lower mean LVEF {24.1 (15.9) % v 37.2 (18.0)%} and higher mean SWMA index {2.3 (0.6) v 1.8 (0.7)}. For both, p value 5 0.001). BBBm compared to non-BBBm was significantly associated with lower mean LVEF {21.9 (13.6)% v 36.8 (18.1)%, p 5 0.001). QRS duration O 120 msec and BBBm were significantly associated with larger LV dimensions. Heart rate and QT interval had no prognostic impact. Conclusions: In a well-defined HF cohort, QRS duration, but not AF or bundle branch block morphology had 3-year prognostic implications. ECG indices are associated with TTE indices.
194 Defibrillator Utilization Rates in 234 Elderly Patients Receiving Cardiac Resynchronization Therapy Thomas A. Charlton1, Frank A. McGrew1, Eric E. Johnson1, Mark A. Coppess1, Barbara Hamilton1, Sandra B. Charlton2, James J. Sims2; 1Stern Cardiovascular Clinic, Germantown, TN; 2Medtronic, Inc., Moundsview, MN Purpose: Few reports document the benefit of utilizing tachyarrhythmia therapies in elderly CRT patients (O70 years). The average patient age in large randomized clinical trials documenting the value of CRT-D has been approximately 66 years. We sought to document whether defibrillator therapy was utilized and the time to first appropriate tachyarrhythmia therapy in our elderly patient cohort. Methods: A retrospective analysis of our CRT database was performed in June 2008. All patients with an FDA approved
195 Change in P Wave Duration on Electrocardiogram Correlates with Effective Treatment of Heart Failure: Sapan N. Talati, Siva Mulpuru, Naresh Mori, Balendu C. Vasavada; Internal Medicine and Cardiovascular Disease, Long Island College Hospital, Brooklyn, NY Background: P wave abnormalities are associated with disturbance in interatrial conduction and increased left atrial volume. In patients with heart failure there is abnormal systolic and diastolic function which may result into increased left atrial volume and inhomogeneous propagation of the sinus impulse. We investigated changes in P wave duration in patients hospitalized for heart failure. Methods: Study population consisted of 30 patients admitted for heart failure in our hospital. We divided these patients into two groups. Group I consisted of patients whose heart failure improved with treatment. Group II consisted of patients whose heart failure worsened over the course and they ended up in CCU. We excluded patients with atrial fibrillation, valvular heart disease, conduction abnormalities and patients on hemodialysis. We measured P wave duration of all these patients from ECG done during admission and ECG done when clinical improvement or worsening was documented. P wave duration was calculated using on screen calipers. Lead II was used for calculation and average of three consecutive beats was taken. A non clinician other than observers was involved for measurement of P wave duration to prevent any bias. A difference between P wave duration was calculated (DPWD). Table 1.
Age Gender(m/f) Mean BNP levels Ejection Fraction Diastolic dysfunction Mean P wave duration Mean (DPWD)
Group I
Group II
60.3 þ 9.1 yrs 12/8 1300.6 pg/ml 44.2 þ 9.1 16/20 98.8 msec þ20 msec
63. 1þ 10.2 yrs 6/4 1800.5 pg/ml 33.1 þ 8.6 8/10 118.2 msec 8 msec
Results: Twenty patients got better with CHF and were classified as Group I. Ten patients had clinical deterioration and classified as Group II. Sixteen patients in Group I showed a decrease in P wave duration (or þ DPWD) once there symptoms had resolved whereas only four patients had a no change or increase in the P wave duration (or - DPWD). However in Group II eight patients had increase or no change in P wave duration. We compared these groups and computed Fischer’s test. Two tailed p value was 0.04 which is statistically significant. Table 2. CHF Better (Group I) Worse (Group II) Total
þ DPWD
DPWD
N
16 2 18
4 8 12
20 10 30
p value 0.04. Conclusion: P wave duration decreases in patients effectively treated for congestive heart failure as compared to patients whose symptoms got worse. However larger study and sample size is required to see this effect.